title: Contextualizing gender differences and methamphetamine use with HIV prevalence within a South African community.
abstract: BACKGROUND
  This study was conducted in a large Black African township outside of Cape Town, South Africa, where HIV infection has been endemic at extremely high levels for years. Problems associated with high HIV prevalence are compounded by gender inequality and high rates of gender-based violence exacerbated by heavy alcohol use and increasing methamphetamine use.
  
  
  METHODS
  Informal drinking establishments (known as shebeens) were geocoded and mapped. Based on visual examination, we identified 36 neighbourhoods, each of which contained between three to seven drinking venues clustered together. Neighbourhoods were separated from each other by at least 200m. We randomly selected 30 of the 36 neighbourhoods. Outreach workers screened males in shebeens and screened their female partners. This analysis includes 580 study participants recruited from 30 neighbourhoods between 2010 and 2012. All participants completed a baseline questionnaire that included individual-level, couple-level, and neighbourhood-level measures of alcohol and other drug use, HIV infection, and HIV risk behaviours. Multilevel fixed effects regression analyses stratified by gender were conducted to examine correlates of HIV infection.
  
  
  RESULTS
  Women were twice as likely as men to be HIV infected, yet they reported fewer sex partners. Neighbourhood prevalence of HIV was correlated with greater likelihood of HIV infection among women, but not men. Neighbourhood methamphetamine use was marginally associated with HIV among women but not among men. At the individual level, heavy alcohol use was marginally associated with HIV infection among men but not among women. Having an HIV positive partner was the strongest correlate of being HIV positive among both men and women.
  
  
  CONCLUSIONS
  Findings from this study underscore the need for policy makers to direct scarce resources to the communities, places within communities, and populations, especially vulnerable women, where the impact on HIV prevention and onward transmission will be greatest.
authors: RTI International, Research Triangle Park, NC, USA; University of North Carolina, Chapel Hill, NC, USA; North Carolina State University, Raleigh, NC, USA; Duke University, Durham, NC, USA. Electronic address: wmw@rti.org.
authors: Wendee M
authors: WM
authors: Wechsberg
authors: RTI International, Research Triangle Park, NC, USA; University of North Carolina, Chapel Hill, NC, USA.
authors: Irene A
authors: IA
authors: Doherty
authors: South African Medical Research Council, Parow, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
authors: Bronwyn
authors: B
authors: Myers
authors: RTI International, Research Triangle Park, NC, USA.
authors: Antonio A
authors: AA
authors: Morgan-Lopez
authors: RTI International, Research Triangle Park, NC, USA.
authors: Andrea
authors: A
authors: Emanuel
authors: South African Medical Research Council, Parow, South Africa.
authors: Tara
authors: T
authors: Carney
authors: RTI International, Research Triangle Park, NC, USA.
authors: Tracy L
authors: TL
authors: Kline
authors: RTI International, Research Triangle Park, NC, USA.
authors: William A
authors: WA
authors: Zule
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage*; D015995:Prevalence; D012044:Regression Analysis; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D008694:Methamphetamine
keywords: Alcohol; Gender; HIV risk; Methamphetamine; Neighbourhood; Place; Social context; South Africa