Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa

Intimate partner violence, substance use, and health comorbidities among women: A narrative review

Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.

Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa

Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD.

Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

The phenomenon of overkill in northern Greece: A descriptive forensic psychiatric study between 2015 and 2020 on criminal offenders found not guilty by reason of insanity

The purpose of this descriptive study was to investigate overkill in a representative sample of Greek psychiatric patients found not guilty by reason of insanity (NGRIs) from a forensic psychiatric - criminological standpoint and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 24 forensic psychiatric records of overkill offenders were identified throughout the 5-year records of the national forensic psychiatric service in northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global literature on homicide perpetrators. The mean age of overkill offenders (at the time of enactment of the crime) was estimated at 36.3 years ranging from 19 to 55 years (variance = 146.72; standard deviation = 12.11). The number of male single-offence killers was ten-times larger compared to their female counterparts, while the number of male multiple-offence killers were three-times larger compared to their female counterparts. Male offenders were averagely 15 years younger (mean 33.7; variance = 81.69; standard deviation = 9) in comparison to female offenders, and single-offence killers were averagely ten years younger compared to multiple-offence killers (mean 40.2; variance = 185.19; standard deviation = 13.6). The phenomenon correlated more strongly with homicides in the context of schizophrenia spectrum disorders (80-100%) as well as domestic violence. Overall, males outnumbered females both as offenders (approximately five-times) and victims (approximately three-times), but regarding domestic violence, the sad majority of overkill victims stood for females murdered by their male relatives. Close female relatives (especially mothers and grandmothers) were most often victimized. Female-perpetrated overkill was directed against male individuals with whom offenders shared a relationship (intimate partners and minors). An important finding was the fact that three-quarters of the overall perpetrator sample were under prescribed medication at the time of offence, but with a very low compliance rate (5.6%). This last particular finding of the present study demonstrated that mental health services within community in Greece may unfortunately have been ineffective in addressing issues requiring risk assessment and timely intervention.

Association between childhood trauma, intimate partner violence, and perceived parental competence among women abusing amphetamine-type stimulant

INTRODUCTION

This cross-sectional study examines the correlation between childhood trauma, intimate partner violence (IPV), and parenting self-efficacy among women who reported using amphetamine-type stimulants (ATS) in an institutional drug rehabilitation center.

METHODS

A total of 106 participants were recruited by purposive sampling, of which 88 were mothers. Questionnaires were used to collect sociodemographic data and study variables.

RESULTS

Most of these women had experienced emotional abuse, sexual abuse, and physical neglect in their childhood. IPV assessments revealed that 70.5% (n = 74) and 30.5% (n = 32) had experienced physical and sexual violence, respectively. In terms of parenting competency, they scored 79.5% for self-efficacy and 54.4% for parenting satisfaction. Childhood emotional abuse significantly increases the odds of individuals experiencing sexual violence by 20.9%.

DISCUSSION

We found that childhood trauma and IPV did not have a significant relationship with parenting efficacy. Conversely, childhood emotional abuse and physical abuse were negatively correlated to parenting satisfaction. It is imperative that any form of childhood abuse be recognized and stopped early to reduce the harm it brings to women later in life.

Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa

INTRODUCTION

KwaZulu-Natal (KZN), South Africa (SA) has the highest prevalence of pregnant women living with HIV in the world. Pregnancy and the postpartum period offer opportunities to engage women in HIV care, to prevent perinatal transmission and to optimise maternal and infant well-being. However, research suggests that remaining engaged in HIV care during this time can be challenging.

METHODS AND ANALYSIS

We are conducting a 5-year prospective cohort study among pregnant women living with HIV in KZN to estimate the rates and factors associated with attrition from HIV care during this critical period. To determine who is most likely to fall out of care, we are examining a range of relevant variables informed by a socioecological model of HIV care, including individual, relational, community and healthcare system variables. We are enrolling 18-45-year-old women, at 28 weeks or more of pregnancy, who are living with HIV and currently taking antiretroviral therapies. Participants complete quantitative assessments at baseline (pregnancy) and at 6, 12, 18 and 24 months postpartum. A subset of women and their partners are invited to complete qualitative interviews to further explore their experiences in HIV care. The main study outcomes are suppressed HIV RNA and retention in care at each study assessment. Our understanding of the factors that drive postpartum attrition from HIV care will ultimately inform the development of interventions to facilitate continued engagement in postpartum HIV care.

ETHICS AND DISSEMINATION

This protocol has been approved by the Human Research Ethics Committee (Medical) at The University of the Witwatersrand (Johannesburg, SA) and the Partners Human Research Committee at Partners HealthCare (Boston, Massachusetts, USA). Site support and approval were obtained from the District Hospital and the KZN Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations (Ethics Registration #170 212).

Methamphetamine use and dependence in vulnerable female populations

PURPOSE OF REVIEW

The study reviews recent publications on methamphetamine use and dependence women in term of their epidemic, physical health impact, psychosocial impacts, and also in the identified vulnerable issues.

RECENT FINDINGS

Studies of vulnerable populations of women are wide ranging and include sex workers, sexual minorities, homeless, psychiatric patients, suburban women, and pregnant women, in which amphetamine type stimulants (ATSs) are the most commonly reported illicit drug used among them. The prenatal exposure of ATS demonstrated the small for gestational age and low birth weight; however, more research is needed on long-term studies of methamphetamine-exposed children. Intimate partner violence (IPV) is commonly reported by female methamphetamine users as perpetrators and victims. However, statistics and gendered power dynamics suggest that methamphetamine-related IPV indicates a higher chance of femicide. Methamphetamine-abusing women often have unresolved childhood trauma and are introduced to ATS through families or partners.

SUMMARY

Vulnerable populations of women at risk of methamphetamine abuse and dependence. Impacts on their physical and mental health, IPV, and pregnancy have been reported continuing, which guide that empowering and holistic substance abuse are necessary for specific group.

Violent offences of methamphetamine users and dilemmas of forensic psychiatric assessment

Methamphetamine (MA), an extremely addictive synthetic stimulant, has quickly spread to become the most frequently used illicit drug in China. People with a history of chronic and heavy MA use have a high possibility of exhibiting schizophrenia-like psychotic symptoms, mainly delusions of reference, auditory hallucinations and cognitive deficits. These emerging findings suggest MA use increases aggression and violence and that there is a correlation between MA use and violence. However, it is unclear how to assess the capacity of criminal responsibility in "MA-induced" psychosis and how to set clear boundaries between schizophrenia and MA-induced psychosis when only limited and inconsistent evidence is available. Furthermore, a final persuasive differential diagnostic method based on improved understanding of schizophrenia and MA-induced psychotic disorders has yet to be developed. This paper will evaluate the epidemiology, social harm, and forensic psychiatric assessment of MA users, propose a future direction for the differential diagnosis between MA-induced psychotic disorders and schizophrenia, and put forward some practical solutions to assess the capacity of criminal responsibility of defendants with drug-induced psychotic disorder.

The role of substance use coping in the relation between childhood sexual abuse and depression among methamphetamine users in South Africa

OBJECTIVE

Childhood sexual abuse (CSA) is a critical global health issue associated with poor psychosocial outcomes. Individuals with CSA histories are at risk for drug use, which is a growing problem in the Western Cape of South Africa. The present study of methamphetamine users in this region examined whether substance use coping, a contextually relevant type of avoidance-based coping, mediates the relation between CSA and depressive symptoms.

METHOD

Participants included 161 men and 108 women seeking treatment for methamphetamine use. Participants completed a computer-assisted survey and a face-to-face interview with clinic staff to evaluate history of CSA, current substance use severity and coping, and current depressive symptoms.

RESULTS

Nearly a third of participants reported a history of CSA, and the average methamphetamine use severity score exceeded the threshold of high risk. A history of CSA was significantly associated with higher substance use coping and more depression symptoms. Substance use coping was a significant mediator of the association between CSA and depression symptoms.

CONCLUSIONS

In this study of high-risk methamphetamine users, substance use coping emerged as a common means of managing stress, especially for those with a history of CSA, which was further linked to depressive symptoms. These findings underscore the potential benefit of integrating coping interventions and mental health treatment into substance abuse treatment programs, particularly for those with a history of childhood abuse and violence. (PsycINFO Database Record

HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.