Multi-level experiences and determinants of alcohol misuse and illicit drug use among occupational groups at high-risk of HIV in sub-Saharan Africa: A thematic synthesis of qualitative findings

Abstract

Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk (n = 4) or sex workers (n = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings.

Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study

“…Meanwhile, variables such as food security and a positive HIV status increased the risk of binge drinking. This is in contrast to literature that suggests that one of the most common structural drivers of substance use in occupational groups at high risk of HIV in South Africa is widespread poverty [60]. Food insecurity and substance use have been shown to be highly correlated for men but not women [61].…”

Alcohol brings burdens: A global and continent wise study on alcohol consumption and global burden of diseases

“…Compared to other variables in RE and FE estimates, consumption of wine, beer and other alcoholic beverages only have a considerable significant positive effect on GBD. Kuteesa, Seeley [ 31 ] have also supported this finding related to alcohol stating that despite the pattern and local context, harmful drinking is common among Africans. Further, this situation has led to adverse consequences where poverty and work environment considered as key drivers of alcohol consumption.…”

Prevalence and correlates of tobacco use in Botswana: evidence from the 2014 Botswana STEPwise survey

“…This connection has been observed in few cross-sectional studies that were also not precisely intended to reveal the likely sequence of substance use behaviours [36][37][38][39][40]. Drinkers have been found to be more likely to use smoked tobacco products than smokeless tobacco products [41]. Given the direction of the relationship between alcohol consumption and tobacco use, future studies should focus on the influence of alcohol use on other substances in order to come up with effective holistic interventions.…”