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

描述（由申请人提供）：工作范围问题：南非，特别是西开普省，在过去十年中甲基苯丙胺的使用急剧上升，也是世界上艾滋病毒感染者人数最多的国家（530万）。人们担心，甲基苯丙胺的使用可能会进一步助长艾滋病毒的流行，因为它与危险的性行为有关。尽管对甲基苯丙胺的普遍关注，但对南非甲基苯丙胺和艾滋病毒流行病的交叉研究有限。目的：本探索性研究的主要目的是描述开普敦甲基苯丙胺使用者中药物使用的模式和严重程度，并确定对该人群中艾滋病毒性风险行为的多层次影响（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个人，社会，环境和社区层面因素的影响，作为本研究的组织框架。第二个目的是测试使用应答者驱动抽样（RDS）招募甲基苯丙胺使用者用于未来艾滋病毒预防研究（目标3）的可行性。方法：经过一个阶段的形成性研究，以告知招募策略和试点测试的评估电池，我们将使用一个链转介的方法，从开普敦的一个乡镇招募160名男性和女性甲基苯丙胺用户的方便样本的多方法研究。所有参与者将完成一项定量调查，评估甲基苯丙胺使用模式和药物滥用治疗史;性风险行为和使用艾滋病毒相关服务的比率;以及多个影响水平下的性风险行为的相关性。将选择30名参与者的子样本进行深入的定性访谈，以探索甲基苯丙胺的使用模式，从偶然使用到成瘾的进展，以及药物使用的社会背景;甲基苯丙胺的使用如何导致性风险行为;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因素。最后，我们将测试的可行性，使用RDS招募甲基苯丙胺用户在开普敦到未来的艾滋病预防研究进行形成性研究，以确定这种招募方法的适用性和可接受性，并校准该人群的方法，并通过分析链转诊数据，以确定是否RDS的要求得到满足。重要性：这一及时的提案是南非首批针对甲基苯丙胺使用者的提案之一，将通过研究甲基苯丙胺使用如何在非注射和主要是异性恋吸毒者的样本中导致艾滋病毒性风险行为，推进艾滋病毒预防领域。拟议研究的目标是确定关键因素，为制定综合预防干预措施提供信息，以减少人群中的甲基苯丙胺使用和性风险行为。 公共卫生相关性：甲基苯丙胺是世界上第二大滥用药物（仅次于大麻），它与较高的性风险行为和艾滋病毒感染率有关 感染近年来，南非的甲基苯丙胺使用量急剧增加，感染艾滋病毒的人数是世界上最多的。这项多方法研究将描述南非甲基苯丙胺使用者滥用药物的模式和严重程度，并将确定对这一人群中艾滋病毒性风险行为的多层次影响，为制定综合预防干预措施提供信息，以改善获得艾滋病毒相关服务的机会，减少艾滋病毒的持续传播。

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. PUBLIC HEALTH RELEVANCE: Methamphetamine is the second most widely abused drug in the world (after marijuana), and it is associated with higher rates of sexual risk behavior and HIV infection. South Africa has experienced a dramatic increase in methamphetamine use in recent years and has the largest number of HIV-infected individuals of any country in the world. This multi-method study will characterize the patterns and severity of drug abuse among methamphetamine users in South Africa and will identify multiple levels of influence on HIV sexual risk behavior in this population to inform the development of integrative prevention interventions to improve access to HIV-related services and reduce the continued spread of the HIV virus.