Social Determinants of Alcohol and Other Drug Misuse Among Women Living with HIV in Economically Underserved Communities in Cape Town, South Africa: A Cross-Sectional Study

Exploring Associations Between Social Factors and Current Substance Use Among Older African Americans with HIV

Background: Substance use is highly prevalent among older people with HIV and continues to have a negative impact on engagement along the HIV care continuum, particularly among African Americans (AA). Social factors like resource insecurity, stigma, and discrimination may play a role in substance use behaviors. However, there is limited research on how these social factors impact substance use among older people with HIV.

Objectives: The purpose of this descriptive study was to examine associations between demographic and social factors and substance use among older AAs with HIV.

Results: Fifty-two participants who were ≥50 years of age, living in Ohio, and identified as Black or AA completed an online survey. Past three-month substance use was self-reported for alcohol, opioids, cocaine, cannabis, and/or amphetamine type stimulants. Separate unadjusted, logistic regression models were conducted to examine factors between each type of substance and HIV-related stigma, food and housing insecurity, discrimination, history of incarceration, employment status, and demographics. The majority of participants self-reported past three-month use of cocaine (53.8%), cannabis (67.3%), amphetamine type stimulants (51.9%), and risky alcohol use (85.0%), and half reported opioid use. HIV-related stigma, discrimination, and housing insecurity were all associated with increased odds of opioid, cocaine, and amphetamine use. Discrimination, food, and housing insecurity were associated with increased odds of cannabis use and risky alcohol use.

Conclusions: More research is needed to further understand how social factors impact substance use among older people with HIV. This understanding can lead to interventions that target these social factors which in turn reduces substance use.

Analyzing the geographic influence of financial inclusion on illicit drug use in Nigeria

Nigeria grapples with a formidable public health concern, as approximately 14 million individuals partake in illicit drug use (IDU). This predicament significantly impacts psychiatric disorders, suicides, disability, and mortality rates. Despite previous investigations into predictors and remedies, the role of financial inclusion (FI) remains inadequately explored. Leveraging existing literature on FI and population health, this study asserts that bolstering FI could be instrumental in mitigating IDU prevalence in Nigeria. We employ spatial analysis to scrutinize the influence of FI and other social factors on IDU, revealing a 14.4 % national prevalence with spatial variations ranging from 7 % in Jigawa state to 33 % in Lagos state. Significant IDU hotspots were identified in the southwest states, while cold spots were observed in the Federal Capital Territory and Nassarawa. Multivariate spatial analysis indicates that FI, income, unemployment, and the proportion of the young population are pivotal predictors of IDU nationwide, explaining approximately 67 % of the spatial variance. Given these findings, the study advocates heightened levels of FI and underscores the need for intensified government initiatives to prevent and address illicit drug use.

Centring the health of women across the HIV research continuum

Despite tremendous advances in HIV research, women and gender diverse people-particularly women from racial and ethnic groups under-represented in research, transgender women, and young women-remain disproportionately affected by HIV. Women and gender diverse people face unique challenges and have been under-represented in HIV research. The National Institutes of Health (NIH) is tasked to apply fundamental knowledge about the nature and behaviour of living systems to enhance health, lengthen life, and reduce disability. Rigorous exploration of-and interventions for-the individual, social, biological, structural, and environmental factors that influence HIV prevention, transmission, treatment, and cure is crucial to advance research for women, girls, and gender diverse people across the lifespan. In this Position Paper, we introduce a framework for an intersectional, equity-informed, data-driven approach to research on HIV and women and highlight selected issues for women and gender diverse people, including HIV prevention, HIV cure, ageing with HIV, substance use and misuse, violence, pregnancy, and breastfeeding or chestfeeding. This framework underlines a new HIV and Women Signature Programme from the NIH Office of AIDS Research and Office of Research on Women's Health that advances the NIH vision for women's health, in which all women receive evidence-based HIV prevention, treatment, and care across their lifespan tailored to their unique needs, circumstances, and goals. The time is now to centre the health of women, girls, and gender diverse people across the HIV research continuum.

Binge drinking and condom negotiation behaviours among adolescent girls and young women living in Cape Town, South Africa: sexual control and perceived personal power

BACKGROUND

Condom use among young people in South Africa has declined in recent years and adolescent girls and young women continue to bear the highest incidence of HIV in the country. Young women who have dropped out of school may be more at risk because of traditional gender norms that create substantial power imbalances and a lack of power to negotiate condom use with their male partners, especially when using alcohol and other drugs.

METHODS

This study presents an analysis of baseline data provided by 500 adolescent girls and young women (AGYW) from Cape Town communities between November 2016 and November 2018 who were reached for a cluster-randomised trial conducted to assess the efficacy of an evidence-based, young woman-focused intervention seeking to reduce HIV risk and substance use behaviours. The analysis focuses on associations between binge drinking, condom use, and sexual negotiation, including impaired sex (any substance use at last sex).

RESULTS

AGYW who reported frequent condom negotiation with their partners were 8.92 times (95% CI: [4.36, 18.24]) as likely to use a condom when alcohol or other drugs were not used at last sex and 5.50 times (95% CI: [2.06, 14.72]) as likely when alcohol or other drugs were used at last sex (p < 0.05). AGYW who reported frequent binge drinking in the past month (n = 177) had significantly reduced odds of condom use at last sex, irrespective of whether the sex was impaired (OR 0.60, 95% CI: [0.49, 0.73]) or not impaired (OR 0.69, 95% CI: [0.60, 0.81]).

DISCUSSION

The findings highlight the need for interventions that reach AGYW in South Africa by specifically aiming to educate AGYW about the effect of binge drinking on negotiating power in their relationships, thus providing them with the knowledge and skills to increase agency regarding condom use.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02974998 (recruitment completed). 29/11/2016.