Rapid Assessment of Drug-Related HIV Risk Among Men Who Have Sex With Men in Three South African Cities

The researchers designed the current study to assess the association between drug use and risky sexual behavior among men who have sex with men (MSM) in locations known to have high prevalence rates of drug use and sexual risk behavior in three South African cities: Cape Town, Durban and Pretoria.

To recruit drug-using MSM, street intercepts and purposive snowball sampling were employed. The rapid assessment included observation, mapping, key informant interviews and interviews of MSM focus groups. HIV testing was performed on drug-using key informants.

"The use of drugs like crack cocaine, cannabis and methamphetamine to specifically facilitate sexual encounters was evident," the authors noted. Even though HIV risk knowledge was high, drugs led to inconsistent condom use and other high-risk sexual activities. Among MSM who were drug injectors, many reported sharing needles and reusing injection equipment. One-third of the MSM who agreed to be tested were HIV-positive.

The men's views about drug and HIV treatment and preventive services and their efficacy were mixed. The results highlighted various barriers to accessing services, including stigma associated with homosexuality and the availability of drugs in treatment facilities.

In conclusion, the authors offered several recommendations, including: addressing the gap between HIV-risk knowledge and practice; extending [voluntary counseling and testing] services for MSM; increasing the visibility of drug abuse services within communities; addressing concerns about drug availability in treatment centers as well as re-integration issues and the need for after-care services; reducing stigma in drug and HIV services for MSM; and "strengthening the link between drug treatment services and HIV prevention by integrating HIV/drug-related risks into HIV prevention efforts and HIV risks into drug use prevention efforts."

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