title: Prevalence and factors associated with use of khat: a survey of patients entering HIV treatment programs in Ethiopia.
abstract: Khat, a plant native to East Africa, has psychoactive constituents similar to amphetamine. Chronic khat use can lead to psychological dependence with multiple physical and mental health harms, complicating clinical management of people living with HIV. In two Ethiopian cities where khat is common, we evaluated prevalence and correlates of khat use among patients new to HIV care.
  
  
  
  During 2013-2014, we surveyed 322 patients recently enrolled in HIV clinics in Dire Dawa and Harar about khat use, demographics, smoking and alcohol use, clinical illness, food insecurity, and social support. We analyzed factors associated with khat use in the past year, as well as heaviest use of khat (based on greatest number of hours used in a typical month).
  
  
  
  242 (75%) respondents reported lifetime khat use; 209 (65%) reported khat use during the previous year. 54% of khat users started before age 19 years. Although 84% believed that using khat every day is dangerous for health if you have HIV, khat was used in the previous year a median of 5 h/days and 30 days/month; 21% said they felt a need to cut down or control their khat use but had difficulty doing so. Those using khat were more likely to report smoking (46%) and alcohol use (49%) compared to non-khat users (1 and 31% respectively). Those reporting heaviest khat use (≥180 h/typical month) were more likely to rate their health status as poor, have an underweight BMI (≤18.5 kg/m2), report more symptoms of chronic illness, and agree with more statements indicating a negative physical quality of life. In multivariate analysis, heavy users were more likely to be male, Muslim, and non-married.
  
  
  
  Khat use was common among HIV patients entering care, and associated with symptoms of poorer physical health. Over half started khat use when they were young. Although most believed khat is harmful for HIV patients, a number of respondents reported some difficulty controlling their drug use. In settings where khat is legal and widely utilized, developing interventions for responsible use represent an important health priority as part of comprehensive care for people living with HIV.
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN, 55454-1015, USA. lifso001@umn.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Lifson
authors.affiliation: Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Sale
authors.initials: S
authors.lastname: Workneh
authors.affiliation: Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Tibebe
authors.initials: T
authors.lastname: Shenie
authors.affiliation: College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
authors.forename: Desalegn Admassu
authors.initials: DA
authors.lastname: Ayana
authors.affiliation: International Center for AIDS Care and Treatment Program, Addis Ababa, Ethiopia.
authors.forename: Zenebe
authors.initials: Z
authors.lastname: Melaku
authors.affiliation: Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Lemlem
authors.initials: L
authors.lastname: Bezabih
authors.affiliation: Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Hiwot Tekle
authors.initials: HT
authors.lastname: Waktola
authors.affiliation: Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Behailu
authors.initials: B
authors.lastname: Dagne
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN, 55454-1015, USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Hilk
authors.affiliation: Oregon Research Institute, Eugene, OR, USA.
authors.forename: Ken C
authors.initials: KC
authors.lastname: Winters
authors.affiliation: Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Slater
mesh_terms: D000328:Adult; D029754:Catha / Q000009:adverse effects*; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: Amphetamine; Ethiopia; HIV; Khat; Sub-Saharan Africa