Rapid assessment of drug-related HIV risk among men who have sex with men in three South African cities

Alcohol & Drug Abuse Research Unit, Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa.
Drug and Alcohol Dependence (Impact Factor: 3.42). 06/2008; 95(1-2):45-53. DOI: 10.1016/j.drugalcdep.2007.12.005
Source: PubMed


The current assessment was undertaken to examine the link between drug use and sexual risk behavior among men who have sex with men (MSM) in locations known to have high prevalence rates of drug use and sexual risk behavior in Cape Town, Durban and Pretoria, South Africa. Street intercepts and purposive snowball sampling were used to recruit drug-using MSM. A rapid assessment was undertaken which included observation, mapping, key informant interviews and focus group interviews with MSM. Drug using key informants were tested for HIV. The use of drugs like crack cocaine, cannabis and methamphetamine to specifically facilitate sexual encounters was evident. Drugs led to inconsistent condom use and other high-risk sexual activities despite HIV risk knowledge being high. Many injecting drug-using MSM shared needles and reused equipment. Among MSM who agreed to HIV testing, one-third tested positive. Views about drug and HIV treatment and preventive services and their efficacy were mixed. Various barriers to accessing services were highlighted including homosexual stigmatization and availability of drugs in treatment facilities. Recommendations include addressing the gap between HIV-risk knowledge and practice, extending VCT services for MSM, increasing the visibility of drug abuse services within communities, addressing concerns about drug availability in treatment centers as well as reintegration issues and the need for after-care services, reducing stigmatization in drug and HIV services for MSM and finally, strengthening the link between drug treatment services and HIV prevention by integrating HIV/drug-related risks into HIV prevention efforts and HIV risks into drug use prevention efforts.

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    • "Despite community-based examinations of HIV testing (Parry et al., 2009; Kalichman & Simbayi, 2003), and knowledge that non-injection drug users (NIDUs) are a high-risk group (Parry et al., 2008; Drumright and Colfax, 2009), there has been little investigation into testing among NIDUs in RSA. One study has examined uptake of testing among individuals with high-risk sexual or substance use behaviors in Pretoria, RSA (Luseno & Wechsberg, 2009), although it was restricted to an all female sample and lacked multivariate analyses. "
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    ABSTRACT: South Africa has some of the highest estimates of human immunodeficiency virus (HIV) in the world, with a prevalence of 21.5%. Despite this, based on population-level data, 39% of sexually active South Africans have never been tested for HIV. Non-injection drug users (NIDUs) are a high-risk and increasingly prevalent group in South Africa. However, few studies have examined HIV test utilization among high-risk groups such as drug users in South Africa. The study was conducted in Pretoria, South Africa between 2002 and 2006. Of the 382 individuals surveyed, 31% had been tested for HIV in the past. Results indicate that females and older individuals were significantly more likely to have been tested for HIV at some point in the past, while individuals who did not know someone with HIV/AIDS as well as individuals who are unsure of their risk of HIV infection were significantly less likely to have ever accessed testing. Identification of these subgroups has implications for the development of targeted interventions to promote greater HIV testing among at-risk groups in South Africa.
    AIDS Care 11/2011; 23(11):1519-26. DOI:10.1080/09540121.2011.582479 · 1.60 Impact Factor
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    • "A study that was undertaken among three high risk and vulnerable populations (men having sex with men, sex workers and injecting drug users) in Cape Town, Durban and Pretoria was the first study in South Africa that elaborates on vulnerable groups and describes the fact that these populations are largely ignored by existing HIV responses. It highlights high risk behavior and the need for prioritizing interventions recognizing the role of drug use in HIV transmission and the need to address issues of access to services, stigma and discrimination [3-5]. Data on HIV risk among drug using populations clearly indicate high levels of HIV risk behaviour due to the sharing of injecting equipment and/or drug-related unprotected sex, as was found in the rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug-using populations in Cape Town, Durban and Pretoria [4]. "
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    ABSTRACT: Within a ten year period South Africa has developed a substantial illicit drug market. Data on HIV risk among drug using populations clearly indicate high levels of HIV risk behaviour due to the sharing of injecting equipment and/or drug-related unprotected sex. While there is international evidence on and experience with adequate responses, limited responses addressing drug use and drug-use-related HIV and other health risks are witnessed in South Africa. This study aimed to explore the emerging problem of drug-related HIV transmission and to stimulate the development of adequate health services for the drug users, by linking international expertise and local research. A Rapid Assessment and Response (RAR) methodology was adopted for the study. For individual and focus group interviews a semi-structured questionnaire was utilised that addressed key issues. Interviews were conducted with a total of 84 key informant (KI) participants, 63 drug user KI participants (49 males, 14 females) and 21 KI service providers (8 male, 13 female). Adverse living conditions and poor education levels were cited as making access to treatment harder, especially for those living in disadvantaged areas. Heroin was found to be the substance most available and used in a problematic way within the Pretoria area. Participants were not fully aware of the concrete health risks involved in drug use, and the vague ideas held appear not to allow for concrete measures to protect themselves. Knowledge with regards to substance related HIV/AIDS transmission is not yet widespread, with some information sources disseminating incorrect or unspecific information. The implementation of pragmatic harm-reduction and other evidence-based public health care policies that are designed to reduce the harmful consequences associated with substance use and HIV/AIDS should be considered. HIV testing and treatment services also need to be made available in places accessed by drug users.
    Harm Reduction Journal 06/2011; 8(1):14. DOI:10.1186/1477-7517-8-14 · 1.26 Impact Factor
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    • "In sub-Saharan Africa, a few studies have documented associations between alcohol and unsafe sex in men who have sex with men [20-22] and in male sex workers [23]. A study in South Africa found that three quarters of men who have sex with men had problem drinking and more than half had 10 or more drinks on a typical drinking day [20]. "
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    ABSTRACT: Previous research has linked alcohol use with an increased number of sexual partners, inconsistent condom use and a raised incidence of sexually transmitted infections (STIs). However, alcohol measures have been poorly standardised, with many ill-suited to eliciting, with adequate precision, the relationship between alcohol use and sexual risk behaviour. This study investigates which alcohol indicator--single-item measures of frequency and patterns of drinking ( > = 6 drinks on 1 occasion), or the Alcohol Use Disorders Identification Test (AUDIT)--can detect associations between alcohol use and unsafe sexual behaviour among male sex workers. A cross-sectional survey in 2008 recruited male sex workers who sell sex to men from 65 venues in Mombasa district, Kenya, similar to a 2006 survey. Information was collected on socio-demographics, substance use, sexual behaviour, violence and STI symptoms. Multivariate models examined associations between the three measures of alcohol use and condom use, sexual violence, and penile or anal discharge. The 442 participants reported a median 2 clients/week (IQR = 1-3), with half using condoms consistently in the last 30 days. Of the approximately 70% of men who drink alcohol, half (50.5%) drink two or more times a week. Binge drinking was common (38.9%). As defined by AUDIT, 35% of participants who drink had hazardous drinking, 15% harmful drinking and 21% alcohol dependence. Compared with abstinence, alcohol dependence was associated with inconsistent condom use (AOR = 2.5, 95%CI = 1.3-4.6), penile or anal discharge (AOR = 1.9, 95%CI = 1.0-3.8), and two-fold higher odds of sexual violence (AOR = 2.0, 95%CI = 0.9-4.9). Frequent drinking was associated with inconsistent condom use (AOR = 1.8, 95%CI = 1.1-3.0) and partner number, while binge drinking was only linked with inconsistent condom use (AOR = 1.6, 95%CI = 1.0-2.5). Male sex workers have high levels of hazardous and harmful drinking, and require alcohol-reduction interventions. Compared with indicators of drinking frequency or pattern, the AUDIT measure has stronger associations with inconsistent condom use, STI symptoms and sexual violence. Increased use of the AUDIT tool in future studies may assist in delineating with greater precision the explanatory mechanisms which link alcohol use, drinking contexts, sexual behaviours and HIV transmission.
    BMC Public Health 05/2011; 11(1):384. DOI:10.1186/1471-2458-11-384 · 2.26 Impact Factor
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