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Stress, Substance Use and Sexual Risk Behaviors Among Primary Care Patients in Cape Town, South Africa

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Abstract

We assessed the relationship between stress, substance use and sexual risk behaviors in a primary care population in Cape Town, South Africa. A random sample of participants (and over-sampled 18–24-year-olds) from 14 of the 49 clinics in Cape Town’s public health sector using stratified random sampling (n = 2,618), was selected. We evaluated current hazardous drug and alcohol use and three domains of stressors (Personal Threats, Lacking Basic Needs, and Interpersonal Problems). Several personal threat stressors and an interpersonal problem stressor were related to sexual risk behaviors. With stressors included in the model, hazardous alcohol use, but not hazardous drug use, was related to higher rates of sexual risk behaviors. Our findings suggest a positive screening for hazardous alcohol use should alert providers about possible sexual risk behaviors and vice versa. Additionally, it is important to address a broad scope of social problems and incorporate stress and substance use in HIV prevention campaigns.

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Acknowledgments

We thank Agatha Hinman for editorial assistance, Jason Bond, PhD. for statistical support, and the fieldworkers, Beulah Marks, Bongu Maku, Morris Manuel, and Asanda Mabusela. We are also grateful to the patients who participated in this study. The US National Institute on Drug Abuse (through the Southern African Initiative) and the South African Medical Research Council provided study funding (grant R37 DA10572).

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Authors and Affiliations

  1. Alcohol Research Group, 6475 Christie Ave. Ste 400, Emeryville, CA, 94603, USA

    Lyndsay Ammon Avalos

  2. School of Public Health, Department of Epidemiology, University of California, Berkeley, Berkeley, CA, USA

    Lyndsay Ammon Avalos

  3. Division of Research, Kaiser Permanente, Oakland, CA, USA

    Jennifer R. Mertens & Constance M. Weisner

  4. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Catherine L. Ward & Alan J. Flisher

  5. Child, Youth, Family and Social Development, Human Sciences Research Council, Cape Town, South Africa

    Catherine L. Ward

  6. Research Center for Health Promotion, University of Bergen, Bergen, Norway

    Alan J. Flisher

  7. Adolescent Health Research Institute, University of Cape Town, Cape Town, South Africa

    Alan J. Flisher

  8. School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Graham F. Bresick

  9. Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA

    Constance M. Weisner

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  1. Lyndsay Ammon Avalos
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  2. Jennifer R. Mertens
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  3. Catherine L. Ward
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  4. Alan J. Flisher
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  5. Graham F. Bresick
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  6. Constance M. Weisner
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Correspondence to Lyndsay Ammon Avalos.

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Avalos, L.A., Mertens, J.R., Ward, C.L. et al. Stress, Substance Use and Sexual Risk Behaviors Among Primary Care Patients in Cape Town, South Africa. AIDS Behav 14, 359–370 (2010). https://doi.org/10.1007/s10461-009-9525-2

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