BACKGROUND : HIV transmission risk among non-injection drug users is high due to the co-occurrence of
drug use and sexual risk behaviors. The purpose of the current study was to identify patterns of drug use
among polysubstance users within a high HIV prevalence population.
METHODS : The study sample included 409 substance users from the Pretoria region of South Africa.
Substances used by 20% or more the sample included: cigarettes, alcohol, marijuana and heroin in combination,
marijuana and cigarettes in combination, and crack cocaine. Latent class analysis was used
to identify patterns of polysubstance use based on types of drugs used. Multivariate logistic regression
analyses compared classes on demographics, sexual risk behavior, and disease status.
RESULTS : Four classes of substance use were found: MJ + Cig (40.8%), MJ + Her (30.8%), Crack (24.7%), and
Low Use (3.7%). The MJ + Cig class was 6.7 times more likely to use alcohol and 3 times more likely to use
drugs before/during sex with steady partners than the Crack class. The MJ + Cig class was 16 times more
likely to use alcohol before/during sex with steady partners than the MJ + Her class. The Crack class was
6.1 times more likely to engage in transactional sex and less likely to use drugs before/during steady sex
than the MJ + Her class.
CONCLUSIONS : Findings illustrate patterns of drug use among a polysubstance using population that differ
in sexual risk behavior. Intervention strategies should address substance use, particularly smoking as a
route of administration (ROA), and sexual risk behaviors that best fit this high-risk population.