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

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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.