The relevance of social contexts and social action in reducing substance use and victimization among women participating in an HIV prevention intervention in Cape Town, South Africa

Abstract

ObjectivesTo examine qualitatively how women’s social context and community mobilization (eg, mobilizing women to take social action and engaging their community in social change) influence substance use abstinence and victimization among women participating in a human immunodeficiency virus (HIV) intervention in Cape Town, South Africa.MethodsThirty women who had participated in a randomized controlled trial of a group-delivered intervention to address substance use, gender-based violence, and associated risk for HIV (The Women’s Health CoOp) were selected to participate in semi-structured interviews about their perceived impact of the intervention on their substance use and exposure to victimization. The Women’s CoOp intervention involved creating a new positive social environment for women within a group setting that also fostered women’s social action (eg, educating peers or family members) in the community. Interviews were analyzed using content analysis and coded to examine women’s descriptions of social contexts and social action, and the influence of these on women’s substance use abstinence and exposure to victimization.ResultsSocial support (eg, via program staff and other participants) and social action (eg, engaging others in the community on issues relevant to substance use prevention or other health topics) promoted within the program, as well as outside social influences within women’s life contexts (eg, support from non-substance using family or male partners, leaving male partners or other peer relationships characterized by drug use, or finding employment) were key factors reported by women in terms of facilitating their substance use abstinence and in reducing women’s exposures to victimization.ConclusionFindings highlight the potential for group-delivered interventions that include mobilizing women to take social action in the larger community to be effective approaches for facilitating substance use abstinence, reductions in victimization, and ultimately, to address the intersection between substance use, violence, and HIV risk among women in this high HIV prevalence setting.

Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women

“… 20 – 24 To address social support needs, we designed this as a group-based intervention, with the hope that groups would evolve into peer support networks, as has happened elsewhere. 31 This intervention is novel in that it comprehensively addresses young women’s service needs. We are not aware of any other trauma-informed substance use interventions that augment therapeutic content with self-care strategies to support the creation of purpose.…”

“Too much boredom isn’t a good thing”: Adapting behavioral activation for substance use in a resource-limited South African HIV care setting.

“…BA has been evaluated in residential substance use treatment and outpatient HIV primary care in the United States for a range of substance types, including alcohol, tobacco, methamphetamine, and polysubstance use (MacPherson et al, 2010;Mimiaga et al, 2012;Reynolds, MacPherson, Tull, Baruch, & Lejuez, 2011). Given the role of boredom as a risk factor for relapse in impoverished communities in Cape Town (Myers, Carney, & Wechsberg, 2016;Reed, Emanuel, Myers, Johnson, & Wechsberg, 2013;Wegner, 2011;Wegner et al, 2006), BA may be particularly appropriate for addressing substance use in this context by providing specific skills to increase activation in one's environment and counter boredom. BA has been found to be a feasible and acceptable therapy specifically for PLWH (Daughters, Magidson, Schuster, & Safren, 2010;Magidson, Seitz-Brown, Safren, & Daughters, 2014;Tull, Berghoff, Bardeen, Schoenleber, This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa

“…Having family members with drug problems might normalize drug use within the family system, thereby diminishing individuals’ awareness of their own problematic drug use [ 39 ] and reducing the likelihood that family members will encourage and support help seeking for drug use [ 41 ]. As previous studies have noted that a lack of emotional and tangible social support for treatment-seeking impacts negatively on treatment initiation [ 11 , 30 , 42 ], interventions that provide women with emotional support for changing their drug use and tangible support (such as assisting with childcare and providing transport to appointments) could potentially address barriers to treatment entry [ 11 ] and enhance women’s perceived need for drug treatment, although this hypothesis requires testing.…”