Abstract
Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.
Highlights
7 million people in South Africa are infected with the human immunodeficiency virus (HIV), accounting for 19.2% of adults aged 15 – 49 (The Joint United Nations Programme on HIV/AIDS [UNAIDS], 2017)
The reduction of alcohol use among non-injection drug use (NIDU) is important because alcohol use has been associated indirectly with HIV through risky sex behaviours and alcohol is one of the substances targeted in behavioural interventions for drug users (Lan, Scott-Shedon, Carey, Johnson, & Carey, 2014; Samet et al, 2007)
Despite the above-mentioned limitations, the findings of the current study and previous studies demonstrate that interventions targeting NIDUs can reduce their substance use to a certain degree, but may not affect other risk behaviours among this population
Summary
7 million people in South Africa are infected with the human immunodeficiency virus (HIV), accounting for 19.2% of adults aged 15 – 49 (The Joint United Nations Programme on HIV/AIDS [UNAIDS], 2017). AOD use is increasingly recognised as playing a direct and indirect role in the transmission of HIV. This occurs directly, through the sharing of injection drug use paraphernalia and indirectly, as AOD use can reduce inhibitions and impair judgement impacting on risky sexual encounters such as having multiple sexual partners and increased length of sexual encounters (Rosengard, Anderson, & Stein, 2004; Semple, Patterson, & Grant, 2004). Studies have demonstrated the impact of drug use on risky sexual behaviour where drug use facilitates high-risk sexual behaviour such as having multiple partners and inconsistent condom use (Parry, Carney, Petersen, Dewing, & Needle, 2008, 2009). A report indicated the HIV prevalence among drug users in this country to be between 5.4% and 35% depending on the subpopulation studied (e.g. injection drug users (IDUs) and noninjection drug users (NIDUs)) and other factors
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.