Substance use disorders among men in urban and rural communities in South Africa: Culture, treatment seeking and service provision

在南非，社会经济地位较低的男性更容易受到物质使用障碍(SUDS)的影响，通常他们对治疗服务的使用率很低。造成这种情况的原因人们知之甚少，但可能是文化因素造成的。这项研究将描述目前存在的SUD治疗，评估在南非的两个城市(Khayelitsa，Soshanguve)和两个农村地区(Madibeng的Dalindyebo国王)阻碍男性使用治疗服务的障碍。具体目标是确定：(1)如何提供sud治疗服务；(2)人口、文化、经济、心理社会因素和城乡移民如何影响男性寻求治疗服务；以及(3)sud的负担和严重程度、相关的常见精神健康障碍和相关因素。我们将对向男性提供服务的3个研究地点的所有治疗服务进行详细审查(已完成审计)。将在每个服务部门约谈一名受访者(经理)，以收集所需信息。将通过32个深入访谈(每个站点8个)和8个讨论小组(每个站点2个)，以及在24个深度访谈(每个站点6个)中，在SUDS治疗服务提供者中探讨文化对SUD患者寻求治疗服务的影响。为了确定肥胖症的负担和严重程度以及相关的健康问题和风险因素，将于第二年在西开普省、东开普省和西北部省进行一次家庭调查，调查对象为8岁及以上的成年男子(每个N=547人)。我们还将在第三年使用一种特殊的抽样方法(受访者驱动抽样)在Soshanguve进行一次社区调查，以估计吸食黑药的流行率。招聘将涉及若干步骤，直到达到建议的350名用户的样本规模。研究结果将提交给社区利益攸关方和主要决策者，以提出改善治疗机会的干预措施。

Men of lower socio-economic status in South Africa are more affected by substance use disorders (SUDs), and generally their use of treatment services is very low. Reasons for this are poorly understood but may be due to cultural factors. This study will describe what SUD treatment exists, evaluating barriers which prevent men using treatment services in 2 urban (Khayelitsha, Soshanguve) and 2 rural sites (King Dalindyebo, Madibeng) in South Africa. Specific objectives are to determine the: (1) how SUD treatment services are provided; (2) how demographic, cultural, economic, psychosocial factors and rural-urban migration influence men to seek treatment services; and (3) the burden and severity of SUDs, related common mental health disorders and associated factors.We will conduct a detailed review of all treatment services in 3 study sites (in Khayelitsha an audit is already completed) providing services to men. One respondent (manager) will be interviewed in each service to collect information required. The influence of culture on how men with SUD seek treatment services will be explored in 32 in-depth interviews (8 per site) and 8 discussion groups (2 per site), and among SUDs treatment service providers in 24 in-depth interviews (6 per site). To determine the burden and severity of SUDs and associated health problems and risk factors, a household survey will be done in Year 2 in the Western Cape, Eastern Cape and North West provinces using random sampling of groups of households, targeting adult men 8 years and above (each N=547). We will also conduct a community survey in Soshanguve using a special sampling method (Respondent Driven Sampling) in Year 3 to estimate prevalence of nyaope use. Recruitment will involve a number of steps until the recommended sample size of 350 users is reached. Study findings will be presented to community stakeholders and key decision makers to propose interventions to improve treatment access.