The Triple Threat: Mental Health, Substance Abuse and Violence in South Africa

Published January 30, 2013 under Research News

african patient seeing health provider

95% of research dollars are spent on 5% of the world's population.

Home to more HIV-infected individuals than any country in the world, South Africa is the setting of a five-year DGHI study examining the triple threat of mental health, hazardous drug and alcohol use, and traumatic experiences including partner violence and childhood abuse. DGHI researchers warn these risk factors are contributing to risky sexual behaviors that may make individuals vulnerable to HIV. 

While most research studies are conducted in traditional environments like a clinic, hospital or home visit, a unique aspect of this research is its strategic targeting of high-risk individuals who frequent informal bars and taverns. With a team of collaborators from the University of Stellenbosch and University of Connecticut, DGHI faculty Kathleen Sikkema, Melissa Watt and Christina Meade have found that bar-goers have high levels of traumatic experiences and mental health problems.

Half of the bar-goers in the study had signs of depression, and one-third had posttraumatic stress disorder (PTSD). Mental health disorders were more common among individuals who had experienced rape, child abuse or physical violence by a sex partner. They also consumed more drugs and alcohol and engaged in more unprotected sex. 

With a greater understanding of the interconnectedness of these issues, the research suggests mental health be addressed as a component of hiv prevention programs, and that alcohol-serving venues can be effective locations for targeting those programs. 

“Our response to the HIV epidemic must address the synergy of co-occurring risk factors,” said Sikkema, professor of psychology and neuroscience and global health. “Only when we address the larger context that pre-disposes people to hiv risk will we begin to curb the spread of the epidemic.”

A research team led by Meade and African collaborators plan to continue this research by studying South Africa’s rapid rise in methamphetamine use in order to develop programs that integrate HIV prevention, substance abuse treatment and mental health. 


"Only when we address the larger context that pre-disposes people to HIV risk will we begin to curb the spread of the epidemic."

- Kathleen Sikkema, DGHI