Alcohol and Drug Abuse Research Unit

Report to Parliament 2009: Alcohol and Drug Abuse Research Unit
Selected Research Highlights 2009-10

A review of sub-Saharan African studies on the association between alcohol use and HIV infection was undertaken to identify and assess studies that have quantified the association between alcohol consumption and HIV infection. It was found that users of alcohol and especially problem drinkers, were more likely to be HIV seropositive than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence.

Ten focus groups were conducted with couples who had been in a relationship one year or more and drink in shebeens as part of a study of substance use, sexual HIV risk and gender-based violence undertaken with RTI International and funded by the US National Institute on Alcohol Abuse & Alcoholism. Sixty-seven individuals from Khayelitsha and Mitchells Plain participated. Extended weekends (Thursday to Sunday) are spent drinking in shebeens, which translates to high levels of unprotected sex with other partners (including sex trading). Women trade sex in Mitchells Plain (for alcohol and methamphetamine) and Khayelitsha (for food). Men often drug women in order to have sex with them. Women often spike beers to rob the men. Couples often fight in shebeens. Both men and women had observed rape outside shebeens. This formative work is being used to adapt existing interventions for couples that will address these risks.

With regard to the abuse of other drugs, little has been done to improve the integration of drug abuse and HIV services in sub-Saharan Africa where substance abuse and HIV epidemics often co-exist. As part of a study funded by the US Centers for Disease Control & Prevention, data were collected from drug users and service providers in two phases in Cape Town, Durban and Pretoria. It was found that drug users put themselves at risk for HIV transmission through various drug-related sexual practices as well as through needle sharing. Drug users in both phases had limited knowledge of the availability of drug treatment services, and those that had accessed treatment identified a number of barriers, including affordability, stigma and a lack of aftercare and reintegration services. Service providers identified similar barriers. Drug users displayed a general awareness of both HIV transmission routes and prevention strategies, but the findings also indicated a number of misperceptions, and problematic access to materials such as condoms and safe injection equipment. Knowledge around HIV treatment was low, and VCT experiences were mixed. Service providers recognized the importance of integrating HIV and substance use services, but barriers such as funding issues, networking/referral gaps and additional burden on staff were reported in Phase 2. A comprehensive, accessible, multi-component intervention strategy to prevent HIV risk in drug users needs to be developed including community outreach, risk reduction counselling, VCT and substance abuse treatment.

Another study funded by National Institute on Drug Abuse (NIDA) investigated the prevalence of methamphetamine use among high-school learners in Cape Town and whether learners reporting methamphetamine use were more likely to be at risk for mental health and aggressive behaviour problems. A cross-sectional survey of 15 randomly selected high-schools in Cape Town was conducted. Findings indicated that 9% of the learners had tried methamphetamine at least once. Methamphetamine use in the past year was significantly associated with higher aggressive behaviour scores, mental health risk scores and depression scores. Screening adolescents in school settings for methamphetamine use and behaviour problems may be useful in identifying youth at risk for substance misuse, providing an opportunity for early intervention.