Background Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town. Methods Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment. Results Participants had used methamphetamine for an average of 7.06 years (SD=3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD=8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning. Conclusion This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.

Persons with severe mental illness (SMI) have been disproportionately affected by the HIV epidemic, with higher rates of HIV prevalence and morbidity than the general population. Recent research has advanced our understanding of the complex factors that influence primary and secondary HIV prevention for those with SMI. Sex risk in this population is associated with socioeconomic factors (e.g., low income, history of verbal violence) and other health risk behaviors (e.g., substance use, no prior HIV testing). Several interventions are effective at reducing risk behavior, and reviews highlight the need for more well-controlled studies that assess long-term outcomes. Recent research has elucidated barriers that interfere with HIV treatment for SMI populations, including individual (e.g., apathy, substance use), social (e.g., stigma), and system factors (e.g., transportation, clinic wait times). Interventions that coordinate HIV care for individuals with SMI show promise as cost-effective methods for improving medication adherence and quality of life.

Background South Africa has experienced a tremendous rise in methamphetamine use since the year 2000. Sex trading is a global phenomenon that has been observed in active drug users and has been associated with risks for HIV infection and violence. Objectives This paper describes and examines the correlates of sex trading among active methamphetamine users in Cape Town, South Africa. Methods Through peer referral, 360 (201 male; 159 female) active methamphetamine users were recruited in a peri-urban township. Demographics, sex trading, drug use, trauma, and mental health were assessed by a structured clinical interview and computer survey. Logistic regression models were used to examine predictors of sex trading for men and women. Results In the past 3 months, 40% of men and 33% of women endorsed trading sex for methamphetamine or money. Among these, they reported trading with same sex partners (33%), high rates of inconsistent condom use (73%), and incidences of physical (23%) and sexual (27%) assault when sex trading. Increased drug use severity was correlated with sex trading. Women with experiences of violence and trauma were also more likely to trade sex. Conclusions/importance The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. Targeted interventions geared towards safe sex practices may reduce risky sexual behaviors. Women need interventions that are attuned to their specific vulnerabilities. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior.

Introduction and Aims Methamphetamine use is highly prevalent in parts of South Africa, and there is concern this will contribute to the country’s substantial HIV epidemic. We examined the feasibility of implementing routine HIV testing at a community-based substance abuse treatment centre in Cape Town, and determined the HIV sero-prevalence among methamphetamine users seeking treatment at this site. Design and Methods In this cross-sectional study, 293 participants completed measures of demographics, substance use and HIV treatment. HIV sero-prevalence was determined by a rapid finger-prick HIV test, and prior HIV diagnosis was confirmed via clinic records. Results The majority of participants were male and self-identified as “Coloured,” with a mean age of 28. The HIV sero-prevalence was 3.8%. Of the 11 participants who tested HIV-positive, four were newly diagnosed. HIV-positive and HIV-negative participants were comparable on demographic and substance use factors. Uptake of HIV testing among all clients at the drug treatment centre increased from <5% prior to study initiation to 89% after study completion. Measures implemented to ensure high rates of HIV testing were regarded as sustainable. Discussion and Conclusions Our study suggests that integrating routine HIV testing into substance abuse treatment is feasible in a community-based health centre. The low HIV prevalence among this sample of treatment-seeking methamphetamine users highlights the potential benefits of supporting expanded efforts to optimise HIV prevention with this young adult population.

South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34% multiple partners, 26% unprotected intercourse with a casual partner, and 24% sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25% had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.

Background The pediatric patient-reported outcomes version of the common terminology criteria for adverse event measure was developed and validated for use in pediatric cancer clinical trials to better capture the symptom experiences through direct self-report. The study aim was to develop and validate a Swahili language version of the patient-reported outcomes version of the common terminology criteria for adverse event measure. Methods The pediatric version of 15 core symptom adverse events, and the corresponding questions, were selected from the patient-reported outcomes version of the common terminology criteria for adverse event library, then forward and back translated into Swahili by bilingual translators. The translated items were further refined using concurrent cognitive interviewing. Each round of interviews included five children, ages 8–17 years-old, receiving cancer therapy at Bugando Medical Centre, the cancer referral hospital for Northwest Tanzania, and continued until at least 80% of participants understood the question. Results Three rounds of cognitive interviews were completed involving 13 patients and 5 caregivers. Among patients, 50% of questions (19/38) were fully comprehended after the first interview round. Two Adverse Events (anxiety and peripheral neuropathy) were the most difficult for participants to understand, associated with education level and experience. Goal comprehension was achieved after three rounds of interviews with no further revisions required. All parents in the first cognitive interview group comprehended the survey, with no additional revisions. Conclusion A Swahili patient-reported outcomes version of the common terminology criteria for adverse event was effective in eliciting patient-reported Adverse Events related to cancer treatment, with good comprehension for children aged 8–17 years. This survey is important to incorporate patient self-reporting of symptomatic toxicities and is an effective tool to increase capacity for pediatric cancer clinical trials throughout East Africa, further reducing global disparities in cancer care.