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Tuesday 11 July 2006
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SOUTH AFRICA: New AIDS threat looms

[This report does not necessarily reflect the views of the United Nations]

©  South African Medical Research Council (MRC)

The crystalline form of methamphetamine - better known as 'tik' in South Africa

CAPE TOWN, 19 June (PLUSNEWS) - South Africa's Western Cape province has so far maintained the lowest HIV prevalence rate in the battle against AIDS, but this could be changing.

According to the 2002 National HIV and Syphilis Antenatal Sero-prevalence, based on a sample of more than 16,000 women attending antenatal clinics in the country's nine provinces, Western Cape recorded a rate of 12.4 percent, compared to a prevalence level of 16 percent to 36.5 percent in other provinces.

However, this figure rose by three percent over the next two years, causing some experts to suspect that increased levels of HIV might be linked to the growing popularity of a relatively new but highly addictive and easily accessible drug.

Andreas Pluddemann, a senior researcher in alcohol and drug abuse at the Medical Research Council (MRC), recalled that sporadic queries about a mysterious substance known only as 'tik' began reaching the offices of the South African National Council on Alcohol and Drug Abuse (SANCA), and the Cape Town Drug Counselling Centre (CTDCC) three years ago.

"It turned out to be crystal d-methamphetamine hydrochloride, otherwise known as 'speed', 'ice', 'crystal meth', 'crystal', or just 'meth'. It is a crystalline form of methamphetamine, a powerfully addictive stimulant often used recreationally as a party drug," he told PlusNews.

Pluddemann noted that when drugs became a factor in social settings, such as nightclubs, there was always a greater danger of risky sexual behaviour.

Among the effects of methamphetamine are euphoria, increased energy, insomnia, restlessness, irritability and a heightened sense of sexuality, as the drug removes inhibitions, boosts confidence and heightens the intensity of sex.

"While there are currently no local studies being conducted to suggest that methamphetamine users could fuel HIV prevalence rates as a result of this heightened and often risky sexual activity, research already done abroad indicated that they could," he said.

Hear what these three youths have to say about tik.

Steven Shoptaw, a psychologist with the Integrated Substance Abuse Programmes at the University of California, Los Angeles, in the US, has carried out some of the most comprehensive research into the effects of the drug on homosexual men in San Francisco and Los Angeles, where it first gained popularity in the 1990s.

He found that if participants said they had used speed in the past six months, there was a low but significant chance that they would be HIV-positive; among those who used it "once in a while" the figure was 25 percent; when chronic users were interviewed the figure jumped to 40 percent; in outpatient drug-treatment programmes, 60 percent of users were HIV-positive; and of those in residential care nearly 90 percent were HIV-positive.

Although a study conducted among gay men in the US does not necessarily relate to the situation in South Africa, the MRC recently advised drug-treatment centres in and around the city of Cape Town to consider testing meth patients for HIV, especially in view of the steady increase in the use of the drug in the province.


The CTDCC revealed in 2002 that less than one percent of its clients mentioned crystal meth as their primary drug of choice, so no alarms were triggered when the number began to rise. Director Grant Jardine noted subsequently that he had never before witnessed such speedy uptake of a drug, not even heroin, which had a strong presence among users before the advent of tik.

"By the end of 2003, the number of tik users coming through our doors had jumped to five percent; by the middle of the following year a third of all our patients were using it; and currently, crystal meth has outstripped heroin in popularity," Jardine told PlusNews.

More than 50 percent of CTDCC clients now used tik as their primary drug of abuse, while between 20 percent and 25 percent named heroin. "With 98 percent of crystal meth patients in the Western Cape coming from the city [Cape Town], the MRC has gone so far as to suggest that ... [it] was now the tik capital of South Africa," he said.

How do people get addicted to Methamphetamine?
The day after taking 'meth' the user feels sick, depressed, guilty, ashamed and angry, and feels that a small amount of 'meth' will eliminate these unpleasant symptoms and produce more good feelings. Eventually the user depends on 'meth' as a solution to the problem the drug use has created, and the cycle of 'meth' addiction is born.
The trouble is that after a while the euphoria turns to numbness, super focus is replaced by confusion, and productivity is limited to simple tasks.

The long term consequences of 'Meth' abuse
Chronic use results in severe dopamine imbalances in the brain. Since this neurotransmitter is critically involved in states of pleasurable arousal, a disruption in the normal supply of this substance creates intense negative emotional states, typically characterised by paranoid delusions, auditory and visual hallucinations, erratic moods and violent rages.

Suicide is a regular occurrence in chronic 'meth' users.
Although there is no significant physical withdrawal state when intake of the drug is stopped, the intense psychological dependency is evident from symptoms such as intense craving, anxiety, loss of energy, palpitations, sweating, irritability and depression.

The medical risks
With every episode of use, the heartbeat increases, blood vessels constrict and blood pressure rises. Prolonged use of 'meth' may eventually cause damage to small blood vessels in the brain and users suffering from hypertension may find themselves in danger of suffering a stroke.

Overdosing on meth is not uncommon and symptoms include hypothermia (elevated body temperature), convulsions and circulatory and respiratory collapse.

SOURCE: Medical Research Council
The ready uptake of the drug was mainly attributed to its low cost of about US$4 per gram, and because it produced states of euphoria lasting up to three days at a time. Jardine also noted that when users were unable to raise the cash for their next fix, theft and commercial sex by both men and women could not be ruled out.

"Obviously this presented the user with increased chances of contracting HIV/AIDS, as some might be willing to forego protection in order score another hit. I imagine that men would also become more receptive to anal intercourse because of the definite occurrence of erectile dysfunction brought on during the high that the drug created."

Jardine's assumption has long been shared by the MRC's Prof Charles Parry, who stated in a 'Methamphetamine Fact Sheet' released in November last year that long-term use increased the risk of contracting HIV and Hepatitis C as a result of injection drug use and risky sexually behaviour.

Even more alarming than the supercharged libido created by the drug was its appeal to non-typical drug users, including school-aged children.


PlusNews managed to interview a female recovering crystal meth user aged 14 receiving counselling at SANCA. It is not uncommon for children as young as 10 to be addicted to crystal meth in Cape Town.

Jody Smith is a presentable, eloquent grade 9 (standard 7) pupil who "just loves" mathematics and looks forward to school every day. She is the image of every parent's dream girl-child but has been a crystal meth addict for nearly 10 months.

"It just happened - I did not plan to use tik," she said. "Me and a couple of school friends skipped class one day and were bored, so we pooled our money and decided to buy tik. We had heard about it from kids at school and just wanted to see what it would be like. You have to smoke it out of a glass pipe and I got it all wrong - my friends laughed at me, but showed me how to do it the right way."

The drug is usually sold in cool drink straws with the ends sealed, and Jody and her friends managed to buy two 'straws'. At least a month went by before her cousin suggested they try it again.

"We did it again, and before long it had gone from one to two, and then three and four straws at a time, but the feeling was nice because it gave me lots of energy. But I remember how paranoid I felt at one point when I had to use public transport home after smoking."

She said she would probably still have been smoking, but she had a disagreement with her cousin, who told her grandparents. "I live with my granny because my mom works away from home, in [the inner-city suburb of] Salt River, and I only met my father in May this year after my grandparents told him about my addiction. In a way, I am grateful that they found out. I have been coming to counselling here at SANCA since May and don't even need to be accompanied by my father anymore."


The MRC fact sheet on tik showed that in the first half of 2005 the average age of patients reporting methamphetamine as their primary substance of abuse was 21 years, and 76 percent were male. Most of the patients - 92 percent - were mixed-race or so-called 'coloured', 7 percent were white, 0.5 percent were Indian/Asian and 0.5 percent were Black/African.

Almost 50 percent of patients were younger than 20, but ages ranged from 12 to 53 years.

Cherith Langenhoven, Jody's psychological counsellor at SANCA, said although addiction was rife within coloured communities, which were often characterised by high unemployment, crime and gang wars, she suspected that this had little to do with the speedy uptake of meth. "Anyone with a high-school knowledge of chemistry could manufacture the substance, because the recipe is accessible over the internet and the ingredients can be found in your own kitchen."

These included battery acid, paraffin, antifreeze, hydrochloric acid, drain cleaner, lye and over-the-counter cold medications containing ephedrine. The acidic make up of the drug often resulted in "meth mouth" because of the rampant tooth decay it often caused.

Like her peers, Langenhoven was also concerned about greater risk during sexual activity.
"Although it is generally accepted that the chances of contracting HIV through oral sex are minimal because saliva in a healthy mouth is able to eliminate any HIV that might be present in semen, it is fair to assume that bleeding gums and decayed teeth resulting from prolonged use of tik would dramatically increase the user's chance of infection," she told PlusNews.

Parents, teachers and guardians were advised to look out for signs of methamphetamine use, such as higher levels of physical activity, incessant talking, anxiety, extreme moodiness and irritability, repetitive behaviour, depression, sleep disturbances and dilated pupils.

"We encourage the involvement of all role players in reversing this escalating and dangerous drug craze," Langenhoven stressed, and warned that if not brought under control soon, the meth situation could help fuel the country's already worrying HIV/AIDS pandemic.


Recent SOUTH AFRICA Reports
Contrasting HIV-positive lives,  30/Jun/06
New strategies needed to meet shortfalls says Global Fund report,  29/Jun/06
Govt wants to monitor PEPFAR funding,  12/Jun/06
HIV-positive Muslims take comfort in their faith,  26/May/06
'In the Continuum' gives HIV/AIDS a human face,  26/May/06
· AIDS Media Center
· The Global Fund to fight AIDS, Tuberculosis & Malaria
· International Community of Women Living with HIV/AIDS
· International HIV/AIDS Alliance

PlusNews does not take responsibility for info in links supplied.

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