Abstract
BackgroundThere are racial disparities in the use of alcohol and other drug (AOD) treatment services in South Africa but little is known about the factors contributing to these disparities. This study aimed to redress this gap through identifying differences in barriers to AOD treatment use among Black African and Coloured persons from Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework.MethodsA case-control design was used to compare 434 individuals with AOD problems who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for Black African and Coloured participants.ResultsAfter controlling for the influence of treatment need and predisposing factors on treatment use, several barriers to treatment were identified. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both race groups. However, Black African persons were more vulnerable to the effects of awareness and geographic access barriers on treatment use. Stigma consciousness was only associated with AOD treatment utilization for Coloured participants.ConclusionDifferences in barriers to AOD treatment use were found among Black African and Coloured South Africans. Targeted interventions that address the unique profile of barriers experienced by each race group are needed to improve AOD treatment use by these underserved groups. Several strategies for improving the likelihood of treatment entry are suggested.
Highlights
There are racial disparities in the use of alcohol and other drug (AOD) treatment services in South Africa but little is known about the factors contributing to these disparities
While the limited availability of AOD services restricts access to treatment for all South Africans, treatment is relatively more difficult to access for people from Black African and Coloured communities disadvantaged during the course of apartheid who remain underrepresented in AOD treatment facilities [5]
Bivariate analyses Predisposing variables Years of education was significantly associated with treatment use for Black African (t (424) = 2.91; p = 0.004) and Coloured participants (t (497) = -0.43; p
Summary
There are racial disparities in the use of alcohol and other drug (AOD) treatment services in South Africa but little is known about the factors contributing to these disparities. Findings from national epidemiological research point to high rates of untreated alcohol and other drug (AOD) use disorders in South Africa [1] This is cause for concern as AOD use poses a significant threat to public health in the country. While the limited availability of AOD services restricts access to treatment for all South Africans, treatment is relatively more difficult to access for people from Black African and Coloured (that is people of mixed race ancestry who form a unique cultural group) communities disadvantaged during the course of apartheid who remain underrepresented in AOD treatment facilities [5]. Race was a major determinant of access to health and social services (including AOD treatment), with Whites having more access to public services than Coloured or Black African South Africans [6,7] These disparities arose from the legislated geographic segregation of race groups and the distribution of resources along racial lines. This geographical apartheid forced Black African and Coloured South Africans to live in township areas with limited infrastructure that were located considerable distances from the well-resourced urban areas reserved for the use of White South Africans [6]
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