SUNScholar - Browsing by Author "Parry, Charles D. H."

Browsing by Author "Parry, Charles D. H."

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Alcohol use, working conditions, job benefits, and the legacy of the "Dop" system among farm workers in the Western Cape Province, South Africa : hope despite high levels of risky drinking
(MDPI, 2014-07) Gossage, J. Phillip; Snell, Cudore L.; Parry, Charles D. H.; Marais, Anna-Susan; Barnard, Ronel; De Vries, Marlene; Blankenship, Jason; Seedat, Soraya; Hasken, Julie M.; May, Philip A.
This study describes alcohol consumption in five Western Cape Province communities. Cross-sectional data from a community household sample (n = 591) describe the alcohol use patterns of adult males and females, and farm workers vs. others. Data reveal that men were more likely to be current drinkers than women, 75.1% vs. 65.8% (p = 0.033); farm laborers were more likely to be current drinkers than individuals in other occupations 83.1% vs. 66.8% (p = 0.004). Group, binge drinking on weekends was the norm; men were more likely to be binge drinkers in the past week than women 59.8% vs. 48.8% (p = 0.086); farm workers were more likely to binge than others 75.0% vs. 47.5% (p < 0.001). The legacy of “Dop” contributes to current risky drinking behaviors. Farm owners or managers were interviewed on 11 farms, they described working conditions on their farms and how the legacy of “Dop” is reflected in the current use of alcohol by their workers. “Dop” was given to farm workers in the past on six of the 11 farms, but was discontinued for different reasons. There is zero tolerance for coming to work intoxicated; farm owners encourage responsible use of alcohol and assist farm workers in getting help for alcohol problems when necessary. The farm owners report some positive initiatives, were ahead of the movement to provide meaningful wages, and provide other important amenities. Further research is needed to assess whether progressive practices on some farms will reduce harmful alcohol use.
Cannabis and other drug use among trauma patients in three South African cities, 1999-2001
(Health & Medical Publishing Group, 2005) Parry, Charles D. H.; Pluddemann, Andreas; Donson, Hilton; Sukhai, Anesh; Marais, Sandra; Lombard, Carl
Objective. To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001. Design. Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples. Outcome measures. Cause of injury and biological markers to assess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and methamphetamine. Results. Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug (N = 1 565). In most cases the drugs were cannabis and/or methaqualone. While no inter-city differences were found, male patients were typically more likely to test positive for drugs in general and specific drugs such as cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries. Conclusions. Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research.
A comparative analysis of pharmacists’ perspectives on codeine use and misuse – a three country survey
(BioMed Central, 2018-03-27) Carney, Tara; Wells, John; Parry, Charles D. H.; McGuinness, Padraig; Harris, Richard; Van Hout, Marie Claire
Background: The misuse of codeine is of increasing concern in a number of countries, particularly as this relates to over -the-counter pain and cough relief medication, and is also supplied as a prescription medicine. The study aimed to obtain and analyse the opinions and experience of pharmacy staff with regard to codeine misuse. Methods: A cross-sectional web-based survey of pharmacy staff’s perspectives on this issue was administered through professional or regulatory bodies and completed by samples drawn in South Africa (n = 124), Ireland (n = 464) and the United Kingdom (n = 129). Results: The majority of participants reported combination codeine-containing products as most popular, but significantly more pharmacy staff in South Africa reported codeine-containing cough syrups as most commonly popular (X2 = 122.7(2), p < 0.001). Codeine use was also seen significantly more of a public health problem in South Africa than in the other two countries (X2 = 7.6(2), p = 0.02). There was no difference across countries in the level of codeine misuse reported by pharmacy staff. Further findings indicate that professional training and education is desired, with unequivocal findings for the need for greater codeine control (X2 = 12.0(2), p = 0.002). Conclusion: In conclusion, there were some inter-country differences, but overall the findings seem to suggest that pharmacists across all three countries view codeine misuse as a problem among their customers. Recommendations centre on risk management, surveillance and staff training.
Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa
(BioMed Central, 2015-11) Myers, Bronwyn; Govender, Rajen; Koch, J. Randy; Manderscheid, Ron; Johnson, Kim; Parry, Charles D. H.
Background: A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA). Methods: First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach’s measure of internal consistency. Results: The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients’ perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach’s α ranging from 0.72 to 0.89. Conclusion: A lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients’ perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.
Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes : a randomised controlled trial protocol
(BioMed Central, 2014-09-12) Parry, Charles D. H.; Morojele, Neo K.; Myers, Bronwyn J.; Kekwaletswe, Connie T.; Manda, Samuel O. M.; Sorsdahl, Katherine; Ramjee, Gita; Hahn, Judith A.; Rehm, Jurgen; Shuper, Paul A.
Background: Little research has examined whether alcohol reduction interventions improve antiretroviral therapy (ART) adherence and HIV treatment outcomes. This study assesses the efficacy of an intervention for reducing alcohol use among HIV patients on ART who are hazardous/harmful drinkers. Specific aims include adapting a blended Motivational Interviewing (MI) and Problem Solving Therapy (PST) intervention for use with HIV patients; evaluating the efficacy of the intervention for reducing alcohol consumption; and assessing counsellors’ and participants’ perceptions of the intervention. Methods/Design: A randomised controlled trial will evaluate the intervention among ART patients in public hospital-based HIV clinics in Tshwane, South Africa. We will recruit patients who are HIV-positive, on ART for at least 3 months, and classified as harmful/hazardous drinkers using the AUDIT-3. Eligible patients will be randomly assigned to one of three conditions. Patients in the experimental group will receive the MI-PST intervention to reduce harmful/hazardous alcohol use. Patients in the equal-attention wellness intervention group will receive an intervention focused on addressing health risk behaviours. Patients in the control condition will receive treatment as usual. Participants will complete an interviewer-administered questionnaire at baseline and 3, 6 and 12 months post-randomisation to assess alcohol consumption, ART adherence, physical and mental health. We will also collect biological specimens to test for recent alcohol consumption, CD4 counts and HIV RNA viral loads. The primary outcome will be reduction in the volume of alcohol consumed. Secondary outcomes include reduction in harmful/ hazardous use of alcohol, reduction in biological markers of drinking, increase in adherence rates, reductions in viral loads, and increases in CD4 T-cell counts. A process evaluation will ascertain counsellors’ and participants’ perceptions of the acceptability and effectiveness of the interventions. Discussion: We have obtained ethical approval and approval from the study sites and regional and provincial health departments. The study has implications for clinicians, researchers and policy makers as it will provide efficacy data on how to reduce harmful/hazardous alcohol consumption among HIV patients and will shed light on whether reducing alcohol consumption impacts on HIV treatment adherence and other outcomes.
Feasibility and acceptability of a bar-based sexual risk reduction intervention for bar patrons in Tshwane, South Africa
(Taylor & Francis Open, 2014) Morojele, Neo K.; Kitlelic, Naledi; Ngakod, Kgalabi; Kekwaletswe, Connie T.; Nkosi, Sebenzile; Fritz, Katherine; Parry, Charles D. H.
Alcohol consumption is a recognised risk factor for HIV infection. Alcohol serving establishments have been identified as appropriate venues in which to deliver HIV prevention interventions. This paper describes experiences and lessons learnt from implementing a combined HIV prevention intervention in bar settings in one city- and one township-based bar in Tshwane, South Africa. The intervention consisted of peer-led and brief intervention counselling sub-components. Thirty-nine bar patrons were recruited and trained, and delivered HIV and alcohol risk reduction activities to their peers as peer interventionists. At the same time, nine counsellors received training and visited the bars weekly to provide brief motivational interviewing counselling, advice, and referrals to the patrons of the bars. A responsible server sub-component that had also been planned was not delivered as it was not feasible to train the staff in the two participating bars. Over the eight-month period the counsellors were approached by and provided advice and counselling for alcohol and sexual risk-related problems to 111 bar patrons. The peer interventionists reported 1323 risk reduction interactions with their fellow bar patrons during the same period. The intervention was overall well received and suggests that bar patrons and servers can accept a myriad of intervention activities to reduce sexual risk behaviour within their drinking settings. However, HIV- and AIDS-related stigma hindered participation in certain intervention activities in some instances. The buy-in that we received from the relevant stakeholders (i.e. bar owners/managers and patrons, and the community at large) was an important contributor to the feasibility and acceptability of the intervention.
Harmful use of alcohol : a shadow over Sub-Saharan Africa in need of workable solutions
(MDPI, 2017) Ferreira-Borges, Carina; Parry, Charles D. H.; Babor, Thomas F.
Alcohol consumption and alcohol-attributable burden of disease in Africa are expected to rise in the near future, yet. increasing alcohol-related harm receives little attention from policymakers and from the population in general. Even where new legislation is proposed it is rarely enacted into law. Being at the center of social and cultural activities in many countries, alcohol’s negative role in society and contribution to countries’ burden of disease are rarely questioned. After the momentum created by the adoption in 2010 of the WHO Global Strategy and the WHO Regional Strategy (for Africa) to Reduce the Harmful Use of Alcohol, and the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases, in 2013, little seems to have been done to address the increasing use of alcohol, its associated burden and the new challenges that derive from the growing influence of the alcohol industry in Africa. In this review, we argue that to have a positive impact on the health of African populations, action addressing specific features of alcohol policy in the continent is needed, namely focusing on particularities linked to alcohol availability, like unrecorded and illicit production, outlet licensing, the expansion of formal production, marketing initiatives and taxation policies.
Heavy drinking and contextual risk factors among adults in South Africa : findings from the international alcohol control study
(BMC (part of Springer Nature), 2018) Trangenstein, Pamela J.; Morojele, Neo K.; Lombard, Carl; Jernigan, David H.; Parry, Charles D. H.
Background: There is limited information about the potential individual-level and contextual drivers of heavy drinking in South Africa. This study aimed to identify risk factors for heavy drinking in Tshwane, South Africa. Methods: A household survey using a multi-stage stratified cluster random sampling design. Complete consumption and income data were available on 713 adults. Heavy drinking was defined as consuming ≥120 ml (96 g) of absolute alcohol (AA) for men and ≥ 90 ml (72 g) AA for women at any location at least monthly. Results: 53% of the sample were heavy drinkers. Bivariate analyses revealed that heavy drinking differed by marital status, primary drinking location, and container size. Using simple logistic regression, only cider consumption was found to lower the odds of heavy drinking. Persons who primarily drank in someone else’s home, nightclubs, and sports clubs had increased odds of heavy drinking. Using multiple logistic regression and adjusting for marital status and primary container size, single persons were found to have substantially higher odds of heavy drinking. Persons who drank their primary beverage from above average-sized containers at their primary location had 7.9 times the odds of heavy drinking as compared to persons who drank from average-sized containers. Some significant associations between heavy drinking and age, race, and income were found for certain beverages. Conclusion: Rates of heavy drinking were higher than expected giving impetus to various alcohol policy reforms under consideration in South Africa. Better labeling of the alcohol content of different containers is needed together with limiting production, marketing and serving of alcohol in large containers.
HIV/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status
(BMJ Publishing Group, 2018-02) Probst, Charlotte; Parry, Charles D. H.; Rehm, Jurgen
Objectives To quantify HIV/AIDS mortality attributable to alcohol use in the adult general population of South Africa in 2012 by socioeconomic status (SES). Design Comparative risk assessment based on secondary individual data, aggregate data and risk relations reported in the literature. Setting South African adult general population. Participants For metrics of alcohol use by SES, sex and age: 27 070 adults that participated in a nationally representative survey in 2012. For HRs of dying from HIV/AIDS by SES: 87 029 adults that participated in a cohort study (years 2000 to 2014) based out of the Umkhanyakude district, KwaZulu-Natal. Main outcome measures Alcohol-attributable fractions for HIV/AIDS mortality by SES, age and sex were calculated based on the risk of engaging in condom-unprotected sex under the influence of alcohol and interactions between SES and alcohol use. Age-standardised HIV/AIDS mortality rates attributable to alcohol by SES and sex were estimated using alcohol-attributable fractions and SES-specific and sexspecific death counts. Rate ratios were calculated comparing age-standardised rates in low versus high SES by sex. Results The age-standardised HIV/AIDS mortality rate attributable to alcohol was 31.0 (95% uncertainty interval (UI) 21.6 to 41.3) and 229.6 (95% UI 108.8 to 351.6) deaths per 100 000 adults for men of high and low SES, respectively. For women the respective rates were 10.8 (95% UI 5.5 to 16.1) and 75.5 (95% UI 31.2 to 144.9). The rate ratio was 7.4 (95% UI 3.4 to 13.2) for men and 7.0 (95% UI 2.8 to 18.2) for women. Sensitivity analyses corroborated marked differences in alcohol-attributable HIV/AIDS mortality, with rate ratios between 2.7 (95% UI 0.8 to 7.6; women) and 15.1 (95% UI 6.8 to 27.7; men). Conclusions The present study showed that alcohol use contributed considerably to the socioeconomic differences in HIV/AIDS mortality. Targeting HIV infection under the influence of alcohol is a promising strategy for interventions to reduce the HIV/AIDS burden and related socioeconomic differences in South Africa.
Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa
(BioMed Central, 2014-02-05) Myers, Bronwyn; Petersen, Zainonisa; Kader, Rehana; Koch, J. Randy; Manderscheid, Ron; Govender, Rajen; Parry, Charles D. H.
Background: A performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers’ to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development. Methods: Three focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions. Results: Participants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system. Conclusion: Findings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented.
Impact of alcohol consumption on tuberculosis treatment outcomes : a prospective longitudinal cohort study protocol
(BioMed Central, 2018-09-29) Myers, Bronwyn; Bouton, Tara C.; Ragan, Elizabeth J.; White, Laura F.; McIlleron, Helen; Theron, Danie; Parry, Charles D. H.; Horsburgh, C. R.; Warren, Robin M.; Jacobson, Karen R.
Background: An estimated 10% of tuberculosis (TB) deaths are attributable to problematic alcohol use globally, however the causal pathways through which problem alcohol use has an impact on TB treatment outcome is not clear. This study aims to improve understanding of these mechanisms. Specifically, we aim to 1) assess whether poor TB treatment outcomes, measured as delayed time-to-culture conversion, are associated with problem alcohol use after controlling for non-adherence to TB pharmacotherapy; and 2) to determine whether pharmacokinetic (PK) changes in those with problem alcohol use are associated with delayed culture conversion, higher treatment failure/relapse rates or with increased toxicity. Methods: Our longitudinal, repeated measures, prospective cohort study aims to examine the associations between problem alcohol use and TB treatment outcomes and to evaluate the effect of alcohol on the PK and pharmacodynamics (PD) of TB drugs. We will recruit 438 microbiologically confirmed, pulmonary TB patients with evidence of rifampicin susceptibility in Worcester, South Africa with 200 HIV uninfected patients co-enrolled in the PK aim. Participants are followed for the six months of TB treatment and an additional 12 months thereafter, with sputum collected weekly for the first 12 weeks of treatment, alcohol consumption measures repeated monthly in concert with an alcohol biomarker (phosphatidylethanol) measurement at baseline, and in person directly observed therapy (DOT) using real-time mobile phone-based adherence monitoring. The primary outcome is based on time to culture conversion with the second objective to compare PK of first line TB therapy in those with and without problem alcohol use. Discussion: Globally, an urgent need exists to identify modifiable drivers of poor TB treatment outcomes. There is a critical need for more effective TB treatment strategies for patients with a history of problem alcohol use. However, it is not known whether poor treatment outcomes in alcohol using patients are solely attributable to noncompliance. This study will attempt to answer this question and provide guidance for future TB intervention trials. Trial registration: Clinicaltrials.gov, Registration Number: NCT02840877. Registered on 19 July 2016.
Indicated prevention of fetal alcohol spectrum disorders in South Africa : effectiveness of case management
(MDPI, 2015-12) De Vries, Marlene M.; Joubert, Belinda; Cloete, Marise; Roux, Sumien; Baca, Beth A.; Hasken, Julie M.; Barnard, Ronel; Buckley, David; Kalberg, Wendy O.; Snell, Cudore L.; Marais, Anna-Susan; Seedat, Soraya; Parry, Charles D. H.; May, Philip A.
In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD.
Knowledge I seek because culture doesn’t work anymore … It doesn’t work, death comes : the experiences of third-generation female caregivers (gogos) in South Africa discussing sex, sexuality and HIV and AIDS with children in their care
(BMC (part of Springer Nature), 2021-03-09) Simmonds, Jane E.; Parry, Charles D. H.; Abdullah, Fareed; Burnhams, Nadine H.; Christofides, Nicola
Background: Sexual reproductive health communication between parents and children has been shown to promote safer sexual choices. In many South African households, third-generation female caregivers, often grandmothers or other older females, locally known as gogos, are primary caregivers of children due to parents being deceased or absent. Subsequently, the responsibility of talking about sex and related issues has shifted to these gogos. This study explored the experiences of gogos living in Alexandra, Johannesburg on talking about sex, sexuality and HIV and AIDS with children aged 10–18 years that are in their care. Methods: Ten primary caregivers were purposively selected. Data were collected through in-depth individual interviews. Thematic analysis was performed and inductive codes and themes identified. Results: All gogos selected found it difficult to discuss sex, sexuality and HIV and AIDS due to culture and traditional values impacting on personal experiences as well as generation and gender barriers. Perceived low selfefficacy due to low levels of knowledge and limited skills in speaking about sex, sexuality and HIV and AIDS also contributed to low levels of sexual reproductive health communication. Conclusions: This study highlights the need for interventions that focus on improving gogos’ knowledge about sexual reproductive health in addition to providing them with the skills to talk about sex, sexuality and HIV and AIDS with children in their care.
Moving beyond access : towards a quality-orientated substance abuse treatment system in South Africa
(Health and Medical Publishing Group (HMPG), 2012-08) Myers, Bronwyn J.; Petersen, Zaino; Kader, Rehana; Parry, Charles D. H.
There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa.1 The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape.
“Moving forward with life” : acceptability of a brief alcohol reduction intervention for people receiving antiretroviral therapy in South Africa
(MDPI, 2020-08) Myers, Bronwyn; Parry, Charles D. H.; Morojele, Neo K.; Nkosi, Sebenzile; Shuper, Paul A.; Kekwaletswe, Connie T.; Sorsdahl, Katherine R.
Background: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.
Reducing substance use and sexual risk behaviour among men who have sex with men in South Africa
(Academy of Science of South Africa, 2016-09-28) Petersen Williams, Petal; Carney, Tara; Parry, Charles D. H.
ENGLISH SUMMARY : Men who have sex with men have been identified as a population at risk of acquiring and transmitting HIV. Studies in South Africa have reported a high prevalence of HIV, as well as high levels of alcohol and other drug use, among men who have sex with men, and the use of substances (alcohol and drugs) to facilitate their sexual encounters. Since 2007, interventions focused on prevention have been rolled out to vulnerable men who have sex with men and who also use alcohol or other drugs. The interventions include community-based outreach; provision of information on HIV/AIDS, substance abuse, and safer sex practices; and the development of risk-reduction plans. Among 195 men who participated in our study, there were significant reductions in the proportion who used cannabis and ecstasy, including the use of these drugs during sex. No reduction was observed in the use of any other substances. In general, after the intervention our participants reported less frequent use of alcohol and drugs and greater engagement in safer sexual practices. Despite these encouraging findings, the combination of substance use while engaging in sex had actually increased. The study findings suggest that interventions that target men who have sex with men, and who use alcohol and other drugs, could reduce risk behaviours in this population.
Replication of high fetal alcohol spectrum disorders prevalence rates, child characteristics, and maternal risk factors in a second sample of rural communities in South Africa
(MDPI, 2017) May, Philip A.; De Vries, Marlene M.; Marais, Anna-Susan; Kalberg, Wendy O.; Buckley, David; Adnams, Colleen M.; Hasken, Julie M.; Tabachnick, Barbara; Robinson, Luther K.; Manning, Melanie A.; Bezuidenhout, Heidre; Adam, Margaret P.; Jones, Kenneth L.; Seedat, Soraya; Parry, Charles D. H.; Hoyme, H. Eugene
Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.
The socioeconomic profile of alcohol-attributable mortality in South Africa : a modelling study
(BioMed Central, 2018-06-25) Probst, Charlotte; Parry, Charles D. H.; Wittchen, Hans-Ulrich; Rehm, Jurgen
Background: Globally, illness and life expectancy follow a social gradient that puts people of lower socioeconomic status (SES) at higher risk of dying prematurely. Alcohol consumption has been shown to be a factor contributing to socioeconomic differences in mortality. However, little evidence is available from low- and middle-income countries. The objective of this study was to quantify mortality attributable to alcohol consumption in the adult (15+ years) general population of South Africa in 2015 by SES, age, and sex. Methods : A comparative risk assessment was performed using individual and aggregate data from South Africa and risk relations reported in the literature. Alcohol-attributable fractions (AAFs) and alcohol-attributable mortality rates were estimated for cause-specific mortality by SES, sex, and age. Monte Carlo simulation techniques were used to calculate 95% uncertainty intervals (UI). Results: Overall, approximately 62,300 (95% UI 27,000–103,000) adults died from alcohol-attributable causes in South Africa in 2015, with 60% of deaths occurring in people in the low and 15% in the high SES groups. Age-standardized, alcohol-attributable mortality rates per 100,000 adults were highest for the low SES group (727 deaths, 95% UI 354–1208 deaths) followed by the middle (377 deaths, 95% UI 165–687 deaths) and high SES groups (163 deaths, 95% UI 71–289 deaths). The socioeconomic differences were highest for mortality from infectious diseases. People of low SES had a lower prevalence of current alcohol use but heavier drinking patterns among current drinkers. Among men, AAFs were elevated at low and middle SES, particularly for the middle and higher age groups (35+). Among women, AAFs differed less across SES groups and, in the youngest age group (15–34), women of high SES had elevated AAFs. Conclusions: Alcohol use contributed to vast socioeconomic differences in mortality. Where observed, elevated AAFs for people of low and middle SES arose from higher levels of consumption among current drinkers and not from the prevalence of current alcohol use per se. The findings can direct preventive measures and interventions on those at highest risk. Future research is needed to investigate socioeconomic differences in the risk functions relating alcohol use to cause-specific mortality.
To what extent does South African mental health and substance abuse research address priority issues?
(Health & Medical Publishing Group, 2000-04) Flisher, Alan J.; Parry, Charles D. H.; Stein, Dan J.
Objective. To investigate the extent to which South African mental health research addresses priority issues. Design. Cross-sectional survey of conference presentations. Setting. The most recent conferences of the following professional societies: the Epidemiological Society of Southern Africa, the Psychological Society of South Africa, the Society of Psychiatrists of South Africa, and the South African Association for Child and Adolescent Psychiatry and Allied Disciplines. Main outcome measures. Whether the presentations addressed priority areas as defined in the list 'Selected priority areas of research' compiled by the Mental Health and Substance Abuse Thrust of the Medical Research Council, and if so which priority areas were addressed. Results. There were 627 presentations, with 267 (43%) on mental health or substance abuse. Seventy-eight papers (29%) reported original research in a priority area identified by the Medical Research Council. Of these, 73 (94%) were on mental health and 5 (6%) were on substance abuse. Of the 73 papers on mental health, 33 (45%) addressed topics in health problem research, 7 (10%) aetiology research, 22 (30%) intervention research, and 11 (15%) operational and health systems research. Conclusion. Much South African mental health research does not address priority issues. There is a particular dearth of research addressing substance abuse research priorities. Funding mechanisms and research capacity development initiatives could help to rectify the situation.
Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa : a cross-sectional baseline study
(BMC (part of Springer Nature), 2019-12-16) Egbe, Catherine O.; Londani, Mukhethwa; Parry, Charles D. H.; Myers, Bronwyn; Shuper, Paul A.; Nkosi, Sebenzile; Morojele, Neo K.
Background: People living with HIV (PLWH) who drink alcohol and use tobacco are particularly vulnerable to tobacco-induced diseases due to an already compromised immune system. This study investigated the prevalence and factors associated with tobacco use (cigarette and snuff) among PLWH who drink heavily. Methods: Participants (n = 623) on antiretroviral therapy for HIV who reported heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C were recruited from six hospitals in Gauteng Province, South Africa. The Fagerström test was used to assess nicotine dependence. Chi Square tests and modified Poisson regression analyses were conducted to identify factors associated with tobacco use. Results: Almost half of the participants reported ever smoking (44.0%; CI: 40.1–47.9) and about a quarter reported ever using snuff (25.5%; CI: 22.2–29.1). Current smokers and current snuff users comprised 27.3% (CI: 23.9–30.9) and 19.1% (CI: 16.2–22.3) of all participants respectively. Among current smokers, 37.9% (CI: 30.8–45.3) were moderately/ highly dependent on nicotine. Current ‘any tobacco product users’ (ATPU: use cigarettes or snuff) were 45.4% (CI: 41.5–49.3) while 1.0% (CI: 0.4–2.0) currently used cigarettes and snuff. Adjusted regression analyses showed that, compared to males, females were less at risk of being: ever smokers (Relative Risk Ratio [RRR] = 0.33; CI: 0.27–0.41), current smokers (RRR = 0.18; CI: 0.12–0.25), and ATPU (RRR = 0.75; CI: 0.63–0.89) but were more at risk of ever snuff use (RRR = 5.23; CI: 3.31–8.25), or current snuff use (RRR = 26.19; CI: 8.32–82.40) than males. Ever snuff users (RRR = 1.32; CI: 1.03–1.70), current snuff users (RRR = 1.40; CI: 1.03–1.89) and ATPU (RRR = 1.27; CI: 1.07–1.51) were more at risk of reporting significant depressive symptoms. We found no significant associations between smoking status and years on ART and viral load. Conclusion: There is a high prevalence of cigarette and snuff use among PLWH who drink heavily. Tobacco use cessation interventions tailored specifically for this population and according to their tobacco product of choice are urgently needed given their vulnerability to ill-health.

Browsing by Author "Parry, Charles D. H."

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