assignment attached - it is actually Anthropology 7 questions!
Seediscussions,stats,andauthorprofilesforthispublicationat:https://www.researchgate.net/publication/281291679 CorrelatesofMandraxuseandcondombeliefsin preventingsexuallytransmittedinfections amongacohortofSouthAfricanprisoninmates Article·August2015 DOI:10.1093/inthealth/ihv048 CITATION 1 READS 99 6authors,including: TorranceTStephens ClarkAtlantaUniversity 83PUBLICATIONS1,720CITATIONS SEEPROFILE SibusisoSifunda HumanSciencesResearchCouncil(HSRC) 34PUBLICATIONS188CITATIONS SEEPROFILE Allin-textreferencesunderlinedinbluearelinkedtopublicationsonResearchGate, lettingyouaccessandreadthemimmediately. Availablefrom:TorranceTStephens Retrievedon:19July2016 Correlates of Mandrax use and condom beliefs in preventing sexually transmitted infections among a cohort of South African prison inmates Torrance T. Stephensa,*, Darius Gardnera, Keena Jonesa, Sibusiso Sifundab,c, Ronald Braithwaited and Selina E. Smithe aDepartment of Psychology, Clark Atlanta University, Atlanta, Georgia, USA; bHIV/AIDS, STIs and TB (HAST), Human Sciences Research Council, Pretoria, South Africa; cWalter Sisulu University, Centre for Global Health Research, Mthatha, South Africa; dDepartment of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA; eDepartment of Family Medicine, Georgia Regents University, Augusta, Georgia, USA *Corresponding author: Tel: +1 404 880-8236; E-mail:
[email protected] Received 24 October 2014; revised 18 May 2015; accepted 19 May 2015 Background: This study was designed to identify the extent to which self-reported Mandrax use impacts condom-use beliefs amongst South African prison inmates. Methods: Participantswere inmates from four prisons in the provinces of KwaZulu-Natal andMpumalanga. In total, 357 inmates participated in the parent study of which 121 are included in this analysis based on their self-reported use of Mandrax. The questionnaire was developed in English, translated into Zulu, and back translated into English. Age significantly predicted the use of Mandrax: younger prison inmates reported higher use. Linear regression ana- lysis was conducted to determine whether the use of Mandrax was associated with length of incarceration and other demographic variables, as well as participants’ self-reported condom use beliefs behavior. Results: Regression results indicated that two factors operationalizing condom-use beliefs were impacted by Mandrax use: 1) it is important to use condoms every time you have sex (p<0.01); 2)="" condoms="" work="" well="" to="" prevent="" the="" spread="" of="" hiv=""><0.02). both factors were also inversely related to mandrax use. conclusion: sti prevention programs among prison inmates that seek to promote safer sex behaviors amongmen must address attitudes to condom use, specifically consistent and correct use of latex condoms and reducing substance misuse. keywords: condom use, drug use, mandrax, prison inmates, south africa introduction it is well documented that sexual risk taking and increased risk for stis is strongly associatedwith substance use.1–6this is particularly apparent among incarcerated populations, which also display substance use as common problem behavior. in fact, research has noted the association between incarcerated populations’ history of substance use and increased risk for stis such as hiv due to low levels of condom use among male inmates.1,7–9 although substance use patterns vary according to assorted demographic factors and the substance used, there is limited information on how specific substances like mandrax impact beliefs about risk taking and condom use among prison inmate populations, especially in africa. most of the knowledge base regarding condom-use beliefs and drug use has been derived from studies conducted in high income countries.10–12studies that have specifically targeted african prison inmate populations have either taken a holistic purview of sub- stance use13,14 or have focused on individual drugs such as mari- juana.15 given that the lifestyles and socio-economic conditions of high income countries vary from african countries, additional research is needed to examine the impact of substance use prac- tices on sexual risk taking. moreover, studies need to examine these issues in the context of drugs thatmay be specific to different geographic regions. in south africa, one such substance is the sedative mandrax. mandrax is a synthetic drug that is made and processed in tablet form. the active ingredient in mandrax is meth- aqualone. the tablet is usually crushed and mixed with marijuana and smoked in a pipe. the use of mandrax among african populations has been docu- mented among male and female heroin injection drug users in tanzania,16 outpatients attending rural and urban health centres in kenya17 and secondary school students in south africa.18 research has shown significant differences in use between men and women © the author 2015. published by oxford university press on behalf of royal society of tropical medicine and hygiene. all rights reserved. for permissions, please e-mail:
[email protected]. o r ig in a l a r ti cl e int health doi:10.1093/inthealth/ihv048 1 of 6 international health advance access published august 27, 2015 by guest on a ugust 28, 2015 http://inthealth.oxfordjournals.org/ d ow nloaded from in south africa, and that its use is a significant predictor of hiv risk behaviors.19 when mixed with marijuana and smoked by adoles- cents in south africa, it is a strong correlate of suicide ideation.18 taiwo and goldstein observed that nearly 4% of a random sample of grade 7–12 students reported using the substance.20 research also suggests that smoking mandrax and marijuana in combination is amajor predictor of individuals defaulting frommultidrug-resistant tuberculosis treatment.21 additional studies have shown that the use of mandrax is problematic and a serious health risk concerning increasing risk for contracting and spreading stis including hiv,22 thus another reason for examining its relationship to condom use associated beliefs and behaviour.19–25 it is well documented that cannabis andmandrax abuse in com- bination is unique to south africa, the abuse of these drugs mainly occurs in the form of inhalation by smoking although it can be swal- lowed or injected.26 within a fewminutes of smoking mandrax, the user usually feels relaxed, calm and peaceful although some may feel aggressive as the effects of the drug start wearing off.27,28 the effects last for several hours during which the user will have a dry mouth and very little appetite. some users will have slurred speech, nausea, stomach pains and exhibit red, glazed or puffy eyes, especially if the mandrax is taken together with cannabis.29 when used on its own, mandrax is a cns depressant employed to reduce stress and anxiety.30 it is not uncommon for individuals to increase usage in order to achieve the same effects as before, which is an indicator of an addiction developing. depression, insom- nia, anxiety and irritability, headaches, restlessness and eating problemsare also commonamongusers.26–29one study investigat- ing the prevalence of recent drug use among 1050 individuals arrested by the police in south africa revealed that 45% tested positive for at least one drug (mainly cannabis or mandrax).31 significantly, none of the studies accounted for in the literature investigated mandrax use among prison inmates or the possibility of it being a contributing factor to sti risk practices among this population. studies published to date which examine substance use in the context of hiv and sti risk behaviors have targeted inmate populations outside of south africa and have not specific- ally studied the relationship between condom use beliefs and mandrax.32–35 this is a significant area for investigation given recent reports of increase in the demand for treatment of patients in trauma units who test positive for cannabis and/or mandrax, since a high proportion of these cases involve cannabis and mandrax-positive arrestees.22 condomuse behavior and beliefs are essential in sti risk reduc- tion and prevention.9,36 consequently, intervention efforts have focused on increasing condom use among people from high risk groups. the literature supports the premise that people who are at the greatest risk of stis come from high risk populations and tend to give an account of inconsistent or low levels of condom use.37–39 empirical support for such low levels of condom use among prison inmate populations is limited although there are a number of reasons documented for other high risk populations.36,38,39 thus examining how the use of mandrax may likely impact condom use beliefs among south african prison inmates is important if health education interventions are to be designed to engender efficacious behaviors to reduce sti risk for this popu- lation, based on increased and consistent condom use. with this understanding, the purpose of this analysis was to conduct an exploratory study designed to identify the extent to which self- reported mandrax use impacts condom use beliefs among a sample of south african prison inmates. methods study setting and participants study participants were inmates from four prisons in the provinces of kwazulu-natal and mpumalanga. all were randomly selected to participate in the study. the aforementioned prisons were clas- sified as medium-sized, medium-security facilities. the sites were selected based on the need to follow participants after being released from prison to their communities, as the intervention was a long-term 12 month cohort study. in total, 357 inmates participated in the parent study of which 121 are included in this analysis based on their self-reported use of mandrax. the general inclusion criteria for participants was that they had to be pre-release male inmates aged 18 years or older, who were scheduled to be released from prison within 3months of receiving the intervention program. prior to this investigation, institutional review board approval was obtained from the south african medical association ethics review committee (samarec) and informed consent was obtained from those who volunteered to take part in this study. the questionnaire was interviewer adminis- tered as most prison inmates had very low literacy levels. participants reported their age, ethnicity, years of formal education, number of years’ incarcerated, prior arrests, and marital status. the questionnaire was developed in english, translated into zulu and back translated into english by a team of research assis- tants who were involved in the project as data collectors and health educators. it was administered either in english (in the prisons in mpumalanga province) or in zulu (in the prisons in kwazulu-natal province). description of the study intervention the curriculum used for the study intervention was adapted and developed from the work of researchers who had engaged in a similar project with offenders in the usa.40 four former prison inmates were recruited and underwent training as peer educators to conduct the training sessions in the prisons. two of the peer edu- catorswere hiv-positive and had to disclose their status to the par- ticipants in their intervention group.41 they had agreed to do this during their recruitment interview. the training process also pro- vided another opportunity to fine tune the intervention. preliminary qualitative studieswere conducted by the south african correction- al system and provided vital information for tailoring the interven- tion to black african male inmates and to capture the cultural and socioeconomic context and prison experience of south africa.41 in each of the participating sites, 12 sessions were conducted during a period of 6 weeks, with each session lasting 1.5 h for a total of 18 h for the full intervention. the curriculum covered the following topics: 1) hiv and aids; 2) stis; 3) nutrition and tb pre- vention and management; 4) alcohol and other drug abuse; 5) sexuality and gangsterism; 6) manhood and general life skills. all sessions were planned between 09:00 and 12:00 h in the educational section of all the participating prisons. two health educators who had no prior history of incarceration conducted all the sessions for the control groups. participants in the control arm of the experiment were shown a series of videos covering t. t. stephens et al. 2 of 6 by guest on a ugust 28 both="" factors="" were="" also="" inversely="" related="" to="" mandrax="" use.="" conclusion:="" sti="" prevention="" programs="" among="" prison="" inmates="" that="" seek="" to="" promote="" safer="" sex="" behaviors="" amongmen="" must="" address="" attitudes="" to="" condom="" use,="" specifically="" consistent="" and="" correct="" use="" of="" latex="" condoms="" and="" reducing="" substance="" misuse.="" keywords:="" condom="" use,="" drug="" use,="" mandrax,="" prison="" inmates,="" south="" africa="" introduction="" it="" is="" well="" documented="" that="" sexual="" risk="" taking="" and="" increased="" risk="" for="" stis="" is="" strongly="" associatedwith="" substance="" use.1–6this="" is="" particularly="" apparent="" among="" incarcerated="" populations,="" which="" also="" display="" substance="" use="" as="" common="" problem="" behavior.="" in="" fact,="" research="" has="" noted="" the="" association="" between="" incarcerated="" populations’="" history="" of="" substance="" use="" and="" increased="" risk="" for="" stis="" such="" as="" hiv="" due="" to="" low="" levels="" of="" condom="" use="" among="" male="" inmates.1,7–9="" although="" substance="" use="" patterns="" vary="" according="" to="" assorted="" demographic="" factors="" and="" the="" substance="" used,="" there="" is="" limited="" information="" on="" how="" specific="" substances="" like="" mandrax="" impact="" beliefs="" about="" risk="" taking="" and="" condom="" use="" among="" prison="" inmate="" populations,="" especially="" in="" africa.="" most="" of="" the="" knowledge="" base="" regarding="" condom-use="" beliefs="" and="" drug="" use="" has="" been="" derived="" from="" studies="" conducted="" in="" high="" income="" countries.10–12studies="" that="" have="" specifically="" targeted="" african="" prison="" inmate="" populations="" have="" either="" taken="" a="" holistic="" purview="" of="" sub-="" stance="" use13,14="" or="" have="" focused="" on="" individual="" drugs="" such="" as="" mari-="" juana.15="" given="" that="" the="" lifestyles="" and="" socio-economic="" conditions="" of="" high="" income="" countries="" vary="" from="" african="" countries,="" additional="" research="" is="" needed="" to="" examine="" the="" impact="" of="" substance="" use="" prac-="" tices="" on="" sexual="" risk="" taking.="" moreover,="" studies="" need="" to="" examine="" these="" issues="" in="" the="" context="" of="" drugs="" thatmay="" be="" specific="" to="" different="" geographic="" regions.="" in="" south="" africa,="" one="" such="" substance="" is="" the="" sedative="" mandrax.="" mandrax="" is="" a="" synthetic="" drug="" that="" is="" made="" and="" processed="" in="" tablet="" form.="" the="" active="" ingredient="" in="" mandrax="" is="" meth-="" aqualone.="" the="" tablet="" is="" usually="" crushed="" and="" mixed="" with="" marijuana="" and="" smoked="" in="" a="" pipe.="" the="" use="" of="" mandrax="" among="" african="" populations="" has="" been="" docu-="" mented="" among="" male="" and="" female="" heroin="" injection="" drug="" users="" in="" tanzania,16="" outpatients="" attending="" rural="" and="" urban="" health="" centres="" in="" kenya17="" and="" secondary="" school="" students="" in="" south="" africa.18="" research="" has="" shown="" significant="" differences="" in="" use="" between="" men="" and="" women="" ©="" the="" author="" 2015.="" published="" by="" oxford="" university="" press="" on="" behalf="" of="" royal="" society="" of="" tropical="" medicine="" and="" hygiene.="" all="" rights="" reserved.="" for="" permissions,="" please="" e-mail:=""
[email protected].="" o="" r="" ig="" in="" a="" l="" a="" r="" ti="" cl="" e="" int="" health="" doi:10.1093/inthealth/ihv048="" 1="" of="" 6="" international="" health="" advance="" access="" published="" august="" 27,="" 2015="" by="" guest="" on="" a="" ugust="" 28,="" 2015="" http://inthealth.oxfordjournals.org/="" d="" ow="" nloaded="" from="" in="" south="" africa,="" and="" that="" its="" use="" is="" a="" significant="" predictor="" of="" hiv="" risk="" behaviors.19="" when="" mixed="" with="" marijuana="" and="" smoked="" by="" adoles-="" cents="" in="" south="" africa,="" it="" is="" a="" strong="" correlate="" of="" suicide="" ideation.18="" taiwo="" and="" goldstein="" observed="" that="" nearly="" 4%="" of="" a="" random="" sample="" of="" grade="" 7–12="" students="" reported="" using="" the="" substance.20="" research="" also="" suggests="" that="" smoking="" mandrax="" and="" marijuana="" in="" combination="" is="" amajor="" predictor="" of="" individuals="" defaulting="" frommultidrug-resistant="" tuberculosis="" treatment.21="" additional="" studies="" have="" shown="" that="" the="" use="" of="" mandrax="" is="" problematic="" and="" a="" serious="" health="" risk="" concerning="" increasing="" risk="" for="" contracting="" and="" spreading="" stis="" including="" hiv,22="" thus="" another="" reason="" for="" examining="" its="" relationship="" to="" condom="" use="" associated="" beliefs="" and="" behaviour.19–25="" it="" is="" well="" documented="" that="" cannabis="" andmandrax="" abuse="" in="" com-="" bination="" is="" unique="" to="" south="" africa,="" the="" abuse="" of="" these="" drugs="" mainly="" occurs="" in="" the="" form="" of="" inhalation="" by="" smoking="" although="" it="" can="" be="" swal-="" lowed="" or="" injected.26="" within="" a="" fewminutes="" of="" smoking="" mandrax,="" the="" user="" usually="" feels="" relaxed,="" calm="" and="" peaceful="" although="" some="" may="" feel="" aggressive="" as="" the="" effects="" of="" the="" drug="" start="" wearing="" off.27,28="" the="" effects="" last="" for="" several="" hours="" during="" which="" the="" user="" will="" have="" a="" dry="" mouth="" and="" very="" little="" appetite.="" some="" users="" will="" have="" slurred="" speech,="" nausea,="" stomach="" pains="" and="" exhibit="" red,="" glazed="" or="" puffy="" eyes,="" especially="" if="" the="" mandrax="" is="" taken="" together="" with="" cannabis.29="" when="" used="" on="" its="" own,="" mandrax="" is="" a="" cns="" depressant="" employed="" to="" reduce="" stress="" and="" anxiety.30="" it="" is="" not="" uncommon="" for="" individuals="" to="" increase="" usage="" in="" order="" to="" achieve="" the="" same="" effects="" as="" before,="" which="" is="" an="" indicator="" of="" an="" addiction="" developing.="" depression,="" insom-="" nia,="" anxiety="" and="" irritability,="" headaches,="" restlessness="" and="" eating="" problemsare="" also="" commonamongusers.26–29one="" study="" investigat-="" ing="" the="" prevalence="" of="" recent="" drug="" use="" among="" 1050="" individuals="" arrested="" by="" the="" police="" in="" south="" africa="" revealed="" that="" 45%="" tested="" positive="" for="" at="" least="" one="" drug="" (mainly="" cannabis="" or="" mandrax).31="" significantly,="" none="" of="" the="" studies="" accounted="" for="" in="" the="" literature="" investigated="" mandrax="" use="" among="" prison="" inmates="" or="" the="" possibility="" of="" it="" being="" a="" contributing="" factor="" to="" sti="" risk="" practices="" among="" this="" population.="" studies="" published="" to="" date="" which="" examine="" substance="" use="" in="" the="" context="" of="" hiv="" and="" sti="" risk="" behaviors="" have="" targeted="" inmate="" populations="" outside="" of="" south="" africa="" and="" have="" not="" specific-="" ally="" studied="" the="" relationship="" between="" condom="" use="" beliefs="" and="" mandrax.32–35="" this="" is="" a="" significant="" area="" for="" investigation="" given="" recent="" reports="" of="" increase="" in="" the="" demand="" for="" treatment="" of="" patients="" in="" trauma="" units="" who="" test="" positive="" for="" cannabis="" and/or="" mandrax,="" since="" a="" high="" proportion="" of="" these="" cases="" involve="" cannabis="" and="" mandrax-positive="" arrestees.22="" condomuse="" behavior="" and="" beliefs="" are="" essential="" in="" sti="" risk="" reduc-="" tion="" and="" prevention.9,36="" consequently,="" intervention="" efforts="" have="" focused="" on="" increasing="" condom="" use="" among="" people="" from="" high="" risk="" groups.="" the="" literature="" supports="" the="" premise="" that="" people="" who="" are="" at="" the="" greatest="" risk="" of="" stis="" come="" from="" high="" risk="" populations="" and="" tend="" to="" give="" an="" account="" of="" inconsistent="" or="" low="" levels="" of="" condom="" use.37–39="" empirical="" support="" for="" such="" low="" levels="" of="" condom="" use="" among="" prison="" inmate="" populations="" is="" limited="" although="" there="" are="" a="" number="" of="" reasons="" documented="" for="" other="" high="" risk="" populations.36,38,39="" thus="" examining="" how="" the="" use="" of="" mandrax="" may="" likely="" impact="" condom="" use="" beliefs="" among="" south="" african="" prison="" inmates="" is="" important="" if="" health="" education="" interventions="" are="" to="" be="" designed="" to="" engender="" efficacious="" behaviors="" to="" reduce="" sti="" risk="" for="" this="" popu-="" lation,="" based="" on="" increased="" and="" consistent="" condom="" use.="" with="" this="" understanding,="" the="" purpose="" of="" this="" analysis="" was="" to="" conduct="" an="" exploratory="" study="" designed="" to="" identify="" the="" extent="" to="" which="" self-="" reported="" mandrax="" use="" impacts="" condom="" use="" beliefs="" among="" a="" sample="" of="" south="" african="" prison="" inmates.="" methods="" study="" setting="" and="" participants="" study="" participants="" were="" inmates="" from="" four="" prisons="" in="" the="" provinces="" of="" kwazulu-natal="" and="" mpumalanga.="" all="" were="" randomly="" selected="" to="" participate="" in="" the="" study.="" the="" aforementioned="" prisons="" were="" clas-="" sified="" as="" medium-sized,="" medium-security="" facilities.="" the="" sites="" were="" selected="" based="" on="" the="" need="" to="" follow="" participants="" after="" being="" released="" from="" prison="" to="" their="" communities,="" as="" the="" intervention="" was="" a="" long-term="" 12="" month="" cohort="" study.="" in="" total,="" 357="" inmates="" participated="" in="" the="" parent="" study="" of="" which="" 121="" are="" included="" in="" this="" analysis="" based="" on="" their="" self-reported="" use="" of="" mandrax.="" the="" general="" inclusion="" criteria="" for="" participants="" was="" that="" they="" had="" to="" be="" pre-release="" male="" inmates="" aged="" 18="" years="" or="" older,="" who="" were="" scheduled="" to="" be="" released="" from="" prison="" within="" 3months="" of="" receiving="" the="" intervention="" program.="" prior="" to="" this="" investigation,="" institutional="" review="" board="" approval="" was="" obtained="" from="" the="" south="" african="" medical="" association="" ethics="" review="" committee="" (samarec)="" and="" informed="" consent="" was="" obtained="" from="" those="" who="" volunteered="" to="" take="" part="" in="" this="" study.="" the="" questionnaire="" was="" interviewer="" adminis-="" tered="" as="" most="" prison="" inmates="" had="" very="" low="" literacy="" levels.="" participants="" reported="" their="" age,="" ethnicity,="" years="" of="" formal="" education,="" number="" of="" years’="" incarcerated,="" prior="" arrests,="" and="" marital="" status.="" the="" questionnaire="" was="" developed="" in="" english,="" translated="" into="" zulu="" and="" back="" translated="" into="" english="" by="" a="" team="" of="" research="" assis-="" tants="" who="" were="" involved="" in="" the="" project="" as="" data="" collectors="" and="" health="" educators.="" it="" was="" administered="" either="" in="" english="" (in="" the="" prisons="" in="" mpumalanga="" province)="" or="" in="" zulu="" (in="" the="" prisons="" in="" kwazulu-natal="" province).="" description="" of="" the="" study="" intervention="" the="" curriculum="" used="" for="" the="" study="" intervention="" was="" adapted="" and="" developed="" from="" the="" work="" of="" researchers="" who="" had="" engaged="" in="" a="" similar="" project="" with="" offenders="" in="" the="" usa.40="" four="" former="" prison="" inmates="" were="" recruited="" and="" underwent="" training="" as="" peer="" educators="" to="" conduct="" the="" training="" sessions="" in="" the="" prisons.="" two="" of="" the="" peer="" edu-="" catorswere="" hiv-positive="" and="" had="" to="" disclose="" their="" status="" to="" the="" par-="" ticipants="" in="" their="" intervention="" group.41="" they="" had="" agreed="" to="" do="" this="" during="" their="" recruitment="" interview.="" the="" training="" process="" also="" pro-="" vided="" another="" opportunity="" to="" fine="" tune="" the="" intervention.="" preliminary="" qualitative="" studieswere="" conducted="" by="" the="" south="" african="" correction-="" al="" system="" and="" provided="" vital="" information="" for="" tailoring="" the="" interven-="" tion="" to="" black="" african="" male="" inmates="" and="" to="" capture="" the="" cultural="" and="" socioeconomic="" context="" and="" prison="" experience="" of="" south="" africa.41="" in="" each="" of="" the="" participating="" sites,="" 12="" sessions="" were="" conducted="" during="" a="" period="" of="" 6="" weeks,="" with="" each="" session="" lasting="" 1.5="" h="" for="" a="" total="" of="" 18="" h="" for="" the="" full="" intervention.="" the="" curriculum="" covered="" the="" following="" topics:="" 1)="" hiv="" and="" aids;="" 2)="" stis;="" 3)="" nutrition="" and="" tb="" pre-="" vention="" and="" management;="" 4)="" alcohol="" and="" other="" drug="" abuse;="" 5)="" sexuality="" and="" gangsterism;="" 6)="" manhood="" and="" general="" life="" skills.="" all="" sessions="" were="" planned="" between="" 09:00="" and="" 12:00="" h="" in="" the="" educational="" section="" of="" all="" the="" participating="" prisons.="" two="" health="" educators="" who="" had="" no="" prior="" history="" of="" incarceration="" conducted="" all="" the="" sessions="" for="" the="" control="" groups.="" participants="" in="" the="" control="" arm="" of="" the="" experiment="" were="" shown="" a="" series="" of="" videos="" covering="" t.="" t.="" stephens="" et="" al.="" 2="" of="" 6="" by="" guest="" on="" a="" ugust="">