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Khoza TV, Mokgatle MM. Maladaptive behaviours of maternal orphans in high schools of Tshwane North of Gauteng, South Africa. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37916719 PMCID: PMC10623582 DOI: 10.4102/phcfm.v15i1.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Some orphaned adolescents find it difficult to cope and adjust to the loss of a mother. Studies to explore specific adjustment challenges experienced by this vulnerable group, are necessitated by the growing need to inform support services for orphans. AIM This study sought to explore maladaptive behaviours among adolescent maternal orphans. SETTING Participants were recruited from the Tshwane North secondary schools of Gauteng province in South Africa. METHODS A qualitative exploratory design was employed; maternal adolescent orphans were purposively selected and included in a one-on-one qualitative enquiry. Twenty-five participants were included in the study. Data were analysed thematically using NVivo12. RESULTS Emerged themes were: negative thoughts such as suicidal ideation, negative perception of self; silence coded as 'keep life matters private and hide personal feelings'; having psychosocial problems reported as anger, fighting, shouting, crying, short temper; engaging in risky behaviours in the form of smoking and alcohol use and unsafe termination of pregnancy; social withdrawal by self-isolation and being afraid of people. CONCLUSION Whole school peer interaction groups could address the functional problems of social ability and silence. Skills development programmes, and other activities that enhance constructive use of free time, instil hope and build self-esteem are recommended.Contribution: The findings of this study serve as a basis to inform interventions that are geared towards supporting adolescent orphans through the school health teams, as one of the domains of the re-engineering of South Africa's primary health care system.
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Affiliation(s)
- Thembi V Khoza
- Sub-department of Health Systems Management and Policy, Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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West NS, Kussaga F, Rittenhouse A, Duroseau B, Knight D, Mbwambo J, Likindikoki S, Saleem HT. From trauma to transmission: exploring the intersection of adversity, substance use, and HIV risk in women's life histories. Int J Equity Health 2023; 22:174. [PMID: 37658358 PMCID: PMC10474777 DOI: 10.1186/s12939-023-01994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND At increased risk for poor health outcomes, physical and/or sexual violence, and onward transmission of HIV, women who use drugs and are living with HIV (WWUDHIV) are vulnerable and in need of services. Understanding the role of trauma across their life history may offer insights into HIV and drug use prevention and opportunities for intervention. We explored trauma and drug use among WWUDHIV in Dar es Salaam, Tanzania. METHODS We conducted in-depth interviews with 30 WWUDHIV from January-March 2019. Interviewers used semi-structured interview guides and asked questions about the life history as related to drug use. Interviews were audio recorded, transcribed, translated, coded, and life histories charted. We utilized content analysis. RESULTS Participants described death of family members as traumatic catalysts for drug use. Sexual partners early in their life history were often the point of introduction to drugs and source of HIV acquisition. Death of partners was present across many life histories and was a traumatic event negatively influencing life trajectories, including start of sex work for survival or to support drug use. Sex work in-turn often led to traumatic events including sexual and/or physical violence. HIV diagnosis for many participants followed the start of drug use, frequently occurred during pregnancy or severe illness and was described by most participants as a trauma. Despite this, particularly during pregnancy, HIV diagnosis was a turning point for some participant's desire to engage in drug use treatment. Traumatic events were often cumulative and regularly described as catalysts for poor mental health that could lead to new or increased drug use for coping. CONCLUSIONS These findings suggest trauma is common in the life history of WWUDHIV and has negative impacts on drug use and HIV vulnerability. Our life history charting highlights the cumulative and cyclical nature of trauma and drug use in this population. This study allows for better understanding of trauma, drug use, and HIV prevention, which offers opportunities for intervention among a group with limited access to services: during adolescence for orphaned youth, following the death of a child or partner, and when vulnerable women engage with the health system (HIV diagnosis, pregnancy, illness).
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Affiliation(s)
- Nora S West
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Frank Kussaga
- Internal/Preventive Medicine, Griffin Hospital, Derby, CT, USA
| | - Alex Rittenhouse
- Department of Environmental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Deja Knight
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Haneefa T Saleem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Nabunya P. Social Support Networks for Adolescents Orphaned by HIV: Definitions, Barriers, Challenges and Lessons from Uganda. VULNERABLE CHILDREN AND YOUTH STUDIES 2022; 18:87-99. [PMID: 36684804 PMCID: PMC9851387 DOI: 10.1080/17450128.2022.2163330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Social support is a key element to the health wellbeing of individuals, especially those experiencing major life transitions and crises. Prior evidence has demonstrated that orphaned adolescents are socially isolated with limited supportive networks. This study focused on how orphaned adolescents define social support, the nature of relationships with non-kin ties, barriers and challenges to seeking support. In-depth interviews from 38 orphaned adolescents (14-19 years) were analyzed using thematic analysis. Findings demonstrated that 1) orphaned adolescents define support in terms of "giving and receiving material and non-material assistance", and "helping individuals overcome problems", 2) relationships are initiated by family members, 3) economic hardships, stigma, and lack of trust deter adolescents from seeking support outside of the family unit. Study findings point to the need to integrate social support strengthening components within programming for orphaned adolescents living in HIV impacted communities.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, 63130, St Louis, MO, USA
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Mork̄unas M. Revealing Differences in Brand Loyalty and Brand Engagement of Single or no Parented Young Adults. IIM KOZHIKODE SOCIETY & MANAGEMENT REVIEW 2022. [DOI: 10.1177/22779752221108797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study reveals differences in brand engagement, brand loyalty and brand evangelism among single or no parented young adults. It was found that persons who were raised without one or both parents for at least three years show higher emotional connectivity to brands compared to their counterparts from a control group. A widely recognized structural equation modelling technique—partial least squares method—has been applied in order to test the research hypotheses. Two Baltic States, namely, Lithuania and Latvia, served as an empirical basis of the study. The results of the research are relevant not only to business related disciplines, such as marketing and management, but also to other social sciences fields presuming the existence of more psychology-related differences among single or no parented persons.
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Affiliation(s)
- Mangirdas Mork̄unas
- Faculty of Economics and Business administration, Vilnius University, Vilnius, Lithuania
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Perry EW, Culbreth R, Self-Brown S, Gilmore AK, Kasirye R, Musuya T, Ndetei D, Swahn MH. Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022; 53:83-110. [PMID: 38577222 PMCID: PMC10989775 DOI: 10.1080/00207411.2022.2073755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12 to 18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-reported mental health concerns, and c) explore the association between polyvictimization and mental health concerns. Data are from a 2014 cross-sectional survey of service-seeking youth ages 12 to 18 years (N = 1134) in Kampala, Uganda. Violence exposure types explored in this study were: witnessing family physical violence, direct physical abuse by a parent, any rape history, and physical dating violence. We used descriptive statistics and multivariable logistic regression to test study objectives. Over half of the sample (60.5%) reported experiencing at least one type of violence exposure; many youth endorsed self-reported depression (57.8%), anxiety (76.8%), and substance use to cope (37.0%). Exposure to violence was associated with higher odds for self-reported depression, anxiety, and using substances to cope. These findings underscore the urgent need to implement evidence-based interventions among this young, underserved population and their families to prevent violence, improve mental health outcomes, and promote resilience.
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Affiliation(s)
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA USA
| | | | - Amanda K Gilmore
- School of Public Health, National Center for Sexual Violence Prevention, Georgia State University, Atlanta, GA USA
| | | | - Tina Musuya
- Center for Domestic Violence Prevention, Kampala, Uganda
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Africa Mental Health Foundation, Nairobi, Kenya
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA USA, School of Public Health, Georgia State University, Atlanta, GA USA
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Chandran T, Unnikrishnan V, Dhamali D, Balakrishna MS, Kavya MJ, Saheer A. Perception of oral health and practices among children residing in orphanages in Bengaluru. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S420-S423. [PMID: 36110653 PMCID: PMC9469308 DOI: 10.4103/jpbs.jpbs_751_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022] Open
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Swahn MH, Culbreth R, Masyn KE, Salazar LF, Wagman J, Kasirye R. The Intersection of Alcohol Use, Gender Based Violence and HIV: Empirical Findings among Disadvantaged Service-Seeking Youth in Kampala, Uganda. AIDS Behav 2021; 25:3106-3114. [PMID: 33988783 PMCID: PMC8120497 DOI: 10.1007/s10461-021-03301-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the “Kampala Youth Survey 2014,” a cross-sectional survey conducted in the spring of 2014, consisting of a convenience sample (N = 1134) of urban youth (12–18 years of age). Descriptive statistics were computed for hypothesized risk factors and demographic variables among the 8 typologies of GBV, HIV, and alcohol use. Multinomial logistic regression was conducted to determine statistically significant correlates with each typology. The overall prevalence of GBV was 31.7%, whereas the overall prevalence of alcohol use in the past 12 months was 31.2%. HIV-Positive youth comprised 10.5% of the total sample. Females comprised the majority of the typology with no SAVA components compared to males (55% vs. 45%, respectively), as well as the SAVA syndemic typology (GBV + HIV + ALC +) (58% vs. 42%, respectively). Engaging in commercial sex work (36%), witnessing parental abuse (61%), and depression/suicidality (81%) were all highly prevalent among youth in the SAVA syndemic typology (GBV, HIV, and alcohol use). Sex work and observing parental abuse were associated with the SAVA syndemic typology in the multivariable model. In our study, alcohol rarely coexisted without GBV among the typologies. Therefore, prevention efforts including structural interventions may be particularly warranted in vulnerable populations to address alcohol use, which may directly or indirectly impact GBV and HIV.
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Affiliation(s)
- Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, 520 Parliament Garden Way, Kennesaw, GA 30144 USA
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA 30302-4019 USA
| | - Katherine E. Masyn
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995 USA
| | - Laura F. Salazar
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995 USA
| | - Jennifer Wagman
- Fielding School of Public Health, University of California, P.O. Box 951772, Los Angeles, CA 90095-1772 USA
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda, USA
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8
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Sibanda A, Batisai K. The intersections of identity, belonging and drug use disorder: struggles of male youth in post-apartheid South Africa. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2021.1899945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Arina Sibanda
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
| | - Kezia Batisai
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
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Henry MB, Bakeera-Kitaka S, Lubega K, Snyder SA, LaRussa P, Pfeffer B. Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda. Afr Health Sci 2019; 19:1888-1896. [PMID: 31656472 PMCID: PMC6794506 DOI: 10.4314/ahs.v19i2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Adolescents experience high rates of depression, initiation of sexual activity, and substance use. OBJECTIVES To better understand the demographics of adolescents presenting to an adolescent clinic in Uganda, and to elucidate which factors are associated with depressive symptoms, sexual initiation, and substance use. METHODS A retrospective review was performed on intake forms obtained during interviews with adolescents presenting to the Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH) in Kampala, Uganda. RESULTS Depressive symptoms in adolescents were correlated with having a chronic illness (p=.026), and reported poor quality of home life (p<.001). Initiation of sexual activity was also correlated with chronic illness (p=.008) and poor quality of home life (p=.006). Substance use was correlated with maternal death (p=.041), chronic illness (p=.038), and substance use among family members (p<.001) and friends (p<.001). CONCLUSIONS Knowing the aforementioned risk factors can help us better understand the needs of adolescents presenting to MMCAH, and allows us to develop targeted interventions aimed at decreasing health risks in Kampala's adolescent population.
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Affiliation(s)
- Michael B Henry
- Columbia University, Department of Pediatrics, College of Physicians and Surgeons, New York, USA
| | - Sabrina Bakeera-Kitaka
- Makerere University College of Health Sciences, Department of Paediatrics and Child health, Kampala, Uganda
- Mulago Hospital, Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH), Kampala, Uganda
| | - Kizza Lubega
- Mulago Hospital, Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH), Kampala, Uganda
| | - Sara A Snyder
- Columbia University, Mailman School of Public Health, New York, USA
- Long Island University, Department of Clinical Psychology, New York, USA
| | - Philip LaRussa
- Columbia University, Department of Pediatrics, College of Physicians and Surgeons, New York, USA
| | - Betsy Pfeffer
- Columbia University, Department of Pediatrics, College of Physicians and Surgeons, New York, USA
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10
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Nabunya P, Padgett D, Ssewamala FM, Courtney ME, Neilands T. Examining the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in Uganda. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:579-593. [PMID: 30394541 PMCID: PMC6397685 DOI: 10.1002/jcop.22139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Abstract
In this study, we examined the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in HIV-impacted communities in Uganda. We analyzed data from a cluster randomized experimental study for orphaned adolescents aged 11-17 years. Participants were randomly assigned to either the control condition, which received bolstered standard of care (BSOC) services, or the treatment condition, which received BSOC services plus an economic-strengthening intervention. We conducted binary logistic regression analyses to examine the effect of the intervention on participants' nonkin support networks. Results indicated that the existing social support networks for orphaned adolescents are small, limited, and usually comprised individuals with similar socioeconomic situations and challenges. Because orphaned adolescents are socially isolated and the threshold for nonkin supportive services is very low, the BSOC services provided to the control condition appeared to be instrumental in their survival and well-being. Availability of personal savings was associated with higher odds of identifying at least one supportive nonkin tie. The extended family system is still the primary and major source of social support to orphaned children in HIV-affected communities. In the absence of public safety nets, building social assets, over and above offering economic opportunities to extended families supporting orphaned children, is critical.
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Affiliation(s)
- Proscovia Nabunya
- Brown School of Social Work, Washington University in St. Louis, Campus Box, 1196, One Brookings Drive, St. Louis, MO, 63130,
| | - Deborah Padgett
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003,
| | - Fred M. Ssewamala
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130,
| | - Mark E. Courtney
- The University of Chicago School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637,
| | - Torsten Neilands
- University of California San Francisco School of Medicine, 550 16th Street, San Francisco, CA 94158,
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Taukoor B, Paruk S, Karim E, Burns JK. Substance use in adolescents with mental illness in Durban, South Africa. J Child Adolesc Ment Health 2018. [PMID: 28639495 DOI: 10.2989/17280583.2017.1318395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Comorbid substance use in adolescents with mental illness is often an indicator of poor treatment outcome. This study aims to determine the prevalence of, and associated risk factors for, substance use in adolescents with mental illness attending a mental health service. Data was collected from hospital records of 162 adolescents, using a structured data sheet, over a two-year period. Substance use was more significant in older adolescents and those with severe mental illness. Sixty-two (38.3%) adolescents used substances. Thirty-seven (38.1%) male adolescents reported substance use compared to 25 (38.5%) female adolescents. Alcohol was the most commonly used substance (n = 48; 29.6%), followed by cannabis (n = 32; 19.8%). There were significant direct associations between substance use and history of abuse or neglect, forensic history, educational setting, admission status, and the psychiatric diagnoses of schizophrenia, other psychotic disorders, and bipolar mood disorder. Inverse associations were found between substance use and adjustment disorders, attention deficit hyperactivity disorder, and intellectual disability. The results of this study indicate an urgent need for substance misuse programmes for at risk youth, and the introduction of dual diagnosis intervention programmes in this age group.
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Affiliation(s)
- Bhoodeo Taukoor
- a Department of Psychiatry, Nelson R. Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Saeeda Paruk
- a Department of Psychiatry, Nelson R. Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Enver Karim
- a Department of Psychiatry, Nelson R. Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Jonathan K Burns
- a Department of Psychiatry, Nelson R. Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
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Elamouri FM, Musumari PM, Techasrivichien T, Farjallah A, Elfandi S, Alsharif OF, Benothman H, Suguimoto SP, Ono-Kihara M, Kihara M. "Now drugs in Libya are much cheaper than food": A qualitative study on substance use among young Libyans in post-revolution Tripoli, Libya. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 53:23-31. [PMID: 29272852 DOI: 10.1016/j.drugpo.2017.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 11/04/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Libya is facing a rapidly growing epidemic of illicit drug use and HIV. This situation is fueled by a complex array of factors, mainly the consequences of the political and military turmoil of the Arab Spring. Although it is extensively documented in other settings that young people are one of the most vulnerable groups to both HIV and illicit drug use, no study has explored this issue among young people in Libya. The current study addresses this research gap. METHODS This study is a qualitative study using in-depth interviews guided by a semi-structured questionnaire. We used a maximum variation, purposive sampling strategy to recruit male and female participants, aged 14-18 years, from schools, prisons, and community-based informal re-education and rehabilitation centers in Tripoli, Libya. RESULTS In total, 31 participants were recruited: 6 females and 25 males. Sixteen participants were prisoners and residents of community-based informal re-education and rehabilitation centers, and 15 were recruited in schools. Risk factors for drug use included peer influence, the increased availability and affordability of drugs, disruption of social life and healthy recreational activities, and the distress and casualties of the war. Protective factors were religious beliefs and practices, good parent-child connectedness, and high self-esteem and future aspiration. Risk factors for HIV were insufficient knowledge related to HIV transmission and unsafe injection practices, such as sharing needles and syringes. CONCLUSION We found individual, interpersonal, family, and structural-level factors that interplayed to shape the vulnerability of young people to drug use and HIV infection in Tripoli, Libya. Structural factors, including the increased availability and affordability of drugs, provided the frame within which other factors, such as peer influence, insufficient knowledge of substance use, and HIV, operated to increase the vulnerability of young people to drugs and HIV, while religious beliefs and parent-child connectedness acted as protective factors. Multisectoral efforts and studies to quantitatively evaluate the magnitude and distribution of these problems are urgently needed.
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Affiliation(s)
- Fauzi Muftah Elamouri
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Patou Masika Musumari
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Teeranee Techasrivichien
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | | | | | | | - Hussein Benothman
- National Center of Disease Control, National AIDS Program, Ain Zara District, Tripoli 71171, Libya.
| | - S Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Masako Ono-Kihara
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Masahiro Kihara
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Pufall EL, Eaton JW, Robertson L, Mushati P, Nyamukapa C, Gregson S. Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 12:360-374. [PMID: 29170681 PMCID: PMC5679749 DOI: 10.1080/17450128.2017.1332398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/14/2017] [Indexed: 06/07/2023]
Abstract
There is a growing interest in education as a means to reduce HIV infection in vulnerable children in sub-Saharan Africa; however, the mechanisms by which education reduces HIV infection remain uncertain. Substance use has been associated with high-risk sexual behaviour and could lie on the causal pathway between education and HIV risk. Therefore, we used multivariable regression to measure associations between: (i) orphanhood and substance use (alcohol, recreational drugs, and smoking), (ii) substance use and sexual risk behaviours, and (iii) school enrolment and substance use, in adolescents aged 15-19 years, in Eastern Zimbabwe. We found substance use to be low overall (6.4%, 3.2%, and 0.9% of males reported alcohol, drug, and cigarette use; <1% of females reported any substance use), but was more common in male maternal and double orphans than non-orphans. Substance use was positively associated with early sexual debut, number of sexual partners, and engaging in transactional sex, while school enrolment was associated with lower substance use in males. We conclude that education may reduce sexual risk behaviours and HIV infection rates among male adolescents in sub-Saharan Africa, in part, by reducing substance abuse.
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Affiliation(s)
- E. L. Pufall
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - J. W. Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - L. Robertson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - P. Mushati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - C. Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - S. Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Kliewer W, Pillay BJ, Borre A, Zaharakis N, Drazdowski T, Jäggi L. Community violence exposure, family management practices, and substance use in youth: a cross-cultural study. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017; 47:246-259. [PMID: 33597789 DOI: 10.1177/0081246316667918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Associations between community violence exposure, family management practices, and substance use were compared in a sample of early adolescents in low-income communities from the United States (N = 151; M age = 12.71 years, standard deviation = 0.65; 50.3% female) and South Africa (N = 175; M age = 12.55 years, standard deviation = 0.85; 64.6% female) using home interviews with youth and their maternal caregivers. Past year victimization was associated with recent youth substance use. The moderating role of family management practices varied by type of practice (e.g., parental knowledge, control, solicitation, or child disclosure), reporter, and country. High parental knowledge reported by caregiver was protective against substance use only for South African youth. In youth reports, parental knowledge was protective across the United States and South Africa. Youth reports of their disclosure to parents were negatively associated with substance use in the United States but not South Africa. These data highlight the importance of considering both ecological context and reporter in the links between violence exposure, parenting, and substance use in youth.
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Affiliation(s)
- Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University, USA.,Honorary Professor, University of KwaZulu-Natal, South Africa
| | - Basil J Pillay
- Department of Behavioural Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Alicia Borre
- Department of Psychology, Virginia Commonwealth University, USA
| | | | - Tess Drazdowski
- Department of Psychology, Virginia Commonwealth University, USA
| | - Lena Jäggi
- Department of Psychology, Virginia Commonwealth University, USA
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Morojele NK, Brook JS, Brook DW. Tobacco and alcohol use among adolescents in South Africa: shared and unshared risks. J Child Adolesc Ment Health 2017; 28:139-52. [PMID: 27562001 DOI: 10.2989/17280583.2016.1200586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Tobacco and alcohol use by adolescents are major public health concerns in South Africa. However, the extent to which key psychosocial risk factors for tobacco use and alcohol use by adolescents in South Africa are shared or unshared is unclear. This study sought to examine the shared and unshared risk factors for tobacco and alcohol use among adolescents in Johannesburg. METHOD Participants comprised 736 males and females aged 12-17 years who were recruited via a household survey conducted during 2004. The participants were interviewed using a questionnaire comprising measures of personal, family (parental bonding and family legal drug use) and contextual (school and neighbourhood) factors. Separate multiple logistic regression analyses were conducted to predict lifetime alcohol use and lifetime tobacco use from variables within each domain (personal, family and contextual), controlling for demographic factors. RESULTS Personal, family (parental bonding) and contextual factors (school factors) were primarily shared risk factors for tobacco and alcohol use, while family legal drug use and neighbourhood factors were largely unshared. CONCLUSIONS Interventions addressing personal, parenting and schooling factors are likely to have an impact on preventing both tobacco and alcohol use, whereas interventions focused on ameliorating family drug use and neighbourhood factors may need to be more substance-specific.
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Affiliation(s)
- Neo K Morojele
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Pretoria , South Africa.,b School of Public Health , University of the Witwatersrand , Johannesburg , South Africa.,c School of Public Health and Family Medicine , University of Cape Town , South Africa
| | - Judith S Brook
- d Department of Psychiatry , New York University School of Medicine , New York , USA
| | - David W Brook
- d Department of Psychiatry , New York University School of Medicine , New York , USA
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16
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Swahn MH, Culbreth R, Staton C, Kasirye R. Psychosocial health concerns among service-seeking orphans in the slums of Kampala. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 12:258-263. [PMID: 30090121 PMCID: PMC6078198 DOI: 10.1080/17450128.2017.1290306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Orphans have many unmet needs. The purpose of the current study is to briefly examine the psychosocial correlates linked to being an orphan among service-seeking youth in the slums of Kampala in order to provide guidance for service provision for youth. The current analysis is based on a cross-sectional survey conducted in 2011 which consisted of a convenience sample of youth living in the slums (ages 14-24) attending a drop-in center, Uganda Youth Development Link (UYDEL). Bivariate and multivariable analyses were used to determine psychosocial correlates with being an orphan. Among the youth participants (n=444), 23.65% (n=105) reported both of their parents died, 37.39% (n=166) reported one parent died, and the remaining 38.96% (n=173) reported both of their parents are living. In the multivariable model, reporting both parents dead was significantly associated with being a female (AOR: 2.79, 95% CI: 1.27, 6.12) and parental abuse (AOR: 0.14; 95% CI: 0.07, 0.27). A large percentage of youth living in the slums of Kampala are orphans. This study presents important findings that inform interventions and policies that can be targeted toward the dire needs of youth living in the streets and slums of Kampala.
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Affiliation(s)
- Monica H. Swahn
- School of Public Health, Georgia State University, PO Box 3984,
Atlanta, Georgia 30302, USA, Phone: 404-413-1148
| | - Rachel Culbreth
- School of Public Health, Georgia State University, PO Box 3984,
Atlanta, Georgia 30302, USA, Phone: 404-413-1148
| | - Catherine Staton
- Duke University Medical Center, Duke University, Durham, North
Carolina 27703, USA, Phone: 919-681-7711,
- Duke Global Health Institute, Box 90519, Durham, North Carolina
27708, USA
| | - Rogers Kasirye
- Uganda Youth Development Link, Sir Apollo Kaggwa Rd, Box 12659,
Kampala, Uganda, Phone: +256 772 470190,
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17
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Kane JC, Murray LK, Bass JK, Johnson RM, Bolton P. Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Drug Alcohol Depend 2016; 166:85-92. [PMID: 27402551 PMCID: PMC4983530 DOI: 10.1016/j.drugalcdep.2016.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/02/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). METHODS Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13-17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. RESULTS Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68-0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. CONCLUSIONS ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.
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Affiliation(s)
- Jeremy C. Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Judith K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Renee M. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Paul Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States.
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18
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George CRG, Mucheuki C, Govender K, Quinlan T. Psychosocial and health risk outcomes among orphans and non-orphans in mixed households in KwaZulu-Natal, South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015. [DOI: 10.2989/16085906.2015.1095774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Jere DL, Norr KF, Bell CC, Corte C, Dancy BL, Kaponda CPN, Levy JA. Substance Use and Risky Sexual Behaviors Among Young Men Working at a Rural Roadside Market in Malawi. J Assoc Nurses AIDS Care 2015; 28:250-265. [PMID: 26264258 DOI: 10.1016/j.jana.2015.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/07/2015] [Indexed: 01/07/2023]
Abstract
Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed.
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Rosenberg M, Pettifor A, Van Rie A, Thirumurthy H, Emch M, Miller WC, Gómez-Olivé FX, Twine R, Hughes JP, Laeyendecker O, Selin A, Kahn K. The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women: A Cross-Sectional Study. PLoS One 2015; 10:e0125510. [PMID: 25954812 PMCID: PMC4425652 DOI: 10.1371/journal.pone.0125510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk. Methods In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption. Results Visiting alcohol outlets was associated with having more sex partners [adjusted odds ratio (aOR), one versus zero partners (95% confidence interval (CI)): 1.51 (1.21, 1.88)], more unprotected sex acts [aOR, one versus zero acts (95% CI): 2.28 (1.52, 3.42)], higher levels of transactional sex [aOR (95% CI): 1.63 (1.03, 2.59)], and HSV-2 infection [aOR (95% CI): 1.30 (0.88, 1.91)]. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex. Conclusions Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2. Trial Registration HIV Prevention Trials Network HPTN 068
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Affiliation(s)
- Molly Rosenberg
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America; Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Annelies Van Rie
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael Emch
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William C Miller
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, NIAID, NIH, Baltimore, Maryland, United States of America; Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Amanda Selin
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
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Not just the needle: the state of HIV-prevention science among substance users and future directions. J Acquir Immune Defic Syndr 2013; 63 Suppl 2:S174-8. [PMID: 23764632 DOI: 10.1097/qai.0b013e3182987028] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Efforts to prevent HIV transmission among substance-using populations have focused primarily among injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by noninjectable means, and there is a dearth of HIV prevention interventions that target noninjecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine, in addition to new and emerging substances (eg, synthetic cannabinoids, cathinones, and other amphetamine analogs) are needed to develop and scale up effective and robust interventions for populations at risk for HIV transmission via sexual behaviors related to noninjection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV infected and those who are HIV uninfected and are at high risk. We propose a research agenda that prioritizes (1) combination HIV-prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in nontreatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance-related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence.
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