Poor mental health and problematic alcohol use common in South Africa and predict HIV risk behaviour

Poor mental health, problematic alcohol consumption, substance use, and HIV risk behaviours among South Africans are related, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The study was conducted in alcohol serving venues in poor areas close to Cape Town.

“Findings from this study support the need to develop HIV prevention interventions that address both mental health problems and their predictors,” comment the international team of investigators.

Earlier research has shown that patrons of alcohol-serving venues in South Africa have high levels of sexual risk behaviour. Depression and post-traumatic stress disorder are common in the country and have been linked to problematic drinking and riskier sex.

Researchers wished to gain a better understanding of the relationship between these factors. They therefore undertook a study in 2009 involving 738 patrons of six alcohol-serving venues in townships near Cape Town. All the participants were Black or Coloured.

The participants completed questionnaires designed assess their experience of post-traumatic stress disorder, traumatic experiences, and depression. They were also asked about their alcohol use and consumption of illicit substances. Individuals were also asked to provide details of their sexual behaviour, including the number of recent partner and frequency of unprotected sex.

The study sample was evenly split between men and women, Black and Coloured.

Mental health among the study participants was poor. A quarter of men and 45% of women had symptoms of post-traumatic stress disorder. Depression was also highly prevalent (68% women; 51% men). About 48% of participants reported a traumatic experience, and 37% of women and 18% of men reported having been hit by a sexual partner.

Approximately 70% of participants reported problematic drinking, and a fifth said they had used an illicit substance in the past four months.

There were high rates of HIV risk behaviours. The mean number of sexual partners in the previous four months was two, and 44% of individuals reported having had unprotected sex at least once. Approximately two-thirds of men and 75% of women had been tested for HIV, and overall HIV prevalence was 6%.

For men, post-traumatic stress disorder was associated with being hit by a sex partner, physical and sexual abuse during childhood, and diagnosis with HIV. Predictors for post-traumatic stress disorder for women were sexual violence, and sexual abuse as a child. Predictors of depression were broadly similar.

Increased sexual risk behaviour for men was associated with problematic alcohol use, drug use, and post-traumatic stress disorder (all p < 0.01). Problematic alcohol use (p < 0.01), depression (p = 0.007) and post-traumatic stress disorder (p = 0.018) were associated with an increased risk of sexual risk behaviour among women.

“Mental health distress, traumatic experiences, and substance abuse may synergistically interact to increase HIV sexual risk behaviour,” comment the investigators.

They continue, “male and female patrons of alcohol serving venues in peri-urban townships in Cape Tow, South Africa reported high rates of mental health problems, alcohol and drug use, and HIV sexual risk behaviours.”

As post-traumatic stress disorder, depression and alcohol and substance abuse were associated with sexual risk taking, the investigators conclude with a call for HIV prevention interventions to address mental health problems and their causes.