[show abstract][hide abstract] ABSTRACT: About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.
A data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature.
Completed data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries.
In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.
[show abstract][hide abstract] ABSTRACT: This study aimed to determine a demographic profile of methamphetamine (MA)-related admissions to major psychiatric services in Cape Town, obtain a substance use profile from admitted patients, a profile of common MA-related symptoms encountered during the assessment of the patients presenting with MA-related problems, and a brief profile of the psychiatric diagnoses made.
Staff in six psychiatric hospitals or wards in Cape Town collected data on methamphetamine related admissions between July and December 2008 using a one-page record review form. The data collection form consisted of the patient's demographic details, presenting symptoms, previous admission details, current MA and other substance use information, and DSM-IV diagnosis.
A total of 235 forms were completed. Most patients were male (69%) and the mean age was 25 years. The most common presenting symptoms were aggressive behaviour (74%), followed by delusions (59%) and hallucinations (57%). Males were two times more likely to present with aggression as compared to females, while females were significantly more likely to present with depressed mood or euphoric/elevated mood. The majority of patients had substance-induced psychotic disorder (41%), followed by schizophrenia (31%). Twelve percent (12%) had bipolar mood disorder.
MA-related psychiatric admissions pose serious challenges to all health services dealing with these patients. Further training and treatment protocol development and distribution is indicated.
[show abstract][hide abstract] ABSTRACT: Objective: To investigate whether methamphetamine use is associated with sexual risk behavior among adolescents. Method: A cross-sectional survey of 1,561 male and female high school students in Cape Town (mean age 14.9 years) was conducted using items from the Problem Oriented Screening Instrument for Teenagers (POSIT) HIV Risk Scale. Results: Nine percent of the students had tried methamphetamine and 30% of male and 17% of female students reported sexual debut. Multinomial logistic regression analyses showed that methamphetamine use in the past year was significantly associated with being in a higher HIV/STI risk category (RRR = 2.1, 95% CI: 1.10–4.03, p
[show abstract][hide abstract] ABSTRACT: Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This study aimed to review research conducted in Cape Town on the link between methamphetamine use and sexual risk behaviour.
A review of published research conducted in Cape Town between 2004 and 2007 was undertaken using PubMed, EBSCOhost and Science Direct.
Eight studies were identified, both quantitative and qualitative, and focusing on diverse populations, such as learners in school, out of school youth, adults in the community, men who have sex with men and sex workers. The total sample across the studies was 8153. Across multiple studies methamphetamine was fairly consistently associated with early vaginal sex, condom use during sex, having casual sex and other HIV risk behaviours. For some sub-groups the direction of the relationship was in an unexpected direction.
The consistency of the findings across studies highlights the increased risk for contracting HIV among methamphetamine users, and reinforces the importance of interventions addressing both methamphetamine use and unsafe sexual behaviour among young people and other sectors of the population. The need for further research is also considered, particularly research that will explain some of the racial differences that were found.
[show abstract][hide abstract] ABSTRACT: The Alcohol and Drug Abuse Research Unit (ADARU) was established at the South African Medical Research Council (MRC) at the beginning of 2001, although its origins lie in the activities of the Centre for Epidemiological Research in Southern Africa and other MRC entities. Initial challenges included attracting external funding, recruiting new staff, developing the skills of junior staff, publishing in international journals and building national and international collaborative networks. ADARU currently comprises a core staff of 33 members who work on 22 projects spanning substance use epidemiology and associated consequences, intervention studies with at-risk populations and services research. A large component of this portfolio focuses on the link between alcohol and other drug use and human immunodeficiency virus (HIV) risk behaviour, with funding from the US Centers for Disease Control and Prevention. Junior staff members are encouraged to develop independent research interests and pursue PhD studies. Research outputs, such as the 20 papers that were published in 2010 and the 35 conference presentations from that year, form an important part of the unit's research translation activities. We engage actively with policy processes at the local, provincial, national and international levels, and have given particular attention to alcohol policy in recent years. The paper includes an analysis of major challenges currently facing the unit and how we are attempting to address them. It ends with some thoughts on what the unit intends doing to enhance the quality of its research, the capacity of its staff and its international standing.
[show abstract][hide abstract] ABSTRACT: This prospective study investigated the association between life-long methamphetamine and other drug use and high school non-attendance, in a sample of high school students in Cape Town, South Africa.
A random sample of 1535 high school students completed a baseline questionnaire in 2006, and were asked to complete a follow-up questionnaire 12 months later. The questionnaire included questions on substance use, including tobacco, alcohol, methamphetamine and cannabis use, demographic factors, and questions relating to school attendance and performance.
Forty-three percent of the students surveyed at baseline did not complete a follow-up questionnaire after 12 months. Compared with students who were not using selected substances, an adjusted logistic regression model showed that life-time methamphetamine use in addition to other substances was significantly associated with non-attendance (OR = 2.58, 95% CI: 1.24-5.36) when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account.
Early identification of students with methamphetamine and other substance use problems, and a supportive rather than punitive school policy, may be valuable in improving high school completion and student retention rates.
[show abstract][hide abstract] ABSTRACT: Methamphetamine use has become a growing problem in a number of countries over the past two decades, but has only recently emerged in South Africa. This study investigated the prevalence of methamphetamine use among high-school students in Cape Town and whether students reporting methamphetamine use were more likely to be at risk for mental health and aggressive behavior problems.
A cross-sectional survey of 15 randomly selected high schools in Cape Town, of 1561 males and females grade 8-10 students (mean age 14.9), was conducted using the Problem Oriented Screening Instrument for Teenagers (POSIT) and the Beck Depression Inventory (BDI).
Findings indicated that 9% of the students had tried methamphetamine at least once. Ordinal logistic regression analyses showed that methamphetamine use in the past year was significantly associated with higher aggressive behavior scores (OR=1.81, 95% CI: 1.04-3.15, p<0.05), mental health risk scores (OR=2.04, 95% CI: 1.26-3.31, p<0.01) and depression scores (OR=2.65, 95% CI: 1.64-4.28, p<0.001).
Methamphetamine use has become a serious problem in Cape Town, particularly among adolescents. Screening adolescents in school settings for methamphetamine use and behavior problems may be useful in identifying youth at risk for substance misuse, providing an opportunity for early intervention. These findings have implications for other parts of the world where methamphetamine use may be occurring at younger ages and highlight the importance of looking at co-morbid issues related to methamphetamine use.
Drug and alcohol dependence 06/2010; 109(1-3):14-9. · 3.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: Injection drug use (IDU) is becoming an increasingly important mode of HIV transmission globally. The number of African countries experiencing IDU is reported to be growing. This is cause for concern as the phenomenon of IDU is arising within the context of an established and growing HIV epidemic. This article provides a concise review of the available literature pertaining to IDU within six African countries, namely Egypt, Kenya, Mauritius, Nigeria, South Africa and Tanzania. The available information contradicts the prevailing view that IDU is extremely rare or non-existent in most African countries. IDU populations within the selected countries are shown to engage in high-risk sexual and injecting behaviours. IDUs in Africa have the potential to provide a significant contribution to the spread of HIV/AIDS on the continent.
[show abstract][hide abstract] ABSTRACT: Self-reported drug use and urinalysis results were compared in a sample of approximately a thousand arrestees interviewed in three major cities in South Africa during 2000. Results showed that only 54% of the arrestees who tested positive for cannabis reported using the drug in the past thirty days, 32% of those who tested positive for Mandrax (methaqualone) and 35% of those who tested positive for cocaine reported having used the respective drug in the past three days. Implications for use of self-report measures alone in research on arrestees and other populations are discussed and the South African findings are compared to those presented in the NEW-ADAM study in the UK.
[show abstract][hide abstract] ABSTRACT: UN reports point to a steady increase in heroin use in a number of African countries, including South Africa. South Africa also has one of the highest HIV infection prevalence rates in the world. Given the link between intravenous heroin use and HIV transmission, this study aimed to investigate HIV-related risk behaviors among heroin users in the city. A snowballing or chain referral sampling technique was used to find 239 heroin users in Cape Town who were interviewed using a structured questionnaire. Overall, 24% of all the participants reported that they had injected heroin in the past 30 days and 89% of these had shared a needle at least once during that period. Condom use was irregular among the survey participants. Three percent stated that they were HIV positive. Heroin use has become a major concern in Cape Town and may still be increasing. While injecting use still appears to be fairly limited, this has the potential to change. Further debate is required regarding the introduction of harm reduction approaches that have been found to be effective elsewhere.
Journal of psychoactive drugs 10/2008; 40(3):273-9. · 1.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: In the past decade, methamphetamine has become increasingly a drug of concern globally. The purpose of this study is to describe the changing trends in treatment admissions for methamphetamine abuse in Cape Town, South Africa and to highlight the implications of these changes for policy, practice and research.
Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance and information on prior treatment.
The results indicate that between 2004 and 2006 a dramatic increase in treatment admissions for methamphetamine abuse occurred, a large proportion of the methamphetamine patients are adolescents and that the drug is almost exclusively smoked.
The rapid increase in admissions for methamphetamine abuse is of great concern, particularly as the drug has a number of serious, often chronic, side effects and that a large proportion of the patients are adolescents. The implications for public health are discussed.
Drug and Alcohol Review 04/2008; 27(2):185-9. · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: To make quantitative estimates of the burden of disease attributable to alcohol use by sex and age group in South Africa in 2000.
The analysis follows the World Health Organization comparative risk assessment (CRA) methodology. Population-attributable fractions (PAFs) calculated from modelled prevalence estimates and relative risks based on the global review were applied to the burden of disease estimates from the revised South African National Burden of Disease study for 2000. The alcohol-attributable fractions for injuries were directly determined from blood alcohol concentrations (BAC > 0.05 g/100 ml) at the time of injury. Monte Carlo simulation-modelling techniques were used to quantify uncertainty in the estimates.
Adults >or= 15 years.
Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, stroke, hypertensive disease, diabetes, certain cancers, liver cirrhosis, epilepsy, alcohol use disorder, depression and intentional and unintentional injuries as well as burden from fetal alcohol syndrome (FAS) and low birth weight.
Alcohol harm accounted for an estimated 7.1% (95% uncertainty interval 6.6 - 7.5%) of all deaths and 7.0% (95% uncertainty interval 6.6 - 7.4%) of total DALYs in 2000. Injuries and cardiovascular incidents ranked first and second in terms of attributable deaths. Top rankings for overall attributable burden were interpersonal violence (39.0%), neuropsychiatric conditions (18.4%) and road traffic injuries (14.3%). Interpersonal violence accounted for 42.8% of the injury DALYs attributed to alcohol in males and 25.9% in females. In terms of alcohol-attributable disability, alcohol use disorders ranked first (44.6%), interpersonal violence second (23.2%), and FAS third (18.1%).
Particular attention needs to be given to preventing and reducing the burden of alcohol-related homicide and violence, alcohol-related road traffic accidents, alcohol use disorders, and FAS. Multilevel interventions are required to target high-risk drinkers, in addition to creating awareness in the general population of the problems associated with alcohol abuse.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 08/2007; 97(8 Pt 2):664-72. · 1.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: Accurate prevalence data on cocaine use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of problematic cocaine use in South Africa.
Data were collected between January 1997 and December 2006 on admissions for drug abuse treatment through a regular monitoring system involving 56 drug treatment centres and programmes in Cape Town, Gauteng Province (Johannesburg and Pretoria) and the Eastern Cape every six months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance, and information on prior treatment.
Treatment indicators point to a significant increase in cocaine related admissions over time in all sites, but with substantial inter-site variation, particularly in recent years. The data indicate high levels of crack cocaine use and high levels of daily usage among patients, most of whom were first time admissions. Patients with cocaine related problems continue to be predominantly male, with a mean age of around 30 years. Substantial changes in the racial profile of patients have occurred over time. Poly drug use is high with cocaine often used with alcohol, cannabis and other drugs.
These trends point to the possibility of cocaine use becoming a serious health and social issue in South Africa and demonstrate the utility of continued monitoring of cocaine treatment admissions in the future. They also highlight the need to address cocaine use in national and provincial policy planning and intervention efforts. In terms of treatment, the findings highlight the need to ensure that treatment practitioners are adequately trained to address stimulant problems, poly drug use, and HIV and other risk behaviour related to crack cocaine use. Possible gaps in access to treatment by certain sectors of the population should be addessed as a matter of urgency.
[show abstract][hide abstract] ABSTRACT: Accurate prevalence data on heroin use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of heroin use in South Africa. Data were collected from 41 specialist alcohol and other drug treatment centres in two metropolitan sites (Cape Town and Gauteng Province) between January 1997 and December 2003. Treatment indicators point to a substantial increase in heroin use over time. Most heroin users in treatment tend to be white, male, between the ages of 21 and 24 years and tend to smoke rather than inject the substance. However, this profile is changing. These emerging trends point to the possibility of heroin use becoming a serious health and social issue in South Africa and demonstrate the need for continued monitoring of heroin use patterns in the future and the development of a strategic plan for intervening before the situation deteriorates further.
Drug and Alcohol Review 10/2005; 24(5):419-23. · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.
Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples.
Cause of injury and biological markers to assess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and methamphetamine.
Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug (N = 1565). In most cases the drugs were cannabis and/or methaqualone. While no inter-city differences were found, male patients were typically more likely to test positive for drugs in general and specific drugs such as cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries.
Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 07/2005; 95(6):429-32. · 1.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study formed part of the 1998 South African Demographic and Health Survey, which included questions assessing the extent of alcohol use, risky drinking and alcohol problems among South Africans to obtain up-to-date baseline estimates of consumption and risky drinking and to inform intervention efforts.
A two-stage random sample of 13,826 persons ages 15 or older (59% women) was included in the survey. Alcohol use was assessed through eight questions, including the CAGE questionnaire. Frequency analyses for different age groups, geographic setting, education level, population group and gender were calculated, as were odds ratios for these variables in relation to symptoms of alcohol problems.
Current alcohol consumption was reported by 45% of the men and 17% of the women. White men (71%) were most likely and Asian women (9%) least likely to be current drinkers. Urban residents were more likely than nonurban dwellers to report current drinking. One third of the current drinkers reported risky drinking over weekends, and 28% of the men and 10% of the women scored above the cutoff level on the CAGE questionnaire. Symptoms of alcohol problems were significantly associated with lower socioeconomic status, no school education in women and being older than 25 years of age.
A comprehensive strategy is required to address the high levels of risky drinking and reported symptoms of alcohol problems.
Journal of studies on alcohol 02/2005; 66(1):91-7.
[show abstract][hide abstract] ABSTRACT: To assess acute alcohol intoxication among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.
Cross-sectional surveys were conducted during a four-week period in each of the above sites in 1999, 2000 and 2001. The concept of an 'idealised week' was used to render representative samples. Breath-alcohol concentrations were assessed in a total of 1900 patients using a Lion SD2 alcolmeter.
Over half of all the patients experienced violent injuries. Across sites and for each respective year of the survey, between 35.8% and 78.9% of patients tested positive for alcohol. Between 16.5% and 67.0% had a breath-alcohol concentration greater than or equal to 0.05g/100ml. Port Elizabeth consistently had the highest proportion of patients testing positive for alcohol. Patients injured as a result of violence were more likely to test positive for alcohol than patient who sustained road traffic or other unintentional injuries.
Alcohol involvement among trauma patients remained consistently high for each of the three study periods. Efforts to combat the abuse of alcohol would appear to paramount in reducing the burden of injuries on health care services.
Injury Control and Safety Promotion 01/2005; 11(4):265-7.
[show abstract][hide abstract] ABSTRACT: This paper aims to provide surveillance information about the extent and consequences of alcohol and other drug (AOD) use by adolescents for three sentinel sites in South Africa (Cape Town, Durban and Gauteng province). From 1997 to 2001, data were gathered from multiple sources, including specialist treatment centres, trauma units, school students, rave party attenders, and arrestees. Since the start of surveillance, an increasing proportion of South African adolescents are using AODs. Surveys point to high levels of alcohol misuse among high school students, with alcohol being the most common substance of abuse. Cannabis is the most frequently reported illicit drug of abuse among adolescents. This is reflected in the large proportion of adolescents receiving treatment for cannabis, cannabis-positive arrestees, and cannabis-positive trauma patients. Cannabis smoked together with methaqualone is the second most common primary drug of abuse in Cape Town. Arrestee data highlights the potentially negative effect of adolescent methaqualone use. Cocaine and heroin are emerging as problem drugs of abuse among adolescents in large metropolitan centres. Ecstasy (MDMA) use occurs mainly among adolescents who attend rave parties and clubs. The study points to the need for AOD intervention programmes that target young people and the need for continued monitoring of adolescent AOD use in the future.
Journal of Adolescence 09/2004; 27(4):429-40. · 2.05 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article provides descriptive surveillance information about the extent and consequences of Ecstasy use for five sentinel sites in South Africa. From January 1997 to December 2001, data were gathered on a biannual basis from multiple sources, including specialist treatment centers, trauma units, school students, rave party attendees, and from police and arrestees. Indicators point to relatively low levels of Ecstasy use in South Africa. Demographic characteristics of Ecstasy consumers in South Africa were identified. Ecstasy is predominantly used among White South African youth of both genders, with the age of users decreasing over recent years. The use of Ecstasy is, however, increasing among other population groups. Some emerging health risks associated with club drug use were identified, including the use of Ecstasy in combination with other substances. On the basis of this information, a number of policy recommendations are made. These are targeted at both Ecstasy demand reduction and harm minimization. The study points to the need for continued monitoring of Ecstasy use and its associated consequences in this country.
Substance Use & Misuse 02/2004; 39(1):87-105. · 1.11 Impact Factor