International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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International Journal of Drug Policy 25 (2014) 583–590 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Contextualizing gender differences and methamphetamine use with HIV prevalence within a South African community q Wendee M. Wechsberg a,b,c,d,∗ , Irene A. Doherty a,b , Bronwyn Myers e,f , Antonio A. Morgan-Lopez a , Andrea Emanuel a , Tara Carney e , Tracy L. Kline a , William A. Zule a a RTI International, Research Triangle Park, NC, USA b University of North Carolina, Chapel Hill, NC, USA c North Carolina State University, Raleigh, NC, USA d Duke University, Durham, NC, USA e South African Medical Research Council, Parow, South Africa f Department of Psychiatry and Mental Health, University of Cape Town, South Africa a r t i c l e i n f o Article history: Received 25 April 2013 Received in revised form 19 September 2013 Accepted 30 October 2013 Keywords: Alcohol Methamphetamine HIV risk South Africa Gender Neighbourhood Place Social context a b s t r a c t Background: This study was conducted in a large Black African township outside of Cape Town, South Africa, where HIV infection has been endemic at extremely high levels for years. Problems associated with high HIV prevalence are compounded by gender inequality and high rates of gender-based violence exacerbated by heavy alcohol use and increasing methamphetamine use. Methods: Informal drinking establishments (known as shebeens) were geocoded and mapped. Based on visual examination, we identified 36 neighbourhoods, each of which contained between three to seven drinking venues clustered together. Neighbourhoods were separated from each other by at least 200 m. We randomly selected 30 of the 36 neighbourhoods. Outreach workers screened males in shebeens and screened their female partners. This analysis includes 580 study participants recruited from 30 neigh- bourhoods between 2010 and 2012. All participants completed a baseline questionnaire that included individual-level, couple-level, and neighbourhood-level measures of alcohol and other drug use, HIV infection, and HIV risk behaviours. Multilevel fixed effects regression analyses stratified by gender were conducted to examine correlates of HIV infection. Results: Women were twice as likely as men to be HIV infected, yet they reported fewer sex partners. Neighbourhood prevalence of HIV was correlated with greater likelihood of HIV infection among women, but not men. Neighbourhood methamphetamine use was marginally associated with HIV among women but not among men. At the individual level, heavy alcohol use was marginally associated with HIV infec- tion among men but not among women. Having an HIV positive partner was the strongest correlate of being HIV positive among both men and women. Conclusion: Findings from this study underscore the need for policy makers to direct scarce resources to the communities, places within communities, and populations, especially vulnerable women, where the impact on HIV prevention and onward transmission will be greatest. © 2014 Elsevier B.V. All rights reserved. Introduction South Africa is the epicentre of the HIV pandemic and HIV is the leading cause of life years lost in the Western Cape q This is an open-access article distributed under the terms of the Creative Com- mons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited. ∗ Corresponding author at: Substance Abuse Treatment Evaluations and Inter- ventions Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, USA. Tel.: +1 919 541 6422; fax: +1 919 541 6683. E-mail address: (W.M. Wechsberg). Province, particularly within its townships (Bradshaw, Norman, & Schneider, 2007; Shaikh et al., 2006). The social context of town- ships increases vulnerability to HIV. Extreme poverty, inadequate education, unemployment, and high rates of labour migration that destabilize families, characterize the plight of these townships. Gender inequalities in this setting often force women to enter multiple transactional sexual partnerships as a means to sustain themselves and their families. The region also carries the high- est burden of alcohol and other drug (AOD) use and the highest prevalence of methamphetamine use in the country (Pasche & Myers, 2012; Pluddemann, Myers, & Parry, 2008), which are asso- ciated with increased likelihood of HIV sexual risk behaviours (Parry, Pluddemann, Myers, Wechsberg, & Flisher, 2011; Townsend 0955-3959/$ – see front matter © 2014 Elsevier B.V. All rights reserved.

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