HIV testing and sero‐prevalence among methamphetamine users seeking substance abuse treatment in Cape Town

Abstract

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.

Prevalence and correlates of HIV infection among people who use drugs in Cambodia: a cross-sectional survey using respondent driven sampling method

“…To start with, these findings suggest that older age may be related to the risk of HIV infection. This is in contrast to other studies in China and South Africa, which did not find a relationship between HIV infection and age among methamphetamine users [23, 24]. However, a previous study among transgender in Cambodia reported that older age increased the risk of HIV infection [25].…”

Contingency management treatment for methamphetamine use disorder in South Africa

“…Data from the South African Community Epidemiological Network on Drug Use, which examines data from specialist substance use treatment centres in the nine provinces of South Africa, show that in 2016, of the 5784 patients presenting for drug abuse treatment, 31% ( n = 1766) reported methamphetamine as the primary substance of use . As in other countries, MUD in South Africa is associated with a broad range of negative health issues, including HIV sexual transmission behaviours , HIV seroconversion and mental disorders (e.g. mood and psychotic disorders) .…”

Addressing HIV risk behaviour in South Africa: Yes, HIV testing in treatment centres in important, but far more is needed

“…The article by Grouse et al [1] addresses the topic of the link between methamphetamine use and HIV and the feasibility of HIV testing in a community substance abuse treatment centre. While the study was underpowered and only found that HIV-infected methamphetamine users in treatment differed significantly from non-HIV-infected methamphetamine users in terms of having a history of injection drug use, it did show that with active support, including being accompanied to HIV testing services, methamphetamine users in treatment could be persuaded to go for HIV counselling and testing.…”

“…Currently, between 15% (Eastern Cape province) and 69% (Western Cape province) of patients in drug treatment report that they have been tested for HIV in the past 12 months [4]. But what Grouse et al [1] also highlight is possibly lower levels of HIV in a drug using population as compared with the underlying community. This has also been found in other studies in South Africa, among drug using sex workers specifically [5], and raises questions about the appropriate response to addressing drug-related HIV risks where resources are scarce and rates of HIV might be lower than in the general population.…”

“…While many believe that drug treatment alone is HIV prevention [6], it can be argued that actively supporting drug users in treatment to get tested should be considered an integral part of a more comprehensive approach to treatment and might be of value, not only in cases where drug users are HIV positive and do not know their status but also in cases where they are not HIV positive and need to be encouraged to work on maintaining their negative status. Getting drug users in treatment to agree to be tested is likely to work better if they are accompanied in going to an HIV testing centre [1] or if independent HIV counselling and testing services are brought to treatment centres and if such testing is delayed until later in the treatment process when they might be more ready to look at drug-related risk-taking, including HIV risk behaviours and their HIV status. This is especially pertinent in the case of methamphetamine users who are in many cases in no shape to confront their HIV status and associated risk behaviours during their detoxification or early stages of treatment.…”