Skip to main content

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

AIDS and Behavior volume 20, pages 2387–2397 (2016)Cite this article

Abstract

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.

Resumen

Sudáfrica está experimentando un problema de metanfetamina en crecimiento, y hay la preocupación que la metanfetamina pueda acelerar la transmisión de VIH. Ha habido poca investigación de las necesidades de prevención de VIH para los usuarios de metanfetamina recibiendo tratamiento de abuso de sustancias en Sudáfrica. Este estudio evaluó la prevalencia y correlatos de la conducta de riesgo de VIH entre 269 usuarios de metanfetamina que inician tratamiento por abuso de sustancias en dos clínicas en Ciudad del Cabo. La prevalencia de comportamientos sexuales de riesgo fue alta entre los participantes sexualmente activos: 34 % en múltiples parejas, el 26 % en relaciones sexuales sin protección con una pareja ocasional, y 24 % de comercio del sexo por dinero/metanfetamina. El predictor más fuerte de todos los comportamientos sexuales de riesgo fue el uso concomitante de otras drogas. Más de la mitad no había sido probado por el VIH en el último año, y el 25 % nunca había sido probado, aunque las actitudes hacia las pruebas de VIH fueron abrumadoramente positivas. Esta población de usuarios de metanfetamina no inyectables, principalmente heterosexuales, es un grupo de alto riesgo en la necesidad de intervenciones específicas de prevención del VIH. El tratamiento de abuso de sustancias es un escenario ideal en el que llega a los usuarios de metanfetamina los servicios de VIH.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Degenhardt L, Mathers B, Guarinieri M, et al. Meth/amphetamine use and associated HIV: implications for global policy and public health. Int J Drug Policy. 2010;21(5):347–58.

    PubMed  Article  Google Scholar 

  2. Ackers ML, Greenberg AE, Lin CY, et al. High and persistent HIV seroincidence in men who have sex with men across 47 U.S. cities. PLoS One. 2012;7(4):e34972. doi:10.1371/journal.pone.0034972.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  3. Plankey MW, Ostrow DG, Stall R, et al. The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2007;45(1):85–92.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. Morineau G, Nugrahini N, Riono P, et al. Sexual risk taking, STI and HIV prevalence among men who have sex with men in six Indonesian cities. AIDS Behav. 2011;15(5):1033–44.

    PubMed  Article  Google Scholar 

  5. Patterson TL, Semple SJ, Staines H, et al. Prevalence and correlates of HIV infection among female sex workers in 2 Mexico–US border cities. J Infect Dis. 2008;197(5):728–32.

    PubMed  PubMed Central  Article  Google Scholar 

  6. Martin M, Vanichseni S, Suntharasamai P, et al. Drug use and the risk of HIV infection amongst injection drug users participating in an HIV vaccine trial in Bangkok, 1999–2003. Int J Drug Policy. 2010;21(4):296–301.

    PubMed  Article  Google Scholar 

  7. Panenka WJ, Procyshyn RM, Lecomte T, et al. Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings. Drug Alcohol Depend. 2013;129(3):167–79.

    CAS  PubMed  Article  Google Scholar 

  8. Volkow ND, Wang GJ, Fowler JS, et al. Stimulant-induced enhanced sexual desire as a potential contributing factor in HIV transmission. Am J Psychiatry. 2007;164(1):157–60.

    PubMed  Article  Google Scholar 

  9. Simbayi LC, Kalichman SC, Cain D, et al. Methamphetamine use and sexual risks for HIV infection in Cape Town, South Africa. J Subst Use. 2006;11(4):291–300.

    Article  Google Scholar 

  10. Wechsberg WM, Jones HE, Zule WA, et al. Methamphetamine (“tik”) use and its association with condom use among out-of-school females in Cape Town, South Africa. Am J Drug Alcohol Abuse. 2010;36(4):208–13.

    PubMed  PubMed Central  Article  Google Scholar 

  11. Meade CS, Watt MH, Sikkema KJ, et al. Methamphetamine use is associated with childhood sexual abuse and HIV sexual risk behaviors among patrons of alcohol-serving venues in Cape Town, South Africa. Drug Alcohol Depend. 2012;126(1–2):232–9.

    PubMed  PubMed Central  Article  Google Scholar 

  12. Pluddemann A, Flisher AJ, Mathews C, Carney T, Lombard C. Adolescent methamphetamine use and sexual risk behaviour in secondary school students in Cape Town, South Africa. Drug Alcohol Rev. 2008;27(6):687–92.

    PubMed  Article  Google Scholar 

  13. Plüddemann A, Flisher AJ, McKetin R, Parry CD, Lombard CJ. Methamphetamine use and sexual risk behavior among high school students in Cape Town, South Africa. J Child Adolesc Subst Abuse. 2012;21(2):181–91.

    Article  Google Scholar 

  14. Shisana O, Rehle T, Simbayi LC, et al. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.

    Google Scholar 

  15. Morris K, Parry C. South African methamphetamine boom could fuel further HIV. Lancet Infect Dis. 2006;6(8):471.

    PubMed  Article  Google Scholar 

  16. Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27(3):253–62.

    PubMed  Article  Google Scholar 

  17. McKetin R, Kelly E, McLaren J. The relationship between crystalline methamphetamine use and methamphetamine dependence. Drug Alcohol Depend. 2006;85(3):198–204.

    CAS  PubMed  Article  Google Scholar 

  18. Parry CD, Petersen P, Carney T, Dewing S, Needle R. Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug using populations in Cape Town, Durban, and Pretoria, South Africa. SAHARA J. 2008;5(3):113–9.

    PubMed  Article  Google Scholar 

  19. Peltzer K, Ramlagan S, Johnson BD, Phaswana-Mafuya N. Illicit drug use and treatment in South Africa: a review. Subst Use Misuse. 2010;45(13):2221–43.

    PubMed  PubMed Central  Article  Google Scholar 

  20. Meade CS, Towe SL, Watt MH, et al. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: a mixed-methods study. Drug Alcohol Depend. 2015;152:79–86.

    PubMed  PubMed Central  Article  Google Scholar 

  21. Pluddemann A, Myers BJ, Parry CD. Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: implications for public health. Drug Alcohol Rev. 2008;27(2):185–9.

    PubMed  Article  Google Scholar 

  22. Dada S, Burnhams N, Parry C, et al. Monitoring alcohol and drug abuse trends in South Africa (July 1996–June 2013). Cape Town: Alcohol and Drug Abuse Research Unit, Medical Research Council; 2014.

    Google Scholar 

  23. Dada S, Burnhams N, Parry C, et al. Monitoring alcohol and drug abuse trends in South Africa (July 1996–December 2012). Cape Town: Alcohol and Drug Abuse Research Unit, Medical Research Council; 2013.

    Google Scholar 

  24. Dada S, Burnhams N, Williams Y, et al. Monitoring alcohol and drug abuse trends in South Africa (July 1996–December 2014). Cape Town: Alcohol and Drug Abuse Research Unit, Medical Research Council; 2015.

    Google Scholar 

  25. Metzger DS, Woody GE, O’Brien CP. Drug treatment as HIV prevention: a research update. J Acquir Immune Defic Syndr. 2010;55(Suppl 1):S32–6.

    PubMed  PubMed Central  Article  Google Scholar 

  26. MacArthur GJ, Minozzi S, Martin N, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. Br Med J. 2012;345:e5945. doi:10.1136/bmj.e5945.

  27. Dutta A, Wirtz AL, Baral S, Beyrer C, Cleghorn FR. Key harm reduction interventions and their impact on the reduction of risky behavior and HIV incidence among people who inject drugs in low-income and middle-income countries. Curr Opin HIV AIDS. 2012;7(4):362–8.

    PubMed  Article  Google Scholar 

  28. Aspinall EJ, Nambiar D, Goldberg DJ, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol. 2014;43(1):235–48.

    PubMed  Article  Google Scholar 

  29. Sorensen JL, Copeland AL. Drug abuse treatment as an HIV prevention strategy: a review. Drug Alcohol Depend. 2000;59(1):17–31.

    CAS  PubMed  Article  Google Scholar 

  30. Meader N, Semaan S, Halton M, et al. An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS Behav. 2013;17(6):1963–78.

    PubMed  Article  Google Scholar 

  31. Meader N, Li R, Des Jarlais DC, Pilling S. Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users. Cochrane Database Syst Rev. 2010;(1):CD007192.

  32. Khan MR, Berger A, Hemberg J, et al. Non-injection and injection drug use and STI/HIV risk in the United States: the degree to which sexual risk behaviors versus sex with an STI-infected partner account for infection transmission among drug users. AIDS Behav. 2013;17(3):1185–94.

    PubMed  PubMed Central  Article  Google Scholar 

  33. Deiss RG, Lozada RM, Burgos JL, et al. HIV prevalence and sexual risk behaviour among non-injection drug users in Tijuana, Mexico. Glob Public Health. 2012;7(2):175–83.

    PubMed  Article  Google Scholar 

  34. Des Jarlais DC, Arasteh K, McKnight C, et al. Associations between herpes simplex virus type 2 and HCV with HIV among injecting drug users in New York City: the current importance of sexual transmission of HIV. Am J Public Health. 2011;101(7):1277–83.

    PubMed  PubMed Central  Article  Google Scholar 

  35. Vickerman P, Martin NK, Roy A, et al. Is the HCV–HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission? Drug Alcohol Depend. 2013;132(1–2):172–81.

    PubMed  Article  Google Scholar 

  36. Watt MH, Meade CS, Kimani S, et al. The impact of methamphetamine (“tik”) on a peri-urban community in Cape Town, South Africa. Int J Drug Policy. 2014;25(2):219–25.

    PubMed  Article  Google Scholar 

  37. Campbell ANC, Tross S, Calsyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. Soc Work Public Health. 2013;28(3–4):333–48.

    PubMed  PubMed Central  Article  Google Scholar 

  38. Shoptaw S, Rawson RA, McCann MJ, Obert JL. The Matrix model of outpatient stimulant abuse treatment: evidence of efficacy. J Addict Dis. 1994;13(4):129–41.

    CAS  PubMed  Article  Google Scholar 

  39. City of Cape Town. 2011 Census suburb Delft Cape Town. Strategic Development Information and GIS Department; 2013.

  40. Lehohla P. Census 2011 municipal report: Western Cape. Pretoria: Statistics South Africa; 2012.

    Google Scholar 

  41. Goga K. The drug trade and governance in Cape Town. Pretoria: Institute for Security Studies; 2014.

    Google Scholar 

  42. South Africa Department of Health. HIV counselling and testing (HCT) policy guidelines. Pretoria: South Africa Department of Health; 2010.

    Google Scholar 

  43. Humeniuk R, Ali R, Babor TF, et al. Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction. 2008;103(6):1039–47.

    PubMed  Article  Google Scholar 

  44. Group WAW. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–94.

    Article  Google Scholar 

  45. Meyer-Bahlberg HFL, Ehrhardt AA, Exner TM, Gruen RS. Sexual risk behavior assessment schedule: adult (SERBAS-A-DF-4) manual. New York: Columbia University, Department of Psychiatry; 1991.

    Google Scholar 

  46. Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect. 2003;79(6):442–7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  47. Meade CS, Towe SL, Watt MH, et al. HIV testing behaviors and attitudes among community recruited methamphetamine users in a South African township. AIDS Behav. 2015;19(1):186–91.

    PubMed  PubMed Central  Article  Google Scholar 

  48. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  49. Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The revised Conflict Tactics Scales (CTS2): development and preliminary psychometric data. J Fam Issues. 1996;17(3):283–316.

    Article  Google Scholar 

  50. Gass JD, Stein DJ, Williams DR, Seedat S. Gender differences in risk for intimate partner violence among South African adults. J Interpers Violence. 2011;26(14):64–89.

    Article  Google Scholar 

  51. Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44. doi:10.1186/1758-2652-13-44.

    PubMed  PubMed Central  Article  Google Scholar 

  52. Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169–90.

    PubMed  Article  Google Scholar 

  53. Shisana O, Rehle T, Simbayi LC, et al. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town; 2014.

  54. Meade CS, Bevilacqua LA, Moore ED, et al. Concurrent substance abuse is associated with sexual risk behavior among adults seeking treatment for prescription opioid dependence. Am J Addict. 2014;23(1):27–33.

    PubMed  Article  Google Scholar 

  55. Harrell PT, Mancha BE, Petras H, Trenz RC, Latimer WW. Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors. Drug Alcohol Depend. 2012;122(3):220–7.

    CAS  PubMed  Article  Google Scholar 

  56. Green TC, Kershaw T, Lin H, et al. Patterns of drug use and abuse among aging adults with and without HIV: a latent class analysis of a US Veteran cohort. Drug Alcohol Depend. 2010;110(3):208–20.

    PubMed  PubMed Central  Article  Google Scholar 

  57. Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV-positive adults over 50: implications for treatment and medication adherence. Drug Alcohol Depend. 2014;139:33–40.

    PubMed  PubMed Central  Article  Google Scholar 

  58. Hahn JA, Woolf-King SE, Muyindike W. Adding fuel to the fire: alcohol’s effect on the HIV epidemic in Sub-Saharan Africa. Curr HIV/AIDS Rep. 2011;8(3):172–80.

    PubMed  Article  Google Scholar 

  59. Hobkirk AL, Watt MH, Green KT, et al. Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa. Addict Behav. 2015;42:167–71.

    PubMed  Article  Google Scholar 

  60. Watt MH, Myers B, Towe SL, Meade CS. The mental health experiences and needs of methamphetamine users in Cape Town: a mixed-methods study. S Afr Med J. 2015;105(8):685–8.

    PubMed  PubMed Central  Article  Google Scholar 

  61. Sdrulla AD, Chen G. The multidisciplinary approach to the management of substance abuse. In: Kaye AD, Vadivelu N, Urman RD, editors. Substance abuse. New York: Springer; 2015. p. 193–207.

    Chapter  Google Scholar 

  62. Drake RE, Mueser KT, Brunette MF, McHugo GJ. A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatr Rehabil J. 2004;27(4):360–74.

    PubMed  Article  Google Scholar 

  63. Ouimette P, Brown PJ. Trauma and substance abuse: causes, consequences, and treatment of comorbid disorders. Washington, DC: American Psychological Association; 2003.

    Book  Google Scholar 

  64. Schäfer I, Najavits LM. Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse. Curr Opin Psychiatry. 2007;20(6):614–8.

    PubMed  Article  Google Scholar 

  65. Smit J, Myer L. Mental health and sexual risk behaviours in a South African township: a community-based cross-sectional study. Public Health. 2006;120:535–42.

    Article  Google Scholar 

  66. Sikkema KJ, Watt MH, Meade CS, et al. Mental health and HIV sexual risk behavior among patrons of alcohol serving venues in Cape Town, South Africa. J Acquir Immune Defic Syndr. 2011;57(3):230–7.

    PubMed  PubMed Central  Article  Google Scholar 

  67. Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. J Natl Med Assoc. 2010;102(7):614–20.

    PubMed  PubMed Central  Article  Google Scholar 

  68. Hutton HE, Lyketsos CG, Zenilman JM, Thompson RE, Erbelding EJ. Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. Am J Psychiatry. 2004;161(5):912–4.

    PubMed  Article  Google Scholar 

  69. Klein H, Elifson KW, Sterk CE. Depression and HIV risk behavior practices among at risk women. Womens Health. 2008;48(2):167–88.

    Article  Google Scholar 

  70. Sikkema KJ, Watt MH, Drabkin AS, et al. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010;14(2):252–62.

    PubMed  PubMed Central  Article  Google Scholar 

  71. Rawson RA, Washton A, Domier CP, Reiber C. Drugs and sexual effects: role of drug type and gender. J Subst Abuse Treat. 2002;22(2):103–8.

    PubMed  Article  Google Scholar 

  72. Corsi KF, Booth RE. HIV sex risk behaviors among heterosexual methamphetamine users: literature review from 2000 to present. Curr Drug Abuse Rev. 2008;1(3):292–6.

    PubMed  Article  Google Scholar 

  73. Sorsdahl K, Stein DJ, Myers B. Negative attributions towards people with substance use disorders in South Africa: variation across substances and by gender. BMC Psychiatry. 2012;12:101. doi:10.1186/1471-244X-12-101.

    PubMed  PubMed Central  Article  Google Scholar 

  74. Meyer JP, Springer SA, Altice FL. Substance abuse, violence, and HIV in women: a literature review of the syndemic. J Womens Health. 2011;20(7):991–1006.

    Article  Google Scholar 

  75. World Health Organization. Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2015.

    Google Scholar 

  76. Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. Risk behaviors by audio computer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drug users. AIDS Educ Prev. 2002;14(5):367–78.

    PubMed  Article  Google Scholar 

  77. Islam MM, Topp L, Conigrave KM, et al. The reliability of sensitive information provided by injecting drug users in a clinical setting: clinician-administered versus audio computer-assisted self-interviewing (ACASI). AIDS Care. 2012;24(12):1496–503.

    PubMed  Article  Google Scholar 

  78. Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil. J Subst Abuse Treat. 2006;30(3):237–43.

    PubMed  Article  Google Scholar 

  79. Perlis TE, Des Jarlais DC, Friedman SR, Arasteh K, Turner CF. Audio-computerized self-interviewing versus face-to-face interviewing for research data collection at drug abuse treatment programs. Addiction. 2004;99(7):885–96.

    PubMed  Article  Google Scholar 

  80. Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of Audio Computer-Assisted Self-Interviewing: utility and acceptability in longitudinal studies. Am J Epidemiol. 2000;152(2):99–106.

    CAS  PubMed  Article  Google Scholar 

  81. NIMH Collaborative HIV/STD Prevention Trial Group. The feasibility of audio computer-assisted self-interviewing in international settings. AIDS. 2007;21(Suppl 2):S49–58.

    Article  Google Scholar 

Download references

Acknowledgments

This study was funded by a Grant from the Duke University Center for AIDS Research (P30-AI064518, with additional support from Grants awarded by the National Institute on Drug Abuse (K23-DA028660, R03-DA033828). The content is solely the responsibility of the authors and does not necessarily represent the official views of the United States National Institutes of Health. A scholarship from the Duke Global Health Institute provided Ryan Lion with funds for travel and living expenses in South Africa and a stipend to work on the study at Duke. We thank Ms. Sadieqa Barodien, Ms. Robyn Human, and other clinic staff for their assistance with data collection.

Author information

Affiliations

  1. Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University, Box 90519, Durham, NC, 27708, USA

    Christina S. Meade

  2. Duke Global Health Institute, Durham, NC, USA

    Christina S. Meade, Ryan R. Lion, Daniella M. Cordero & Melissa H. Watt

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

    John A. Joska & Hetta Gouse

  4. City Health, City of Cape Town, Cape Town, South Africa

    Warren Burnhams

Authors
  1. Christina S. Meade
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan R. Lion
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniella M. Cordero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melissa H. Watt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John A. Joska
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hetta Gouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Warren Burnhams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina S. Meade.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Meade, C.S., Lion, R.R., Cordero, D.M. et al. HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa. AIDS Behav 20, 2387–2397 (2016). https://doi.org/10.1007/s10461-016-1333-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1333-x

Keywords

  • South Africa
  • Drug abuse
  • Methamphetamine
  • Sexual risk behavior
  • Substance abuse treatment
  • HIV transmission