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子受药物使用障碍的影响更大，一般来说，他们对治疗服务的利用率很低。其原因尚不清楚，但可能是由于文化因素。本研究将描述存在的SUD治疗，评估南非2个城市（Khayelitsha，索尚古韦）和2个农村地区（King Dalindyebo，Madibeng）阻止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徙如何影响男子寻求治疗服务;和（3）SUD的负担和严重程度，我们将对3个研究中心的所有治疗服务进行详细审查，（在Khayelitsha，审计已经完成）向男子提供服务。每项服务将约谈一名答复者（管理人员），以收集所需信息。文化对男性SUD寻求治疗服务的影响将在32次深入访谈（每个站点8次）和8个讨论组（每个站点2次）中进行探讨，并在SUD治疗服务提供者中进行24次深入访谈（每个站点6次）。为了确定SUD的负担和严重程度以及相关的健康问题和风险因素，将在第2年在西开普省、东开普省和西北省进行家庭调查，采用随机抽样的家庭组，目标是8岁及以上的成年男子（每个N=547）。我们还将在第3年使用特殊抽样方法（受访者驱动抽样）在索尚古韦进行社区调查，以估计nyaope使用的流行率。在达到350名用户的建议抽样规模之前，招募工作将涉及若干步骤。研究结果将提交给社区利益攸关方和关键决策者，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.