A qualitative understanding of the socio-cultural and situational context of substance abuse and sexual risk-taking behaviours in women.

Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.South Africa is one of the six southern African countries where the HIV levels for childbearing women are 20% or higher. In South Africa, like most countries, behaviours such as multiple sexual partners, unprotected sex and drug use expose individuals to the risk of HIV infection and drive the HIV epidemic. Thus, research on sexual risk behaviours associated with HIV/AIDS is vital in identifying target groups at risk for HIV. Previous research has shown a link between substance use and sexual risk behaviour however in South Africa research within this field is still evolving. Furthermore, research on substance abuse among women in South Africa is limited. In the light of increasing HIV infection in women and the possible influence substance use has on sexual risk behaviours including HIV, exploring the association between substance use and sexual risk behaviours among women would provide valuable information. Socio-cultural and situational factors are explored within substance use and sexual risk behaviours as women's lives occur with realm of individual, family and community. The sample was drawn from an Alcohol and Drug Rehabilitation Centre situated in the Durban area. Study participants included Black/African, White, Indian and Coloured women who were admitted to the treatment centre for alcohol abuse. One focus group discussion and six in-depth interviews were conducted with women to understand the socio-cultural and situational context of substance abuse and sexual risk-taking behaviours (including HIV/AIDS). Substance abuse emerged from women's lack of coping mechanisms to deal with poor relationships and lack of employment which led to financial dependence on their partners. Women reported that within their settings, alcohol can be related to sexual risk behaviours because alcohol tends to lead to unsafe sexual behaviours. Women reported that alcohol use facilitates intimacy and rapport between couples thus some women tended to consume alcohol. Women reported that knowledge of safe and unsafe sex is known however implementation is difficult because condom use requires her partner's co-operation. Women were financially and emotionally dependent on their partners, social norms which determine women's role in society and sexual relationships governed their behaviour. Partner violence was a common feature among women which impacted on women's ability to negotiate condom use. The paper discusses the intrapersonal, interpersonal and contextuall situational factors that influence substance use and sexual risk behaviours in these women's lives