| Summary: | Thesis (PhD)--Stellenbosch University, 2013. === ENGLISH ABSTRACT: HIV infection, substance abuse, and psychiatric disorders are major public health
issues in South Africa. Psychiatric disorders and substance-use disorders together
have a negative impact on the health outcomes of people living with HIV and AIDS
(PLWHA), such as poor adherence to anti-retrovirals (ARVs), HIV disease
progression, lower CD4 counts, vulnerability to opportunistic infections, high viral
loads, possible drug resistance, and an earlier onset of death. The overall aim of this
study was to investigate the relationship between substance abuse practices and the
health status and health behaviour of patients attending HIV clinics in the Cape
Metropole.
The study used a cross-sectional study design for collecting data on hazardous or
harmful use of alcohol and problematic drug use, demographic information and
health status among patients attending eight HIV clinics in the Cape Metropole. A
sub-sample of patients were assessed on the following domains: depression,
psychological distress, psychopathology, post-traumatic stress disorder (PTSD),
risky sexual behaviour, adherence to ARVs, levels of resilience, levels of social
support and patient’s work, family and social functioning. Of the 608, 10% of
consecutively selected patients completed an additional psychiatric diagnostic
interview (Mini International Neuropsychiatric Interview).
The main findings to emerge from this study are:
1. Patients reporting hazardous or harmful use of alcohol and/or drug use are
significantly more likely to be non-adherent to ARVs and have lower CD4 counts
than their non-substance abusing counterparts 2. Hazardous or harmful use of alcohol has a direct influence on CD4 count
resulting in lower CD4 counts and participants being less likely to be on ARVs.
3. Hazardous or harmful use of alcohol has a direct relationship in predicting
tuberculosis (TB).
4. Hazardous or harmful users of alcohol and/or problematic drug users are more
likely to report psychological distress (anxiety and depression), depression and
low levels of family support than their non-using counterparts.
5. Participants who met the criteria for major depression are significantly more likely
to be non-adherent to ARVs.
6. Gender, depression, psychological distress, and PTSD were found to be
significant determinants of hazardous or harmful use of alcohol.
7. Psychological distress (anxiety and depression) is significant in directly predicting
ARV non-adherence.
8. Male participants and those who stopped taking their ARVs were more likely to
have lower CD4 counts than female participants and those who did not stop.
9. PTSD was found to predict psychological distress indicating that participants who
experienced trauma were more likely to suffer from psychological distress
(anxiety and depression) compared to those who did not experience any PTSD.
Participants with lower levels of family support were more likely to suffer from
psychological distress than those with high levels of family support. === AFRIKAANSE OPSOMMING: MIV infeksie, dwelmmisbruik en geestesversteurings is groot gesondheidskwessies
in Suid-Afrika. Geestesversteurings en dwelmmisbruik het gesamentlik 'n negatiewe
uitwerking op die gesondheid van mense wat met MIV en VIGS saamleef (PLWHA),
soos byvoorbeeld nie-nakoming in die gebruik van antiretrovirale (ARV’s), MIVsiekteverloop,
laer CD4-tellings, vatbaarheid vir opportunistiese infeksies, hoë virale
ladings, moontlike weerstand teen medikasie en 'n verkorte leeftyd. Die
oorkoepelende doel van hierdie studie was om die verhouding tussen dwelmmisbruik
en die gesondheidstatus en -gedrag van pasiënte wat MIV klinieke in die Kaapse
Metropool besoek, te bestudeer.
Die studie het 'n deursnee-ontwerp gebruik om data in te samel oor die nadelige en
gevaarlike gebruik van alkohol en problematiese dwelmgebruik, demografiese
inligting, en die gesondheidstatus onder pasiënte wat agt MIV klinieke in die Kaapse
Metropool besoek het. 'n Subgroep pasiënte geassesseer op die volgende gebiede:
depressie, psigologiese angsversteuring, psigopatologie, posttraumatiese
stresversteuring (PTSV), riskante seksuele gedrag, nakoming in die gebruik van
ARV’s, weerstandigheidsvlakke , vlakke van sosiale ondersteuning, asook pasiënte
se werk, familie en sosiale funksionering. Van die 608 deelnemers is 10% van die
pasiënte opeenvolgend geselekteer om 'n addisionele diagnostiese psigiatriese
onderhoud te ondergaan (Mini International Neuropsychiatric Interview).
Die vernaamste bevindinge wat uit die studie gekom het, is:
1. Pasiënte wat nadelige en gevaarlike gebruik van alkohol en/of dwelms rapporteer
is beduidend meer geneig om nie die gebruik van ARV’s na te kom nie, en het
laer CD4-tellings as hulle eweknieë wat nie dwelms misbruik nie. 2. Die nadelige en gevaarlike gebruik van alkohol het 'n direkte invloed op CD4-
tellings wat lei tot laer CD4-tellings en dat pasiënte minder geneig is om op
ARV’s te wees.
3. Die nadelige en gevaarlike gebruik van alkohol hou direk verband met die
voorspelbaarheid van tuberkulose (TB).
4. Nadelige en gevaarlike gebruikers van alkohol en/of problematiese
dwelmgebruikers, is meer geneig om psigologiese angsversteurings (angs en
depressie), depressie, en laer vlakke van familieondersteuning te rapporteer as
hul niegebruiker-eweknieë.
5. Deelnemers wat aan die kriteria vir ernstige depressie voldoen, is aansienlik
meer geneig tot nie-nakoming in die gebruik van ARV’s.
6. Daar is gevind dat geslag, depressie, psigologiese angs en PTSV beduidende
bydraende faktore is tot die nadelige en gevaarlike gebruik van alkohol.
7. Psigologiese angsversteurings (angs en depressie) is beduidend om direk die
nie-nakoming van ARV’s te voorspel.
8. Manlike deelnemers en diegene wat hul ARV’s gestaak het, was meer geneig om
laer CD4-tellings te hê as vroulike deelnemers en diegene wat nie die gebruik
van medikasie gestaak het nie.
9. Daar is gevind dat PTSV psigologiese angs voorspel het wat aandui dat
deelnemers wat trauma ondervind het, meer geneig was om aan psigologiese
angsversteurings (angs en depressie) te ly in vergelyking met diegene wat geen
PTSV ervaar het nie. Deelnemers met laer vlakke van familieondersteuning was
meer geneig om aan psigologiese angsversteurings te ly as diegene met hoë
vlakke van familiebystand.
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