CAPE TOWN - The use of mandrax may contribute to HIV risk among adolescent girls and young women (AGYW), according to new research published by the South African Medical Journal.
The study titled: ‘Mandrax use, sexual risk, and opportunities for pre-exposure prophylaxis (PrEP) among out-of-school adolescent girls and young women in Cape Town, South Africa’ sought to examine the role of mandrax use in sexual behaviours and the extent to which AGYW who use mandrax were aware of and willing to initiate PrEP.
The research was conducted by Courtney Bonner from the Research Triangle Institute and experts in child health, psychology, psychiatry and behavioural sciences and drug research from the South African Medical Research Council, University of North Carolina, North Carolina State University and Duke University School of Medicine.
Baseline and six-month follow-up data was provided by 500 AGYW participating in a cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk.
AGYW who self-identified as black African or coloured and were using substances reported condomless sex in the past three months, and had dropped out of school early, were recruited from 24 community clusters across Cape Town.
Following consent, participants provided biological specimens to test for recent drug use (including mandrax) and completed a self-report questionnaire.
Researchers found that although mandrax use is reported in all of the country’s provinces, “it is particularly well established in Western Cape Province, where it is consistently the third most frequently reported substance of abuse among persons entering specialist substance abuse treatment facilities”.
In South Africa, researchers explain, mandrax tablets are crushed and mixed with cannabis and tobacco before being smoked in a pipe, called “white pipe”.
The effects after smoking include a “euphoric high followed by drowsiness, temporary unconsciousness or passing out, with potential sedation lasting up to five hours”.
“Given its sedative effects, mandrax may affect women’s ability to negotiate condom use during sex, refuse sex without a condom, or consent to sex, thereby increasing their risk for HIV,” the study said.
“Logistic regression analysis revealed that the AGYW who had a positive test result for mandrax use were less likely to use a condom during last sex with any partner and with their main partner compared with the AGYW who had a negative mandrax test result. The AGYW who tested positive for mandrax use were also almost three times more likely to use alcohol and/or other drugs before or during their last act of sexual intercourse.
“The study findings suggest that mandrax use may be negatively related to condom use with a main partner and positively related to using alcohol and other drugs before sex.”
The findings further showed that there was a belief that mandrax may be a “love drug” leading to less inhibition during sex.
“The idea of less inhibited sex may involve condomless sex, which may increase HIV risk among AGYW, an already vulnerable population,” researchers added.
The authors have recommended HIV prevention efforts to “include and prioritise AGYW who use substances, such as mandrax”.
“Efforts seeking to reduce HIV among AGYW may consider addressing substance use, especially drugs such as mandrax. Key decision-makers may want to consider incorporating substance use prevention efforts into existing programmes that seek to reduce HIV, and to equip youth-friendly clinics with the resources to identify AGYW who use mandrax and offer them PrEP. Addressing substance use among AGYW is an essential component of reducing HIV among this population,” said the authors.
Cape Times