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Community centres that work with clinics regarding public health education

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1. WHO | Other psychoactive substances: World Health Organization; 2018 [updated 2018-02-22 16:23:52. Available from: http://www.who.int/substance_abuse/facts/psychoactives/en/.

2. United Nations P. WORLD DRUG REPORT 2017. [S.l.]: UNITED NATIONS PUBNS; 2017.

3. Homer JB, St. Clair CL. A Model of HIV Transmission through Needle Sharing. Interfaces [Internet]. 1991; 21(3):[26-49 pp.].

4. Owen S. Levels of Prevention Georgia: Georgia State University; 2000 [cited 2018 23 April]. Available from: http://www2.gsu.edu/~wwwche/Primary%20Secondary%20Tertiary%20Prevention.htm.

5. Sahasrabuddhe VV, Vermund SH. The future of HIV prevention: control of sexually transmitted infections and circumcision interventions. Infectious disease clinics of North America. 2007;21(1):241-57.

6. Mallin R, Porter M. Substance Use Disorders. In: South-Paul JE, Matheny SC, Lewis EL, editors. CURRENT Diagnosis &amp; Treatment: Family Medicine, 4e. New York, NY: McGraw-Hill Education; 2015.

7. King TE, Jr., Wheeler MB. Medical management of vulnerable and underserved patients : principles, practice, and populations. New York :: McGraw Hill Education; 2016. Available from: AccessMedicine http://accessmedicine.mhmedical.com/book.aspx?bookid=1768.

8. Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Longitudinal associations between outpatient medical care use and substance use among rural stimulant users. The American Journal of Drug and Alcohol Abuse. 2018;44(2):235-43.

9. Devil Bones: Cheap heroine grips SA's youth [Internet]. YouTube. 2018 [cited 23 April 2018]. Available from: https://www.youtube.com/watch?v=l8fDXSqE_ZM&feature=youtu.be&has_verified=1

10.The Nyaope 'Bluetooth' craze caught on camera [Internet]. YouTube. 2018 [cited 23 April 2018]. Available from: https://youtu.be/qD0w36VRkg8

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The sharing of blood and needles between fellow users and its contribution to HIV.

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MUST WATCH: The Nyaope 'Bluetooth' craze caught on camera

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3. What is the evidence for causation between your selected intervention and the health concern that it is trying to address/solve? 

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3. What is the evidence for causation between your selected intervention and the health concern that it is trying to address/solve? 

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⁽⁶⁾Data from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) show that drug use disorders have an overall prevalence of 6,2%. Drug abuse is a component cause for HIV. Risk factors such as the sharing of used needles and Bluetooth significantly increase the spread of HIV and therefore it is paramount to address the issue of substance abuse. ⁽⁷⁾40% of HIV positive patients reported using illicit drugs in the past 12 months. Multidisciplinary HIV clinics and drug abuse clinics are effective prevention methods for this comorbid condition. By treating this non-primary health issue of HIV patients, you can increase their overall adherence to ARV regimens.

⁽⁸⁾Drug abusers in rural settings are less likely to make use of formal in-patient clinics than their urban counterparts (24% in the past 3 years to 37% in the last year alone). A more practical and appealing alternative is outpatient medical care (OMC). Studies conducted in the USA that looked specifically at methamphetamine users in rural communities, showed a reduction in drug use with an increase in OMC by drug users with no medical insurance and a lower than high school education. Drug users without medical insurance but a higher level of education also showed a decrease in drug usage with more OMC. Contrary to this, people with a higher education and medical insurance increased their drug usage when they visited outpatient clinics three or more times in the 6-month period. Similar results were observed under cocaine users. The reason for this is unclear, but a possible explanation can be that the people who visited the clinics more often experience more severe substance abuse related health problems.

⁽⁸⁾ The study concluded that more visits to outpatient health clinics help to reduce and treat substance abuse in some cases but not in all, since drug-abuse is such a highly multi-causal disorder. 22% of the test subjects reported no visits to OMC facilities at baseline, but at the end of the study results showed conclusively that even just one visit reduces the total number of days that the drug is used. It is necessary to assign resources and focus on outpatient clinics in rural communities. However, care should be taken in the coordination of these resources, since data shows that this prevention is not the most effective method in all cases. Further research is necessary to determine a better course of action, bur for now these clinics are sufficient in reducing drug abuse and sequentially the prevalence of HIV.

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Nyaope crisis under youth of South-Africa.

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Nyaope crisis under youth of South-Africa.

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Devil Bones: Cheap heroine grips SA's youth

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1. Jacobus Botha, u17070822

2. Revan Schmidt, u17004943

3. Rhoda Hartzer, u17003670

4. Barbara Emslie,u17023182

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4. What role do you play as a citizen and future doctor in this intervention? How could you support this?

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4. What role do you play as a citizen and future doctor in this intervention? How could you support this?

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1.       There are 5 major ways that we could help and support this intervention that I would like to touch on.⁽⁶⁾ Firstly, we will have to advise the family about how to support and communicate with the drug user. This will be essential if the patient might be a child. Secondly, we must be able to communicate important information regarding drugs with the patient, the family of the patient as well as everyone in the community. This will include the emotional and physical effects of use and abuse on the patient, the effects on their relationships and the rest of the community as well as treatment of the user. Thirdly we have the responsibility to not only be a looker-on when it comes to community drug intervention efforts, but to take part and support it. We should know about nearby drug abuse clinics and helpline numbers which can be used in case of an emergency regarding drug abuse. We can contribute greatly to this intervention as citizens if we volunteer at these clinics. As future doctors we will also have to screen all patients regardless of age, gender and sex for drug usage symptoms. Lastly, we should always back policies that discourage drug use and abuse and encourage the treatment of drug usage disorders.

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1.What health concern is your selected intervention trying to address/solve? How big is the health concern in South Africa and/or globally?

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1.What health concern is your selected intervention trying to address/solve? How big is the health concern in South Africa and/or globally?

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According to the World Health Organization substance abuse is classified as:⁽¹⁾ “The harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs” regular substance abuse of psychoactive substances can lead to dependence syndrome – the symptoms of dependence syndrome is a wide variety of symptoms which include psychological, social and physical problems. The psychological problems are a powerful desire for the use of the drug, difficulties controlling the drug and tolerance. The social aspect of the symptoms is withdrawal from all other activities and obligations for the use of the drug. The main physical symptom is withdrawal symptoms which occur when the drug is not being used.

Globally it is estimated that⁽¹⁾255 million people used illicit drugs such as cannabis, opioids and amphetamines,⁽²⁾ it is estimated that 92% of drug users has shared needles in the past and there is currently 12 million drug users that inject drugs according to the world drug report of 2017. Drug abuse ⁽³⁾ increases the prevalence of HIV due to the use of needles that has been shared among peers. This occurs due to people unknowingly of the other users HIV status shares a needle contributing in reckless behaviour and by doing so the virus is spread, the virus spreads further especially when a person shares a needle with multiple friend groups.

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Drug abuse clinics.

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2.What level of prevention would you consider it to be? Why/not?

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2.What level of prevention would you consider it to be? Why/not?

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When looking at prevention one should take into account⁽⁴⁾ intervention, purpose and strategies. Drug abuse clinics or community rehab centres usually addresses most of the level of prevention. At primary level (population or individual ) these clinics⁽⁴⁾intervenes before risk behaviour starts with the purpose to educate individuals and communities as a whole using strategies such as personal goal setting, learning skills for refusal and decision making and promoting individual responsibility for prevention. ⁽⁵⁾At primary level the focus group is HIV negative individuals ,where they are encouraged to take part in testing services and counselling with the main focus on education about blood/needle safety in the case of this intervention strategy.

At secondary level once⁽⁴⁾ experimentation of these risk behaviour have been initiated/ onset of social consequences(individual or community engages in drug use), strategies include creating positive user-health worker relationships, positive peer group support systems with the purpose to arrest drug abuse process. ⁽⁵⁾At this level we look at newly HIV positive individuals and intervention suggests prompt treatment such as the description of antiretroviral drugs/chemotherapy(ARV) as well as helping with coping strategies and increasing access to health care.

At tertiary level these clinics intervene the ⁽⁴⁾establishment of this risk behaviour with the purpose to reduce addiction and its inducement of other health concerns. Once this level is reached we are already working with patients with established HIV/AIDS. ⁽⁵⁾Strategies here focus on providing a claim to a quality life thus ARV are still prescribed to battle opportunistic infections and also to HIV+ mothers to prevent transmission to their child during pregnancy(PMTCT). Support also plays a major role as to assist these individuals back into their workplace and communities.

Clinics like these use systems that make use of external and internal framework when assisting in the prevention of drug abuse and its relationship to diseases such HIV.

⁽⁴⁾Externally they focus on creating positive experiences between the patient and the people and clinic in their lives by focusing on these main points:

• Reinforcement- Addicts and people exposed to these conditions need support and assistance from friends, family and the community.

• Equipped-Patients should be empowered and given the opportunity to give back to their community.

• Trust-They should know their boundaries and what is expected of them, but be given the freedom to operate within their communities.

• Time consumption- teach member how to use time wisely in such a way to contribute to constructive personal growth.

⁽⁴⁾Internally the focus is more on the community in the sense that they should assist them in the teachings of qualities such as confidence, positive choices and decision making by focusing on these categories:

• Dedication to education- Develop of lifelong devotion to learning.

• Worth- Development of values to guide decision making

• Capability- to be able to function efficiently and/or successfully