Browsing by Author "Pluddemann, Andreas"

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    "--are you gonna wait until it kills you or are you gonna kill it?'' : narratives of individuals dependent on crystal methamphetamine
    (2008) Ajodah, Anju; Wild, Lauren; Pluddemann, Andreas
    The aim of this study was to investigate the current crystal methamphetamine problem and its trends of abuse as manifested in the local context of Cape Town, South Africa. Twelve individuals (four ex-users, five users in recovery and three current users) who were dependent on crystal methamphetamine took part in the study. They ranged between the age of seventeen and twenty eight years. Semi-structured interviews were conducted in order to gather participants' stories about their subjective understanding of their dependence on crystal methamphetamine. Onset of use was often driven by curiosity and/or peer pressure, as well as to avoid states of psychological discomfort. Crystal methamphetamine use was usually maintained due to the enjoyment of its rewarding effects. Smoking the substance became especially important with more regular use as it served as a powerful, albeit temporary, stress eliminator. Crystal methamphetamine ubiquity appeared to be highly influential in the onset as well as maintenance of the substance's consumption. A range of debilitating physiological and psychological symptoms comprised the state of dependence. The presence of psychotic symptoms was rife within the sample and was often indicative of severe and prolonged crystal methamphetamine use. An inability to function within the external 'drug-free reality' was characterised by participants not being able to fulfill responsibilities and thus was also suggestive of maladaptive patterns of use. Polydrug use was generally common among participants. Some female participants' narratives also pointed towards the association of crystal methamphetamine use and sexual risk-taking behaviours. Identifying an external motivating factor was important in encouraging cessation of use but internal motivation often appeared to be just as significant in attaining as well as sustaining abstinence. Sleeping was the most common strategy used in dealing with the state of severe withdrawal which followed post use. In general, most participants did not perceive treatment as being the most useful means of achieving sobriety. Identifying goals and a perceived sense of purpose appeared important in motivating the individual along the path towards recovery as well as in the maintenance of abstinence.
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    Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries
    (BioMed Central Ltd, 2013) Petersen, Zaino; Myers, Bronwyn; van Hout, Marie-Claire; Pluddemann, Andreas; Parry, Charles
    BACKGROUND:About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries. METHODS: A data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature. RESULTS: Completed data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries. CONCLUSIONS: In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.
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    Methamphetamine (tik) use, sexual risk, aggression and mental health among school going adolescents in Cape Town
    (2010) Pluddemann, Andreas; Flisher, Alan J; Parry, Charles D H; McKetin, Rebecca; Lund, Crick
    Methamphetamine use has become a growing problem in many regions of the world.Cape Town has shown a particularly sharp increase in use over the past six years. The aim of this thesis is to establish the extent of methamphetamine use among adolescents in Cape Town, and to investigate mental health problems and sexual risk behaviour related to methamphetamine use among adolescents. In addition the study aimed to establish whether methamphetamine use is associated with not continuing to attend high school. The results of the thesis are presented through five journal articles, which address the above aims. The articles are based on two quantitative high school surveys and an ongoing surveillance of substance abuse counselling and rehabilitation centres in Cape Town. Findings in the first paper in Chapter 3 indicate that the proportion of individuals seeking substance abuse treatment for methamphetamine related problems increased steadily from 2004 to 2006 and that in 2006 73% of adolescents in treatment for substance abuse reported methamphetamine as their primary or secondary drug. Findings of the high school surveys in Chapters 4-7 indicated that between 9% and 12% of high school students (mean age = 15) reported life-time use of methamphetamine. The second and fourth papers in Chapters 4 and 6 indicated associations between methamphetamine use and sexual risk behaviour, particularly for students who reported recent use of methamphetamine. The third paper in Chapter 5 indicated associations between methamphetamine use in the past year and mental health problems among adolescents, including aggressive behaviour, depression and higher scores on a composite measure of mental health. The fifth paper in Chapter 7 showed that life-time methamphetamine use in addition to other substances was significantly associated with high school nonattendance when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account. This thesis clearly demonstrates that methamphetamine use is a significant problem in Cape Town, and that developing strategies to curb and address this problem should be given priority. The thesis presents among the first and most comprehensive studies on adolescent methamphetamine use and associated problems internationally, and to our knowledge the first publications on this problem among adolescents in Africa. For South Africa, and Cape Town in particular, the greatest concern remains the associations between methamphetamine use and sexual risk behaviour, leading to an increased exposure to HIV. Further prevention efforts targeting both methamphetamine use and sexual risk behaviour should be a high priority for government and community based prevention efforts.