By Kennedy Kipkoech Mutai , Jack Stone , Andrew Scheibe , Hannah Fraser , Leigh F. Johnson , Peter Vickerman 

  Background: Illicit drug use results in considerable global morbidity, but there is little data on its trends and factors associated with it in sub-Saharan Africa. We consider these questions using national data from South Africa for 2002–2017. Methods: We analysed data among individuals aged 15 years or older from five national population-based household surveys in South Africa (2002–2017; n = 89,113). Recent drug use was defined as the last three- months use of illicit drugs, i.e., any use of cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens, opioids, and/or other illicit drugs. Time trends in recent drug use were assessed using logistic regression. Multivariable logistic regression assessed the association between recent drug use and socio-demographic factors and between drug use and sexual risk behaviours, HIV-related and other well-being variables. Results: The prevalence of recent drug use increased from 1⋅5% to 10⋅0% from 2002 to 2017, driven by increases in cannabis use (1⋅5% to 7⋅8%) and use of opioids (0⋅01% to 1⋅6%), cocaine (0⋅02% to 1⋅8%), or amphetamines (0⋅1% to 1⋅5%). In adjusted analyses, male gender, younger age, living in urban areas, mixed-ancestry or white ethnicity (compared to black-African), and unemployment were positively associated with recent drug use. Recent drug use was associated with: multiple sexual partners (adjusted odds ratio [aOR] 2⋅13, 95% confidence interval [CI]: 1⋅80–2⋅51); sexual debut before 15 years old (aOR 1⋅70, 95%CI: 1⋅29–2⋅23); hazardous/harmful alcohol use (aOR 2⋅50, 95%CI: 2⋅14–2⋅93) or alcohol dependence (aOR 3⋅33, 95%CI 2⋅92–3⋅80); ever experiencing intimate partner violence (aOR 1⋅56, 95%CI 1⋅12–2⋅17); psychological distress (aOR 1⋅53, 95%CI: 1⋅28–1⋅82); and lower chance of ever testing for HIV (aOR 0⋅89, 95%CI 0⋅80–1⋅00). Recent drug use was not associated with HIV positivity, condom use or being on antiretroviral therapy. Conclusion: Illicit drug use has increased substantially in South Africa and is associated with numerous socio- demographic characteristics, higher sexual risk behaviours and other well-being variables.

www.sciencedirect.com/science/article/pii/S0955395924000379  

  International Journal of Drug Policy 125 (2024) 104352