Background Over the last decade, South Africa’s Western Cape has experienced a dramatic increase in methamphetamine (“tik”) use. Our study explored local impressions of the impact of tik use in a peri-urban township community in Cape Town, South Africa. Methods We conducted individual in-depth interviews with 55 women and 37 men who were regular attendees of alcohol-serving venues. Interviews were recorded and transcribed. A content analysis approach was used to identify themes related to the impact of tik use based on levels of the socio-ecological framework (individual, inter-personal and community). Results Tik use was reported to be a greater issue among Coloureds, compared to Blacks. At an individual level, respondents reported that tik use had adverse effects on mental, physical, and economic well-being, and limited future opportunities through school drop-out and incarceration. At an inter-personal level, respondents reported that tik use contributed to physical and sexual violence as well as increased rates of sexual risk behaviour, particularly through transactional sex relationships. Respondents described how tik use led to household conflict, and had negative impacts on children, including neglect and poor birth outcomes. At a community level, respondents linked tik use to increased rates of crime, violence and corruption, which undercut community cohesion. Conclusions Our results highlight the negative impact that tik is having on individuals, households and the overall community in a peri-urban setting in South Africa. There is a clear need for interventions to prevent tik use in South Africa and to mitigate and address the impact of tik on multiple levels.

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ABSTRACT. Objective: South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship. Method: A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0-7) and drinking behavior. Results: The mean Alcohol Use Disorders Identifi cation Test score in the sample was 12.15 (range: 0-34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT ≥ 8). The mean PTSD score was 36.32 (range: 17-85, SD = 16.3), with 20.9% meeting symptom criteria for PTSD (PTSD ChecklistCivilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the "other" category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior. Conclusions: Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas. (J. Stud. Alcohol Drugs, 73, 549-558, 2012)

This qualitative study explores alcohol-serving venues as sites of risk or protection from violence against women (VAW) in one South African community. In 2010, we conducted in-depth interviews with 31 female patrons, 13 male patrons and 11 venue staff, and conducted structured observations in six alcohol venues. VAW was a common experience and venues contributed to risk through aggression, negative attitudes towards women, risks leaving the venues, and owners tolerating VAW. Concurrently, venues offered potential to avoid VAW through perceived safety and owner protection. Results highlight the influence of the venue environment and importance of addressing the setting of alcohol consumption.