HIV risk behaviors among methamphetamine users in Cape Town, South Africa

说明(申请人提供)：工作范围问题：南非，特别是西开普省，在过去十年中经历了甲基苯丙胺使用量的急剧上升，也是世界上感染艾滋病毒人数最多的国家(530万)。人们担心，甲基苯丙胺的使用可能会进一步加剧这种艾滋病毒流行，因为它与危险的性行为有关。尽管人们普遍担心甲基苯丙胺，但对甲基苯丙胺和艾滋病毒在南非流行的交集进行的研究有限。目的：这项探索性研究的主要目的是描述开普敦甲基苯丙胺吸毒者的吸毒模式和严重程度，并确定对这一人群中艾滋病毒性行为的多重影响(目标1和2)。我们将应用生态系统理论，该理论认为行为受到来自个人、社会、环境和社区层面的因素的相互影响，作为本研究的组织框架。第二个目的是测试使用响应者驱动抽样(RDS)招募甲基苯丙胺使用者进行未来艾滋病毒预防研究的可行性(目标3)。方法：经过一个阶段的形成性研究，为招募策略提供信息，并对评估小组进行试点测试，我们将使用连锁转诊方法，从开普敦的一个乡镇招募160名男性和女性冰毒使用者进行多方法研究。所有参与者都将完成一项量化调查，评估甲基苯丙胺的使用模式和药物滥用治疗史；性危险行为和艾滋病毒相关服务的使用率；以及在多个影响水平上的性危险行为的相关性。将选择30名参与者进行深入的定性访谈，以探索甲基苯丙胺的使用模式、从临时使用到成瘾的进展情况，以及吸毒的社会背景；甲基苯丙胺的使用如何有助于性危险行为；以及戒毒和治疗、安全性行为和艾滋病毒检测的障碍和促进者。最后，我们将测试使用RDS将开普敦的甲基苯丙胺使用者招募到未来的艾滋病毒预防研究中的可行性，方法是进行形成性研究，以确定这种招募方法的适用性和可接受性，并对该人群的方法进行校准，并通过分析链转介数据来确定是否满足RDS的要求。意义：这项及时的提案是第一批针对南非甲基苯丙胺吸毒者的提案之一，它将通过研究甲基苯丙胺的使用如何可能导致非注射和主要是异性恋吸毒者的艾滋病毒性行为风险行为，推动艾滋病毒预防领域的发展。拟议研究的目标是确定关键因素，以便制定综合预防干预措施，以减少人群中甲基苯丙胺的使用和性危险行为。

DESCRIPTION (provided by applicant): Scope of Work Problem: South Africa, particularly the Western Cape, has experienced a dramatic rise in methamphetamine use over the past decade and also has the largest number of HIV-infected individuals (5.3 million) of any country in the world. It is feared that methamphetamine use may further fuel this HIV epidemic because of its association with risky sexual behaviors. Despite widespread concern about methamphetamine, there has been limited research examining the intersection of the methamphetamine and HIV epidemics in South Africa. Aims: The primary purpose of this exploratory study is to characterize the patterns and severity of drug use among methamphetamine users in Cape Town, and to identify the multiple levels of influence on HIV sexual risk behavior in this population (Aims 1 and 2). We will apply Ecological Systems Theory, which views behavior as reciprocally influenced by factors from the individual, social, environmental, and community levels, as an organizing framework for this research. A secondary purpose is to test the feasibility of using respondent driven sampling (RDS) to recruit methamphetamine users for future HIV prevention studies (Aim 3). Method: Following a phase of formative research to inform the recruitment strategy and pilot test the assessment battery, we will use a chain referral approach to enroll a convenience sample of 160 male and female methamphetamine users from a township in Cape Town for a multi-method study. All participants will complete a quantitative survey that assesses patterns of methamphetamine use and history of substance abuse treatment; rates of sexual risk behavior and use of HIV-related services; and correlates of sexual risk behavior at multiple levels of influence. A sub-sample of 30 participants will be selected for in-depth qualitative interviews to explore patterns of methamphetamine use, progression from casual use to addiction, and the social context of drug use; how methamphetamine use contributes to sexual risk behavior; and barriers and facilitators to drug cessation and treatment, safer sex practices, and HIV testing. Finally, we will test the feasibility of using RDS to enroll methamphetamine users in Cape Town into future HIV prevention research by conducting formative research to determine the suitability and acceptability of this recruitment method and to calibrate the method for this population, and by analyzing the chain referral data to determine whether RDS requirements are met. Significance: This timely proposal, among the first to target methamphetamine users in South Africa, will advance the field of HIV prevention by examining how methamphetamine use may contribute to HIV sexual risk behavior in a sample of non-injecting and primarily heterosexual drug users. The goal of the proposed research is to identify key factors that will inform the development of integrative prevention interventions to reduce methamphetamine use and sexual risk behaviors in the population.