tag:theconversation.com,2011:/us/topics/risky-sexual-behaviour-33718/articlesRisky sexual behaviour – The Conversation2020-07-28T14:14:20Ztag:theconversation.com,2011:article/1428652020-07-28T14:14:20Z2020-07-28T14:14:20ZKnowledge about HIV doesn’t always change adolescents’ behaviour: peers matter<figure><img src="https://images.theconversation.com/files/349131/original/file-20200723-17-5nuqh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adolescents need to be part of prevention interventions.</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>HIV and AIDS remain major global public health challenges, especially for sub-Saharan Africa. The region accounts for around <a href="https://aidsinfo.unaids.org/">70%</a> of the world’s burden of infections. Young people, especially young women, are affected more than other groups. </p>
<p>In Malawi, for example, the prevalence of HIV among people aged 15-24 years rose to 5.9% between 2010 and 2015. Prevalence fell in the broader age group of 15-49 years. In 2016, Malawi had <a href="https://www.tandfonline.com/doi/full/10.1080/17290376.2018.1529612">36,000</a> new HIV infections, over half of them among young people. </p>
<p><a href="https://www.unaids.org/en/resources/documents/2016/Global-AIDS-update-2016">UNAIDS</a> and the <a href="http://www.hiv.org/tools/201243national-hiv-prevention-strategy-2015-2020">National AIDS Commission</a> reports show that only about 42% of young Malawians aged 15-24 years have accurate knowledge of HIV and AIDS. This is despite various efforts to inform people and change behaviour that could put people at risk of infection. Efforts have included mandatory sexuality education in schools and extracurricular interventions such as <a href="https://gogograndmothers.com/why-wait-schools">“Why wait”</a> and <a href="https://www.tfacafrica.com/">AIDS Toto</a>. These were intended to impart risk avoidance skills and knowledge to encourage abstinence, delayed sexual debut, condom use and faithfulness to one partner. </p>
<p>The question is why the intervention efforts are not having the <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4729-2">intended effect</a>. Is their relevance the problem, or is it implementation bottlenecks?</p>
<p>Against the background of this rising HIV incidence and disappointing behaviour change interventions, we <a href="https://www.tandfonline.com/doi/pdf/10.1080/17290376.2018.1529612">designed a study</a> to identify where the gap could be. We also wanted to explore alternative interventions within a sociocultural framework. </p>
<p>We got the help of adolescents themselves to design an intervention and then <a href="https://www.tandfonline.com/doi/full/10.1080/15381501.2019.1620664">tested</a> it to see whether it could work at a larger scale. This could be a useful part of efforts to address a combination of influences on behaviour, such as poverty and gender. </p>
<h2>What we did</h2>
<p>Our project, conducted in northern Malawi, had three phases. </p>
<p>In the <a href="https://www.tandfonline.com/doi/full/10.1080/17290376.2018.1529612">first phase</a>, we wanted to find out what effect knowledge about HIV had on the behaviour of adolescents. Specifically, we were looking at behaviour to limit the number of sexual partners, delay sexual initiation, practise abstinence and consistently use condoms.</p>
<p>We asked 552 girls and boys aged 11-19 to confidentially fill in questionnaires. We asked them whether they had sexual experience and what they knew about how HIV is transmitted and prevented. Of the respondents, 47.5% were sexually active. We found a weak link between knowledge about HIV and subsequent HIV risk reduction. This was <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.2010.01874.x">similar</a> to other <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1016/j.ijgo.2015.02.006">studies</a> that have found many people continue with risky sexual behaviours even when they have the facts about HIV. </p>
<p>One of the reasons, we found, is that young people get contradictory information from different sources. Or the emphasis is different from one source to another.</p>
<p>We also found that peer pressure was driving a lot of their risky behaviour. So, involving adolescents in designing research could help us get closer to what we need to know.</p>
<p>We then designed an alternative bottom-up model that would be more relevant to the context and culture. The risk reduction behavioural model we designed with young people’s help was also meant to suit a sub-Saharan African setting where resources are constrained. It needed to be cost-effective. </p>
<p>In the <a href="https://www.tandfonline.com/doi/abs/10.1080/15381501.2019.1620664">second phase</a>, we tested the peer education intervention. Some school goers were exposed to this HIV intervention. A control group were exposed to a different package of health information focusing on TB and malaria prevention that we also designed to parallel the intervention. </p>
<p>After eight months we found that the intervention group was 96% less likely to have sex than the control group. They were more than three times more likely to use condoms and less likely to have multiple sexual partners. No significant differences were registered on abstinence and the desire for medical male circumcision.</p>
<p>Lastly, we presented the model to stakeholders such as Population Service International, Livingstonia Synod AIDS Programme, Girls Empowerment Initiative, Plan International and World Vision Malawi to see whether it was acceptable and could be scaled up to the entire population of adolescents in Malawi. The stakeholders agreed that it had this potential. </p>
<h2>Our peer intervention</h2>
<p>Our model was an effort to shift intervention from knowledge alone to building risk reduction skills. Unlike previous programmes, we tailored our intervention in line with age categories of adolescents. This was because we found in the first phase that sexual behaviour dynamics differ between early and late adolescents. For instance, early adolescents (11-14 years) are mostly sexually inexperienced, but their late adolescent (15-19 years) counterparts are more likely to be sexually active. We therefore wanted to give early adolescents the skills to remain abstinent for longer. Older adolescents needed the skills to use condoms and be faithful to one partner.</p>
<p>The model is sociocultural and premised on Malawian socialisation and rites of passage. Young people are mainly modelled into their norms and values by older siblings and older children within the community acting as mentors and demonstrating expected cultural behaviour. Song and role modelling are often scripted to offer practical value. The model was a modification of such Malawian cultural traditions for context specificity, acceptability and sustainability.</p>
<p>When we tested the risk reduction model, we involved university students aged 18-23 years as facilitators and mentors in line with our cultural adaptation. This was based on sociocultural and social-learning theoretical frameworks to shift the focus of interventions towards underlying social and structural causes of behaviour – such as poverty and gender disparities. These are often ignored but are potential drivers of HIV infection among young people. </p>
<p>The older mentor involvement would mimic socialisation in communal sub-Saharan African settings. We also hoped that younger people would identify with the age group of the mentors and look up to them as achievers.</p>
<p>As recommended by adolescents themselves, we included some entertainment in our risk reduction model. </p>
<h2>Conclusions</h2>
<p>We believe that our intervention could improve HIV risk reduction outcomes among adolescents in Malawi and perhaps similar settings. Our study shows that interventions designed with the involvement of adolescent beneficiaries and which are specific to a context and culture have greater potential for HIV risk and incidence reduction. </p>
<p>We understand that designs are also shifting towards combination options which integrate various strategies. Most incorporate a structural component, to address not only the immediate determinants of sexual behaviour but also less direct ones like poverty and gender disparities.</p><img src="https://counter.theconversation.com/content/142865/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adamson S. Muula receives funding from the Malawi Government as Director of the Africa Center of Excellence in Public Health and Herbal Medicine (ACEPHEM) through a grant from the International Development Association (IDA).</span></em></p><p class="fine-print"><em><span>Marisen Mwale does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Underlying social and structural causes of behaviour - such as poverty and gender disparities - are often ignored. But these are potential drivers of HIV infection among young people.Marisen Mwale, Lecturer in Psychology, Mzuzu UniversityAdamson S. Muula, Professor of Epidemiology and Public Health, University of MalawiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200262019-07-16T14:49:41Z2019-07-16T14:49:41ZCan free schools in South Africa reduce HIV risk?<figure><img src="https://images.theconversation.com/files/283341/original/file-20190709-44457-1m4xjig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young girls play netball in an open field near King Williams Town.</span> <span class="attribution"><span class="source">EPA/Kim Ludbrook</span></span></figcaption></figure><p>South Africa has the largest HIV epidemic in the world. An estimated <a href="https://www.unaids.org/en/regionscountries/countries/southafrica">7.2 million</a> people are living with HIV and 4.4 million are on antiretroviral therapy. Despite the progress made, AIDS remains the <a href="https://www.unaids.org/en/resources/presscentre/featurestories/2015/august/20150812_PACT">leading cause of death</a> among adolescents. There were an estimated 270 000 new HIV infections in 2017. The rate is particularly high in young women between the ages of 15 and 24.</p>
<p>Risky sexual behaviour, such as failing to use a condom, or having sex <a href="https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-risk-from-alcohol-and-drug-use/alcohol-and-hiv-risk">while drunk or on drugs</a>, increases the risk of HIV infection. </p>
<p>In <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25262">our study</a>, we wanted to examine why adolescent girls are engaging in risky sexual behaviour. Is this behaviour driven by childhood adversity, such as poverty, coming from a family where someone is ill with HIV/AIDS, or exposure to violence and experiencing psychological distress? We also wanted to find out if a government policy such as free schooling has the potential to mitigate some, or all, of these drivers.</p>
<h2>Our study</h2>
<p>We interviewed 1 498 teenage girls between the ages of 10 and 17 in rural and urban areas in South Africa using a standardised questionnaire in 2011. We interviewed the same teenage girls again in 2012. </p>
<p>During both interviews we asked them about child abuse experience, exposure to domestic violence, numbers of days per week in which they did not have enough food in the home, and if a caregiver was ill with AIDS. We screened them for depression, anxiety and suicidal thoughts, measured their drug use, conduct, and peer relationships. We asked how often they did not use a condom during sex, or had sex with multiple partners or while they were drunk or using drugs. </p>
<p>We also measured if they received a free school meal or free text books and attended a no-fees school.</p>
<h2>This is what we found</h2>
<p>Our study showed that rates of childhood adversity were high in this study. We found that 34.3% of girls had a family member ill with HIV/AIDS. They reported an average of two days without sufficient food in the home and an average of three abusive events in their life.</p>
<p>The study also found that 12% did not always use condoms, 2% had sex while drunk or on drugs and 8% had multiple sexual partners in the past year. Of those interviewed, 71% received free schooling.</p>
<p>Our research showed that the association between childhood adversity and HIV risk behaviour is not direct. Instead, we found that increased vulnerability led to certain negative outcomes. These included internalised psychological distress in the form of suicidal thoughts, depression and anxiety, and externalised psychological distress in the form of drug and alcohol use, problems with behaviour and poor peer relationships. These pathways, in turn, heightened the probability that girls would engage in risky sexual behaviour. </p>
<p>These findings are important because they help us understand why girls have risky sex, and help us consider interventions that might help prevent this behaviour. They support and complement <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178106">existing</a> evidence that suggest <a href="https://journals.sagepub.com/doi/full/10.1177/0886260517752153">vulnerability</a> is an important driver of <a href="https://jiasociety.biomedcentral.com/articles/10.1186/1758-2652-14-25">risky sexual behaviour</a>.</p>
<p>And this is where free schooling may help. </p>
<h2>Free schooling</h2>
<p>South Africa introduced <a href="https://www.gov.za/education-no-fee-schools-2007">non-fee schools</a> in 2007 and the <a href="https://www.education.gov.za/Programmes/NationalSchoolNutritionProgramme.aspx">National School Nutrition Programme</a> for primary schools in 2004. This was extended to secondary schools in 2009. Learners in the poorest three-fifths of schools (so called three lowest quintiles) pay no school fees and receive a hot, nutritious meal. </p>
<p>To date, school feeding reaches 77% of learners in public schools, while 66% benefit from not paying <a href="http://rodra.co.za/images/countries/south_africa/research/P03182017%20household%20survey%20stats%20sa.pdf">tuition fees</a>. </p>
<p>Tentative evaluations of these two policies have shown a reduction in stunting, heightened levels of school enrolment in primary and secondary schools, and improved attendance and <a href="https://foodsecurity.ac.za/wp-content/uploads/2018/06/CoE-FS-WP4-School-Feeding-in-South-Africa-11-jun-18.pdf">educational outcomes</a>.</p>
<p>Our findings show additionally that receipt of free schooling directly reduces externalising psychological distress and mitigates the association between childhood adversity and internalising mental health distress; and thereby lessens HIV risk behaviour. </p>
<p>Further research may help us understand why this is the case. One possibility is that free schooling reduces hunger and worries about the <a href="https://link.springer.com/article/10.1007%2Fs40609-014-0022-9">ability to pay school fees</a>, thereby reducing psychological distress. Free schooling could also <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004676.pub2/abstract">increase attendance</a>, giving teenage girls the opportunity to make friends with peers and build support <a href="http://journals.sfu.ca/jmde/index.php/jmde_1/article/view/384">networks</a> .</p>
<p>Whatever the mechanisms, our findings suggest that free education in the forms of no-fees, free meals and text books appear important in promoting mental health among teenage girls in South Africa – and, in turn, reducing risky sexual behaviour.</p>
<hr>
<p><em>This article is based on a <a href="https://onlinelibrary.wiley.com/doi/10.1002/jia2.25262">paper</a> written in collaboration with Professor <a href="https://scholar.google.com/citations?user=nse86TsAAAAJ&hl=en">Mark Orkin</a> and Professor <a href="https://www.spi.ox.ac.uk/people/profile/cluver.html">Lucie Cluver</a> using data from the <a href="https://www.youngcarers.org.za">YoungCarers</a> study.</em></p><img src="https://counter.theconversation.com/content/120026/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Franziska Meinck has previously consulted for Frontline AIDS, Save the Children and the World Health Organization. This study was funded by the Economic and Social Research Council (UK) and the National Research Foundation (RES‐062‐23‐2068), the National Department of Social Development, the Claude Leon Foundation, the Nuffield Foundation (OPD/31598), the Health Economics and HIV/AIDS Research Division at the University of KwaZulu‐Natal (R14304/AA002), the John Fell Fund (103/757), the University of Oxford Impact Acceleration Account (1602‐KEA‐189, 1311‐KEA‐004, 1069‐GCRF‐227) and the Leverhulme Trust (PLP‐2014‐095). Franziska Meinck is funded by an ESRC Future Research Leader Award (ES/N01747/1). Franziska Meinck is a Counselor of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN).</span></em></p>Adolescent girls experience a number of vulnerabilities which incease their risk of engaging in risky sexual behaviours.Franziska Meinck, Lecturer in Social Work, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1117392019-02-25T14:15:08Z2019-02-25T14:15:08ZReligiosity, risky behaviour and young people: a South African case study<figure><img src="https://images.theconversation.com/files/258707/original/file-20190213-181589-183uodl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Religiosity is thought to influence positive health outcomes or behaviours.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Alcohol and other drug use and risky sexual behaviour remain high among adolescents across the globe. It’s <a href="https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf">estimated</a> that more than a quarter of 15 to 19 year-olds drink alcohol – 45% of these engage in heavy episodic or binge drinking. Nine out of 10 <a href="https://africacheck.org/wp-content/uploads/2018/10/3rd-Annual-Youth-Risk-Survey-2011.pdf">smokers</a> started by the age of 18. </p>
<p>The problem is acute in sub-Saharan Africa too, where risky sexual behaviour is a big challenge given the high HIV infection rates. </p>
<p>The question we set out to answer was: is frequency of engaging in religious activities and events – what we call religiosity – associated with these kind of behaviours? </p>
<p>To answer this question we looked at data collected in a <a href="http://www.mrc.ac.za/sites/default/files/files/2016-06-28/SurveySubstanceUseRiskBehaviours8-10LearnersWCprovince%202011.pdf">survey</a> done in 2011 of 20,227 learners in 240 public high schools in the Western Cape province of South Africa. Learners completed questionnaires about various aspects of their lives including past and current drug use and sexual behaviour. They also answered questions about how often they took part in religious services or activities. We made no distinction between types of religion because high religiosity can be evident regardless of religious affiliation.</p>
<p>We analysed the portion of learners who said they participated in religious activities, engaged in risky sexual behaviour, and used alcohol and other drugs in the past 30 days. Additionally, we looked at the association between religiosity, alcohol, other drug use and risky sexual behaviours.</p>
<p>We <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211322">found</a> that learners reporting high religiosity were significantly less likely to have consumed alcohol or used drugs in the previous 30 days. These learners were also less likely to engage in risky sexual behaviours.</p>
<p>Overall we found that nearly three quarters of learners reported attending religious activities at least once or twice per month. This was higher among female learners than male learners. </p>
<p>But our study design can’t tell with certainty whether there is a causal relationship between religiosity and alcohol and drug use and risky sexual behaviours. In other words we were unable to say with certainty whether being religious caused learners to abstain from these activities. What we do know is that there is an association between the two. </p>
<p>Our findings support <a href="https://www.ncbi.nlm.nih.gov/pubmed/23762764">a systematic review on religiosity, spirituality and health</a> which suggested that there’s a link between higher religious or spiritual beliefs and positive health behaviours. It looked at original research published in peer reviewed journals between 1872 and 2010. </p>
<h2>The role of religiosity</h2>
<p>One way religiosity is thought to influence positive health outcomes or behaviours is by imparting meaning, purpose in life, and peace of mind to individuals. A <a href="https://link.springer.com/article/10.1007%2Fs10943-017-0400-6">study</a> done in Brazil found that meaning and peace were associated with less stress and better quality of life. </p>
<p>This suggests that people with high religious involvement may be <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460313001792?via%3Dihub">less likely</a> to resort to the use of alcohol or drugs as coping mechanisms in stressful situations. </p>
<p>Religiosity also involves interaction and cohesion within groups where the social or religious norms typically <a href="https://www.ncbi.nlm.nih.gov/pubmed/18698380">discourage</a> engaging in behaviours that may be harmful or risky for health (such as avoiding drugs and alcohol) or may be considered to be morally unacceptable, such as <a href="https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/religion-religiosity-and-premarital-sexual-attitudes-of-young-people-in-the-informal-settlements-of-nairobi-kenya/04993D777038D5C7FAE0C48D8A8F3EAF">sex</a> before marriage. </p>
<h2>What Next</h2>
<p>Our study calls for further exploration of how religious practice could serve as one platform (among others) for alcohol, drug use and risky sexual behaviours interventions for young people. </p>
<p>A starting point could be to borrow a leaf from a faith-based HIV prevention <a href="https://journals.sagepub.com/doi/pdf/10.1177/00333549101250S102">intervention</a> in the US. The programme involved a number of activities that church leaders could choose from. These include getting trained to foster an environment in which young people can more openly talk about HIV and sexually transmitted infections.</p><img src="https://counter.theconversation.com/content/111739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel Msafiri Francis received funding from HIV Research Trust, UK</span></em></p><p class="fine-print"><em><span>Neo Morojele receives funding from the South African Medical Research Council, UK Medical Research Council and the International Development Research Centre and is affiliated to the Southern African Alcohol Policy Alliance.</span></em></p>Religiosity has been associated with lower alcohol, drug use and risky sexual behaviours in young people in the Western Cape.Joel Msafiri Francis, Epidemiologist, Wits Reproductive Health and HIV Institute, University of the WitwatersrandNeo Morojele, Chief Specialist Scientist : Alcohol Tobacco and Other Drug Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1070872018-12-06T22:35:10Z2018-12-06T22:35:10ZGay men who use crystal meth need integrated care<figure><img src="https://images.theconversation.com/files/249061/original/file-20181205-186082-1x9rh0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The growing trend of sexualised injection meth use — colloquially referred to as 'slamming' — is a growing public health concern due to the dual risk of transmission of HIV and other blood-borne viruses via both injection and sexual transmission. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The use of cheap and potent crystal methamphetamine (meth) is reaching a “<a href="https://www.thestar.com/news/canada/2018/10/28/inexpensive-crystal-meth-eclipsing-opioids-on-the-prairies.html">crisis point in Canada</a>” and <a href="https://journals.sagepub.com/doi/abs/10.1177/1057567717730104">globally,</a> replacing opioids as the drug of choice in some areas. </p>
<p>In media and policy conversations about this drug, one important population is often missed out: Gay, bisexual and other men who have sex with men (herein, referred to as gay and queer men).</p>
<p>Used alone or in combination with other substances, the sexualized use of meth is a practice often referred to as “chemsex” or “party n’ play.” It is <a href="https://doi.org/10.1177/0956462416642125">one of the key drivers of high and rising HIV rates</a> and other sexually transmitted infections. And meth use can lead to many other negative health outcomes, including depression, anxiety and suicide.</p>
<p>Unfortunately, there are limited options available for gay and queer men who want to quit or reduce their meth consumption. Most sexual health-care services do not offer specialized substance use services. Similarly, conventional substance use services do not consider how a patient’s sexuality or sexual behaviour may relate to their drug use patterns. </p>
<p>My research team at the <a href="http://www.bccsu.ca/">British Columbia Centre on Substance Use</a> recently published a systematic review offering compelling evidence that <a href="https://doi.org/10.1016/j.drugalcdep.2018.09.023">integrating sexual health services and substance use care for gay and queer men who use meth can work</a>. </p>
<p>We found that most of the effective strategies to integrate services rely on various counselling techniques — including those that centre around an individual’s internal motivations to change their substance use behaviour.</p>
<h2>‘Slamming’ and risky sex</h2>
<p>Meth use can result in a variety of negative health and psychosocial outcomes, including drug-induced psychosis, depression, suicide, anxiety and a tendency toward anti-social behaviour. </p>
<p>What makes this even more concerning is that as the illicit drug supply becomes increasingly contaminated with synthetic opioids such as fentanyl, there are more cases of overdose being reported by those using non-opioid-based substances, including meth.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Seized crystal meth is shown at a news conference at the RCMP headquarters in Surrey, B.C. in April 2018.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Jonathan Hayward)</span></span>
</figcaption>
</figure>
<p>While meth use is harmful to one’s health generally, using meth during sex can further compound the harms. Research indicates that <a href="https://sti.bmj.com/content/93/3/203">meth is often used by gay and queer men as a means to reduce anxiety and increase disinhibition, pleasure and sociability</a>. Gay and queer men who use meth often report engaging in sex practices that they would not otherwise choose, including having anal sex with multiple partners without condoms. </p>
<p>Some also report that the use of meth and other substances during sex can lead to situations in which they experienced sexual violence.</p>
<h2>London and Vancouver blaze the trail</h2>
<p>There are a few exceptional initiatives in major urban centres — for example the <a href="http://dean.st/">56 Dean Street Clinic in London</a> — that have been trying to address the harms associated with the sexualized use of substances. </p>
<p>In Canada, the Vancouver-based <a href="https://checkhimout.ca/">Health Initiative for Men</a> recently launched a <a href="https://whenthepartyisover.ca/">specialized service and information campaign</a> for those who use meth. The initiative now offers counselling specifically for those who use meth. It is also launching new harm reduction services for those who use substances, including a <a href="https://www.bccsu.ca/wp-content/uploads/2017/12/Drug-Checking-Evidence-Review-Report.pdf">drug checking service</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1036690666254942209"}"></div></p>
<p>Despite the positive findings from our review that show the value of integrating sexual health and substance use care, it is important to emphasize that effective treatment strategies for those who would like to reduce or stop their meth use remain elusive. </p>
<p>Unlike for opioid use disorder, there are no effective pharmaceuticals that one can take. Even psychosocial interventions such as counselling demonstrate moderate to limited efficacy, particularly for those who use meth regularly or heavily.</p>
<h2>Loneliness at the root</h2>
<p>Some researchers are looking towards new and innovative approaches to treating meth use. For example, the recent <a href="https://theconversation.com/ca/topics/marijuana-legalization-canada-2018-48796">legalization of recreational cannabis in Canada</a> may have important implications for those who wish to reduce or taper their meth use. </p>
<p>In our ongoing research, many of the young gay and queer men who report using meth have told us that they have reduced their meth use by using cannabis. </p>
<p>Nevertheless, cannabis is unlikely to be helpful for all gay and queer men who use meth, as we are also seeing that some of those using cannabis continue to report a variety of mental health problems, including anxiety, feeling paranoid and a tendency to isolate themselves.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For gay and queer men who use meth, complex motivations are often rooted in experiences of loneliness or violence.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The harms associated with meth use among gay and queer men are unlikely to be addressed via psychosocial interventions alone. While many countries like Canada have made profound advances in terms of improving human rights for LGBTQ people, we continue to see severe inequities with regards to social, mental and physical health outcomes compared to heterosexual and cisgender counterparts. </p>
<p>For gay and queer men who use meth, the motivations are complex and often rooted in experiences of <a href="https://slate.com/human-interest/2017/03/gay-loneliness-is-real-but-toxic-gay-cultures-isnt-the-problem.html">loneliness</a>, violence and other forms of trauma resulting from the social conditions of their lives, rather than the individual choices they make.</p><img src="https://counter.theconversation.com/content/107087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rod Knight holds funding from the Canadian Institutes of Health Research and is supported by a Scholar Award from the Michael Smith Foundation for Health Research.</span></em></p>The sexualized use of crystal meth by gay men is one of the key drivers of rising HIV rates and has many negative mental health consequences. Integrated sexual and substance use care is vital.Rod Knight, Assistant Professor of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/904842018-01-25T13:35:08Z2018-01-25T13:35:08ZAfter school clubs aren’t always safe spaces: what should be done about it<figure><img src="https://images.theconversation.com/files/202823/original/file-20180122-46235-1s57rnx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting involved in after-school sports can be positive, but it comes with risks too.</span> <span class="attribution"><span class="source">Reuters/David Gray</span></span></figcaption></figure><p>Young people around the world are encouraged to get involved in extracurricular activities. These range from choirs and drama clubs to sports teams, with many other options available depending on the school. These activities are important for several reasons.</p>
<p>Sports and other physical activities, such as drama clubs, <a href="https://www.researchgate.net/publication/251678774_Extracurricular_sport_participation_A_potential_buffer_against_social_anxiety_symptoms_in_primary_school_children">support</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16802902">the development</a> of young people into healthy adults. For parents who work long days, these activities are a productive way to keep their children busy when nobody is at home to supervise them. Finally, these activities often differ from what children are taught in class, so they encourage new interests beyond school work.</p>
<p>But, as research I’ve just published with my colleagues <a href="http://www.tandfonline.com/doi/full/10.1080/02673843.2017.1423505">shows</a>, after school clubs can also be risky environments because they’re not always properly supervised. This can present opportunities for risky sexual behaviour and drug use. Our study focused on South Africa, and bears out an extensive global body of research that’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/27565582">found an association</a> between young people’s participation in sport and their use of drugs and alcohol.</p>
<p>South Africa’s Department of Sports and Recreation <a href="http://www.kzndsr.gov.za/LinkClick.aspx?link=GIS/Participation+patterns+in+sport+and+recreation+activities+in+SA.pdf">has found</a> that 51.7% of the country’s young people participate in sports and recreational activities.</p>
<p>This is not to suggest that after-school clubs and teams should be scrapped in South Africa. Rather, greater supervision is needed; parents need to get more involved so they know exactly what their children are doing in their after-school time and policies must be created that better monitor and evaluate extracurricular activities. </p>
<h2>Risky business</h2>
<p>Risky behaviour, including sexual and illicit drug use, have devastating health consequences. Some of these relate to health: young women may fall pregnant and contracting HIV is a real risk especially in a country with such <a href="https://www.statssa.gov.za/publications/P0302/P03022015.pdf">high prevalence rates</a> of the disease.</p>
<p>There’s also a real risk of young people becoming addicted to drugs or alcohol.
They may also be separated from their families, lose out on future and current employment or even end up in jail.</p>
<p>To many parents, after-school activities are a way to prevent their children from engaging in risky behaviour. The idea is that if youth are kept “busy” during their leisure periods they will not have time to experiment in these behaviours. They also believe that their kids will benefit from the social interaction and physical exercise. And research <a href="https://www.researchgate.net/publication/251678774_Extracurricular_sport_participation_A_potential_buffer_against_social_anxiety_symptoms_in_primary_school_children">has confirmed</a> that these benefits exist.</p>
<p>But after-school clubs are not always entirely safe. They can be spaces where young people try their first cigarette or experiment with alcohol for the first time.</p>
<p>Our study concentrated on young people aged between 10 and 22 – in South Africa, it’s not unusual for those <a href="https://www.ncbi.nlm.nih.gov/pubmed/19248721">aged between 18 and 22</a> to still be in the secondary school system. This is usually because of prolonged absence through illness, the responsibility of caring for an ill relative, pregnancy and grade repetition.</p>
<p>Our statistical analysis of the <a href="http://www.cjcp.org.za/uploads/2/7/8/4/27845461/monograph_6_-_running_nowhere_fast_-_2008_youth_lifestyle.pdf">South African Youth Lifestyle Survey 2009</a> controlled for a number of factors. These included age, sex, race, whether they lived in an urban or rural area, the number of income earners in the household, food security in the household and whether or not the youth had set goals for their future. </p>
<p>We found an association between sports participation and youth group involvement and risky sexual behaviour as well as illicit drug use. The risks were higher for females and those who live in the country’s rural areas; they were lower for those who’d identified predefined goals for their future and those involved in choirs or drama groups. </p>
<h2>Finding solutions</h2>
<p>Several things can be done to tackle the issues raised in our research. For starters, there’s a clear need for better supervision and organisation of after-school activities so that they don’t become enabling environments for risky behaviour.</p>
<p>Young people who participate in sports and other clubs should not be left unattended. And supervisors, coaches and other authority figures should be monitored to ensure that they’re not allowing anyone to engage in risky behaviour on their watch. </p>
<p>Parent involvement is also key. Parents should attend practices and events to meet the people who supervise these clubs, and ask their children about their activities. Of course, it can be tough for parents who work long hours to make time for this; other adult relatives could be asked to get involved here.</p>
<p>National policies and programmes also need to be aware of these issues. Policymakers must broaden their scope to include the monitoring and evaluation of after-school programmes. </p>
<p>This will allow South Africa to protect its young people from peer and adult pressure to engage in acts which risk their health and social well-being.</p><img src="https://counter.theconversation.com/content/90484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole De Wet receives funding from the National Research Foundation Thuthuka Post-Doc Grant.</span></em></p>When after-school clubs aren’t properly monitored, they can become risky spaces.Nicole De Wet- Billings, Senior Lecturer, Demography and Population Studies, Schools of Social Sciences and Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/693112016-11-29T18:06:14Z2016-11-29T18:06:14ZFacebook use and risky sex in Swaziland: unpacking the relationship<figure><img src="https://images.theconversation.com/files/147937/original/image-20161129-10969-18h5v45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is a link between online social networking technologies and increased risky sexual behaviour.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Young Swazi adults who spend a significant amount of time on Facebook and have previously had sex with someone they met on the popular social networking site are likely to have several partners, according to <a href="http://dx.doi.org/10.2989/16085906.2016.1171790">a study</a> we conducted in Swaziland. </p>
<p>The backdrop to the survey was that Swaziland has identified multiple sexual partners as a major risk factor in the transmission of HIV. Swaziland has the <a href="https://www.cdc.gov/globalhealth/countries/swaziland/">highest HIV infection rate</a> in the world. In 2015 about <a href="http://www.unaids.org/en/regionscountries/countries/swaziland">28% of people</a> between the ages of 15 and 49 were HIV positive in Swaziland. The country has a population of 1.3 million people. </p>
<p>As a key strategy to manage the pandemic Swaziland’s Ministry of Health has <a href="http://www.infocenter.nercha.org.sz/sites/default/files/PreventionPolicy.PDF">prioritised policies</a> to try and reduce the number of people who have multiple sexual partners – and particularly concurrent multiple partners. This has been identified as a <a href="http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/SwazilandMOT22March09Final.pdf">key risk factor</a> in the spread of HIV, particularly because <a href="http://www.k4health.org/sites/default/files/Swaziland_MoT_Country_Synthesis_Report_22Mar09.pdf">studies</a> show that heterosexual sex is responsible for 94% of new infections in the country. </p>
<p>We chose to focus on Facebook users because the uptake of social media has increased dramatically in the country with the arrival of <a href="http://www.impactoftheinternet.com">low-cost mobile telephones</a>. <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062271">Studies</a> conducted in the developed world have shown that online social networking technologies have been linked to increased risky sexual behaviour.</p>
<p>Our study looked at what kind of risky sexual behaviour is displayed by people who use social network sites. The hope is that the findings could inform policy. </p>
<h2>Finding the right people</h2>
<p>Fifty four million of Facebook’s <a href="https://www.statista.com/statistics/264810/number-of-monthly-active-facebook-users-worldwide/">more than 1.7 billion active users</a> live in Africa. </p>
<p>When we conducted our study an estimated <a href="https://www.socialbakers.com/statistics/facebook/pages/total/swaziland/">63 720 people in Swaziland</a> were using Facebook. This accounted for about 8.3% of the population aged 15 years and older.</p>
<p>To evaluate the trends in a statistically significant study we needed a sample size of 2,000 people. We randomly selected 2,000 participants whom we contacted through the social media site. Only Swazi citizens who were Facebook users, 18 years or older and had displayed their full surnames publicly on the social networking site were considered. </p>
<p>To develop a culturally sound questionnaire we conducted focus group interviews on a range of topics. These included HIV and AIDS, people’s activities on Facebook, opinions and experiences of finding sexual partners on Facebook and general sexual behaviour. </p>
<p>This questionnaire included:</p>
<ul>
<li><p>the number of sexual partners participants had had in the 12 months leading up to the study, </p></li>
<li><p>whether they had used a condom the last time they’d had sex, </p></li>
<li><p>whether they thought their steady partner had other sexual partners,</p></li>
<li><p>how much time they spent on Facebook each day, </p></li>
<li><p>their sexual experience with people they met on Facebook, and </p></li>
<li><p>whether they would use a health information Facebook page.</p></li>
</ul>
<h2>Study findings</h2>
<p>Responses to the questionnaires showed that just over 80% of the men and women in the survey were sexually active. Over two thirds were between 20 and 29 years old and were not married. </p>
<p>Many of the participants said they found it easier to initiate a romantic conversation on Facebook than face-to-face. As a result they spent more time on Facebook. </p>
<p>A significant proportion of our study population admitted that they’d had sex with someone they had met on Facebook – and that they had had several partners at the same time.</p>
<p>For the purposes of the study we defined “someone met on Facebook” as someone participants had spoken to on Facebook for the first time. This included people they knew as well as strangers. <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.700.1797&rep=rep1&type=pdf">Studies</a> have shown that up to a quarter of Facebook users accept friend requests from strangers.</p>
<p>Although we were able to identify important factors associated with multiple sexual partners, our study did not delve into how people used Facebook to transform relationships into sexual ones.</p>
<h2>Changing the landscape</h2>
<p>Our study also showed that Facebook has the potential to be used as a channel for health communication. Most of the participants with multiple sexual partners were willing to use a health communication Facebook page if it became available. </p>
<p>This suggests that policies to reduce the number of multiple sexual partners in the country could include these kinds of promotions. </p>
<p>As Facebook use among young people continues to expand people’s sexual networks are likely to increase. This potentially places young people at a high risk of HIV infection. HIV prevention programmes should therefore be designed with deliberate social media strategies.</p><img src="https://counter.theconversation.com/content/69311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bhekumusa Lukhele does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Online social networking technologies have been linked with increased risky sexual behaviour – and Swaziland is no different.Bhekumusa Lukhele, PhD candidate and teaching assistant, Kyoto UniversityLicensed as Creative Commons – attribution, no derivatives.