Gender Differences in the Prevalence and Behavioral Risk Factors of HIV in South African Drug Users

Abstract

South Africa continues to be the global epicenter of HIV infection. Further, extensive gender disparities in HIV infection exist with females four times as likely to be infected with HIV/AIDS as males (UNAIDS, AIDS epidemic update, 2006; WHO, Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections, 2006). A cross-sectional collection of drug users recruited in the Pretoria region of South Africa (N = 385) was used to model HIV infection as a function of sexual risk behaviors and drug use as modified by gender. Receiving money from illicit sources and knowing someone with AIDS were loosely associated with HIV. Gender interactions were observed for age, cocaine use and condom use. Gender stratified analyses revealed that males who used condoms, were younger and tested negative for cocaine use were less likely to test positive for HIV. Findings suggest that males may have more control of risk behaviors and support the need for gender specific prevention strategies.

Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users

“…Injection drug use in the sample was low, with only 4 participants (1.0%) indicating that they had ever injected any drug. Past 6-month drug use is a common duration of time used in substance use research and is often defined as “recent” (e.g., Hedden et al, 2009; Walley et al, 2008). Substances used in the past 6 months are noted in Table 1.…”

“…General sexual risk behaviors included condom use at last sex and transactional sex. Transactional sex is defined as ever having traded sex for money or drugs (Floyd et al, 2010; Hedden et al, 2009, 2011). Specific sexual risk behaviors were identified with steady and casual partners that included alcohol use before or during sex and drug use before or during sex.…”

“…In addition, drug-related activity in South Africa has been associated with poverty, reduced productivity, unemployment, familial dysfunction, political instability, drug-related violence, gang activity, escalating rates of blood-borne illnesses such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), injury, and premature death (Peltzer et al, 2010; Van Wyk, 2011). Furthermore, research has indicated high rates of recent cannabis (85.7%), opiate (56.3%), and cocaine (35.6%) use among substance users in South Africa (Hedden et al, 2009). In addition, studies in sub-Saharan Africa have documented strong links between substance use and sexual risk behavior such as having multiple sex partners, having unprotected sex, and engaging in sex for money and/or gifts (Fisher et al, 2007; Kalichman et al, 2007, 2008; Morojele et al 2005, 2006; Parry et al, 2009; Roerecke et al, 2008).…”

“…Polysubstance use in South Africa has been cited to be common (Parry et al, 2008a; Floyd et al, 2010) and there is a strong link between substance use, sex trade, and HIV transmission in this region (Parry et al, 2008b; Hedden et al, 2009). Research suggests that the increase in the use of “sugars” in South Africa, low quality heroin and cocaine mixed with marijuana, (Pluddemann et al, 2008), use of cocaine prior to sex work (Hedden et al, 2011) for coping or increased energy (Needle et al, 2008), and heroin and marijuana after sex work for relaxation (Needle et al, 2008; Floyd et al, 2010) contributes to unsafe sex and HIV in South Africa.…”

“…Although several noteworthy studies have focused on substance use, risk behavior, and HIV infection in South Africa (Floyd et al, 2010; Hedden et al, 2009, 2011; Kalichman et al, 2006; Peltzer et al, 2009; Weschberg et al, 2006), research has yet to examine patterns of substance use and risk among drug users in this population. Despite the high prevalence of substance use and high potential for exposure to, and transmission of, blood-borne illnesses, to our knowledge, no studies have explored patterns of polysubstance use, sexual risk behavior, and infectious disease in this region.…”