CRISA AFRICAChapter 7: Alcohol use, gender and high risk sexual behaviour among undergraduates by Leonard C. Onwukwe, Nkwarn C. Uwaoma & Ann U. Madukwe - CRISA AFRICA

Chapter 26: Opening Address by Ahmadu Giade

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OPENING ADDRESS
Ahmadu Giade
Chairman/Chief Executive
National Drug Law Enforcement Agency (NDLEA)
1 Lagos, Nigeria
PREAMBLE
It gives me utmost pleasure to be part of this all-important gathering. All-important because the issue we are gathered here to dissect is as topical as it is critical. Drugs and HIV/AIDS have remained a twin issue that directly affects a large proportion of people in Africa and the rest of the world, particularly the youths. Although we cannot readily ascertain the number of people that are dependent on drugs, it has been reported that in Nigeria, an estimated 3.6 percent of the
population are living with HIV and AIDS. Although HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population (around 149 million) meant that by the end of 2009, there were almost 3 million people living with the deadly scourge. Statistics of drug dependent persons cannot be lower in any way. Conservatively, one out of every ten persons is dependent on one form of drugs or another, especially socially
acceptable drugs also known as gateway drugs.
By convoking this conference, the Centre for Research and information on Substance Abuse (CRISA) is, no doubt, setting an agenda that is cardinal to Africa’s developmental strides both in human and material resources. This is because, either drugs or HIV/AIDS, easily regarded as deadly partners, is worse than the dreaded Second World War both in terms of impact on the global human population and the resources deployed to contain these challenges. A combination
of these problems therefore has so far left unimaginable tales of woe to the entire humanity. ln spite of this, these twin problems have not been the popular choice of institutions and individuals in their efforts towards uncovering ways of tackling the menaces.

Chapter 25: Ergogenic effect of varied doses of coffee-caffeine an maximal aerobic power of young black African subjects Sikiru Lamina & Danladi I. Musa

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Caffeine (1,3,7- trimethyl-xanthine) is a methyl derivative of xanthine, one of the readily available stimulants consumed daily by more than 80% of the world’s population, making it the most widely consumed drug in history. It is basically a Purina compound containing two condensed heterocyclic rings. It is a naturally occurring chemical found in over 60 different species of plant leaves, seeds and fruits. Specifically, much caffeine is found in coffee (Coffee arabica), tea, cola nuts (Cola acuminata). lt is also found but in least quantity in cocoa (Theobroma cacao) (Essig, Costill, & Vanhandel, 1980; James, 1987; Wilcox, 1990; VanHandel, 1983).

The ability of caffeine and other xanthines to aid sport performance is based on both the direct and indirect action on the heart or skeletal muscles, mediated through the nervous system, altered hormonal activities or shift in mobilization of substances (free fatty acid mobilization and glycogen sparing). There is also the possibility that the drug may alter the release, binding or activity of neurotransmitter in the brain, thereby affecting the perception of work intensity (Robertson, Wade, Workman, Woosley, & Oates, 1981)..
The controversy surrounding the use of caffeine as food beverages by laymen or use as an ergogenic aid by local, national and international athletes has drawn the attention of many scientists to research into the effects of this wonderful drug. Some Scientists (Graham, Fiush, & Vansoeren, 1994; Wilcox, 1983) view this aid as a justifiable extension of the body’s natural capacities, while others (Jacobson & Kulling, 1989) see it as a dangerous and unethical violation of the code of fair play in sports.

Chapter 24: Use of Mobile telephone technology to enhance adherence to antiretroviral therapy by Margaret O. Afolabi, Francis J. Olatoye, Omoniyi J. Ola-Olorun, Oluwafunmi A. Akinyemi & Adedayo I. Irinoye

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Acquired immune deficiency syndrome (AIDS) is an extremely devastating disease which presents as a key issue in world health in recent times. AIDS is not curable yet, but it is preventable and increasingly treatable with modern medicine. With adherence to appropriate pharmacotherapy, progression of the infection to AIDS could be reasonably delayed (Hogg, Health, Yip, et aI., I998; Mocroft, Ledergerber, Katlama., Konopnicki, De-Wit, & Antunes, 2003). Antiretroviral medicines (ARV) and use of combinations of these medicines increase the life expectancy of people living with HIV/AIDS (PLWHA). Combination therapy defends against viral resistance to medication but there are possibilities of pill burden and serious side effects as a result of large dosing schedules (Saitoh, Hull, Franklin, & Spector, 2005). Despite the burden associated with multiple medications, adherence to ARV regimen is pivotal to preventing development of mutant strains of the virus. AR)/s delay progression of HIV infection thus transforming the disease into a treatable but chronic condition; however the need to continue treatment for decades rather than months calls for a long term perspective on antiretroviral therapy (ART). Adherence is a major determinant of the success of ART (Coopman, 2002; Paterson, Swindells, Mohn, Brester, Vergis, Squire, Wagener et al., 2000) and generally, adherence to a medication regimen is defined as, ‘the extent to which patients take medications as prescribed by their health care providers’ (Osterberg
& Blaschke, 2005). Studies have shown that long term viral suppression requires near perfect adherence (Bangberg, Perry, Charlebois, Clark, Roberston, Zolopa et al., 2001) and up to 95% adherence to ARV is required to suppress viral replication and to avoid the emergence of resistant strain_s (lckovics, Cameron, Zackin, Bassett, Chesney, Johnson, et al., 2002). It has been demonstrated that a 10% higher level of adherence results in a 21% reduction of disease progression (Nischal, Khopkar, & Saple, 2005).

Chapter 23: Utilization of community-based outpatient addiction treatment programmes in Kenya by Clement S. Deveau, Ludovick Tengia, Carolyne Mutua, Samuel Njoroge, Lillian Dajoh & Barney Singer

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Alcohol and drug abuse continue to be a significant problem in Kenya as well as other African countries. The Kenya National Campaign Against Drug Abuse Authority (NACADA) reported in their 2007 study that 70% of adults aged 15-64 with multiple partners are likely to be substance abusers. In addition, 50% of alcohol users report ongoing craving for alcohol and 25% need to consume alcohol first thing in the morning (NACADA, 2007). Alcohol abuse in Kenya has also been documented in other studies. According to Shaffer (2004), 54% of patients attending public health clinics in western Kenya reported hazardous drinking behaviour, as measured by the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT). In a study at voluntary counseling and testing (VCT) centers in eight Kenyan districts, Mackenzie and Kiragu (2007) reported that 76% of males and 25% of females who consume alcohol report hazardous drinking behaviour, also measured by the AUDIT. Alcohol abuse in Kenya has been identified for some time.
In 1989, Nielsen, Resnick & Acuda reported that 54% of the males and 25% of the females attending Kisii district hospital in Kenya met the DIS (Diagnostic Interview Schedule) criteria for alcohol abuse and/or alcoholism. Types of substances abused in Kenya are similar to other parts of Africa. The most commonly abused substances in Africa are alcohol, cannabis and khat/miraa (Odejide, 2006), while the most commonly abused substances in Kenya are alcohol, cigarettes, cannabis and khat/miraa (NACADA,2007; Ndetei et al, 2006). NADACA (2010a) reports that alcohol, followed by khat/miraa, are the most commonly used substance in the coast province of Kenya. Commonly used substances among Kenyan secondary school students are alcohol, tobacco, cannabis and khat/mirra (NACADA, 2007; Ndetei et al, 2009}. In another study, alcohol, cannabis, khat/miraa and kuber were considered the most commonly abused substances among Kenyan secondary school students (Ngesu, Ndiku & Masese, 2008).

Chapter 22: Review of interventions to reduce alcohol use-related sexual risk behaviour in Africa by Neo K. Morojele & Chitra Ranchod

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The harmful use of alcohol has long been recognized as a major contributor to mortality and morbidity in many parts of the globe, and in various parts of Sub-Saharan Africa in particular (WHO, 2004). Levels of alcohol consumption among those who consume alcohol are extremely high (Roerecke, Obot, Patra, & Fiehm,2008; WHO, 2004), and in some regions of Sub-Saharan Africa, those who drink are particularly involved in heavy/binge drinking patterns of consumption (Clausen, Rossow, Naidoo, & Kowal, 2009), which make them prone to acute problems
such as intentionai injuries, unintentional injuries and a range of other social and health problems (Babor, Caetano, Casswell, Edwards, Giesbrecht, Graham et al.,2003; Rehm, Baliunas, Borges, Graham, Irving, Kehoe et al., 2010).

Alcohol consumption is increasingly being recognized to be associated with HIV infection in various parts of Africa (Fritz, Morojele & Kalichman, 2010), and particularly, in those regions of the continent, such as Southern and Eastern Africa, that have the greatest burden of HIV (UNAlDS & WHO, 2009). A recent meta-analysis of studies globally found that alcohol consumption was associated with incident HIV (Baliunas, Rehm, Irving, & Shuper, 2009), and its findings were similar to those of a meta-analysis (Fisher et al., 2007) and a descriptive review (Pithey & Parry, 2009) of studies in Africa which showed strong associations between alcohol consumption and HIV infection. Sexual risk behaviour is understood to be the main mediator between alcohol consumption and HIV infection (Kalichman, Sibayi, Kaufmann, Cain, & Jooste, 2007a). Indeed, Kalichman et al.’s systematic review of studies conducted in Africa provides substantial evidence of alcohol’s association with sexual risk behaviour. Qualitative and quantitative research has uncovered some of the moderators of the relationship between drinking and sexual risk behaviour.

Chapter 21: Prevalence and specific psychosocial factors associated with substance use and psychiatric morbidity among patients with HIV infection at Usmanu Danfodiyo University Teaching Hospital, Sokoto State. Nigeria by Mufutau A. Yunusa, Ayodele Obembe, Taofeek Ibrahim and Chibueze H. Njoku

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There is no gainsaying that HIV infection has assumed a pandemic nature the world over. In addition to its contribution to morbidity and mortality, possible relationship of outcome of treatment with psychiatric morbidity and substance use presents another dimension to the disease. In one study, about 50% of patients with HIV infection had substance use problems; 18.5% were frequent users of alcohol while half of the patients had psychiatric morbidity (Bing et al., 2001). Earlier studies however reported a smaller percentage (Ferrando, Evans, Goggin, Sewell, Fishman, & Fiabkin, 1998; Maj et al., 1994). In yet other studies prevalence of 22% to 32% (Evans, Ferrando, Sewell, Goggin, Fishman, & Rabkin, 1998; Rabkin, Goetz, Remien, Williams, Todak, & Gorman, 1997) was reported which is two to three times higher than the prevalence of psychiatric disorders in general community population (Blazer, Kessler, McGonagle, & Swartz, 1994).

Lower prevalence of 9% of major depression and 2% of anxiety disorder were reported among the patients after 6-months follow up (Perkins, Stern, Golden, Murphy, Naftolowitz, & Evans, 1994). It was observed that while depression had substantial impact on quality of life, anxiety has negative impact on social role and mental functioning. In addition, where substance use problem is present but not treated, there is non-adherence to antiretroviral drugs (Ironson et al., 2005). The overall consequence of substance use and psychiatric morbidity among patients with HIV infection is poor physical health, rapid progression to AIDS and death, particularly non AIDS related death (Ironson et al.. 2005). in addition, Ironson et al. (2005) reported that psychosocial factors contribute significantly to the variance in disease progression.

Chapter 20: Substance use among mentally ill out-patients of Ndera psychiatric HIV unit and Kigali psychosocial consultation center. Rwanda by Alfred Ngirababyeyi, Vvonne Kayiteshonga, Beata Mukarusanga, Chantal Nyirarnugisha & Daniel Uwimana

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Mental disorders can be a risk factor as well as a consequence of HIV infection. Multiple studies have shown that certain mental illnesses (including substance dependence) increase vulnerability to HIV infection (Bogart et al., 2006; Stoff1 et ai., 2004). HIV infection can also lead to psychological reactions that range from emotional distress to frank mental disorders.’The stress of living with a chronic, stigmatized life-threatening disease; caring for others who are ill; witnessing the death of individuals in one’s social network; and managing the loss of income when breadwinners succumb to the illness often bring feelings of fear and sadness that may be mild and transient or severe and enduring- (McKinnon,Cournos, & Herman, 2002; Meade, & Sikkema, 2005). The patients identified as HIV infected therefore need special care that takes into account the impact of HIV and AIDS on their mental health (Collins et al., 2009). The triple diagnoses of HIV/AIDS, substance use disorder and psychiatric disorder have long been recognized by those who Work with this population. In the general population, approximately 50% of people with psychiatric disorders will meet criteria for substance use disorder in their lifetime (George & Krystal, 2000). Rates of mental disorders and substance use disorders tend to be higher in HIV population than in the general population (Mckinnon et al., 2002).
Further, HIV-infected patients with mental illness and substance abuse disorders face special challenges related to adherence to care and medications (Mugavero et al., 2006). Klinkenberg and Sacks found in 2004 that among opiates users, a current and lifetime history of any mental disorder has been associated with a higher frequency of sharing injection equipments and less condom use. They are also less likely to receive medical treatment or to accept to undergo highly active antiretroviral therapy in the first instance.

Chapter 19: Assessment of co-occurring substance related disorders and mental illness among psychoactive substance users by Gloria S. Karuri, Gray G. Ejikeme & Andrew Zamani

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Substance related disorders and mental illness are ailments that have been with man since the days of old. The use of psychoactive substances dates back to the primitive age when man experimented with herbs and roots for survival, both as food and medicament. While the harmless ones were chosen for food, those with psychoactive properties were kept for social and ritual purposes. Their addictive properties served as motivational factors that encouraged and sustained their use in large quantities across societies. The presence of mental health problems and psychoactive substance use can result in the user abusing the substancels) as a means of coping with prolonged stress, which is perceived as being relatively permanent or as a way of seeking relief and/or distraction from other emotional distress (Ross, Glaser & Germanson, 1988; Fiegier, Farmer, Rae, Locke, Keith,Judd &Godwin, 1990).

Nigerians‘ understanding of the dangers of psychoactive substance use/abuse revealed that most users and significant others are either ignorant or careless. Many surveys in Nigeria among secondary school students reveal and supports the view that availability and use of these substances by adolescents is on the increase (NDLEA 1992, 1993, 1999; Obot, Karuri & Ibanga, 2003). A detailed retrospective analysis of the case records of all psychiatric patients admitted to 13 centres in Northern Nigeria and 15 in the South in 1989 revealed that in the north the relative frequency at which abuse of drugs was recorded was 77% for cannabis; 19.9% for alcohol; 2.4% tor heroin‘, 1.1 % tor cocaine; 0.26% tor pethidine; 3.5% for amphetamine and 8.7% for a mixture of ill- defined psycho – stimulants. In the southern centres, the figures were 60.6% for cannabis; 15.6% for alcohol; 40.3% for heroin; 23.7% for cocaine (Ohaeri & Odejide, 1993). Most patients were young males from low socio – economic background.

Chapter 18: Sexual risk behaviours among patients admitted for substance use disorder and schizophrenia in a psychiatric hospital in Lagos, Nigeria by Veronica O. Nyamali, Olufemi Morakinyo & Rahmaan Lawal

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Human Immunodeficiency Virus (HIV). the virus that causes Acquired Immunodeficiency Syndrome (AIDS) has become one of the most serious healths and development challenges (Kaiser 2009). In spite of the enormous work carried out on its etiology, mode of transmission and treatment, HIV infection has continued its global spread. There were 33.4 million people living with HIV/AIDS (PLWHA) in 2008, up from 29 million in 2001 (UNAIDS /WHO, 2008).
Behavioural risk factors for HIV identified in people with mental illness include low rates of condom use during sexual activity (Sacks, Silberstein, Weiler, Perry, 1990; Jeffrey, Debra, Bahr et al.,1999), having multiple/same sex partners and sex in exchange for drugs, shelter or basic survival needs (Kalichman et aI., 1994; Kelly, Murphy & Sikkerna., 1995), coercion into unwanted sexual activity (Weinhardt, Carey, Carey, & Verdecias, 1999; Coverdale & Turbott, 2000), living in impoverished inner city areas with high rates of drug use and sexually transmitted disease (Jeffrey et al., 1991), coexisting substance use patterns (Blanchard, Brown, Horan, & Sherwood, 2000; Carey, Chandra, Carey, & Neal, 2003) especially the use of alcohol, cannabis and crack cocaine (Carey, Carey, & Kalichman, 1997). Intravenous drug use and needle sharing has also been reported (Grassi, Pavanati, & Cardelli, 1999; Carey, Carey, Maisto, Gordon, & Vanable, 2001).
Use of psychoactive substances also plays a major role in HIV transmission among non-injecting drug users (Jeffrey, 2002). Excessive use of alcohol (intoxication, binge drinking) has been associated with the development of neuro—psychiatric conditions, physical injuries, unsafe sexual behaviour and the use of other psychoactive drugs (Odejide, 2006). Similarly, like people with schizophrenia, injecting drug users are particularly vulnerable to HIV as a result of sharing of contaminated injecting equipment and high-risk sexual behaviours. lt has been documented that psychiatric patients particularly those with a diagnosis of schizophrenia may be at high risk of HIV infection (Gray & Brewin, 2002). The risk behaviours include sharing injection needles during intravenous drug use, promiscuity associated with unprotected sex and high-risk sexual activity after using drugs.

Chapter 17: Socio-demographic characteristics and personality profiles of patients with substance use disorders by Mfon E. Ineme, Helen O. Osinowo, Rachel B. Asagba, Kayode O. Taiwo, Imisioluwa O. Ibikunle, Iboro F. A. Ottu, Onyeye A. Aguiyi, Michael O. Akinlabi & Akin O. Akinhanmi

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Substance abuse remains one of the leading anti-social behaviours the world over. In many societies it is viewed as a leading cause of violence among individuals and groups. To the respective individuals, it has been a major cause of physiological illnesses such as liver, cardiovascular and cranial problems (Kazimir, 2010). It has exposed many to the risk of auto accidents (Bob, 2011), leading to physical deformity, loss of property, and even loss of lives. In addition, substance abuse is known to have a causal relationship with many psychological disorders including mental and behavioural disorders (Larson, 2011). Indeed, the dangers of taking drugs are far greater than its short – term illusory pleasures (Agrawal, Puliyel, Chansoria, Mukerejee & Kaul, 2007). Being more specific, Obedunmi (2008), explains that the harmful effect of smoking outweighs the presumed warmth and comfort. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harms (Wikipedia, 2010). Yet drinking is woven into the fabric of many societies as often experienced when sharing a bottle of wine over a meal, going out for drinks with friends, celebrating special occasions with champagne etc. But because alcohol is such a common, popular element in many activities, it can be hard to see when one’s drinking has crossed the line from moderate or social use to problem drinking (Smith, Segal & Robinson 2010).
These and many other problems associated with substance or drug misuse or abuse notwithstanding, the behaviour is still persisting, and indeed, increasing and taking different forms and dimensions. This persistence has therefore attracted the attention of the scientific/academic community globally, provoking many research and findings in the area. The research has covered such areas as definitions, types, causes, effects, prevention, and management/treatment of drug victims.
Psychoactive drugs are chemical substances that alter mood, behavior, perception, or mental functioning. They are substances that can be abused and have been classified according to their behavioural and psychological effects. The classes include alcohol, sedative-hypnotics, narcotic analgesics, stimulant-euphoriant, hallucinogens, and psychotropic drugs (Hewitt & Enoch, 2009).

Chapter 16: Injecting drug abuse and HIV/AIDS in Kenya by David M. Ndetei, Anne W, Mbwayo & Victoria Mutiso

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Of the 134 countries where drug injecting was confirmed in 1999, 114 reported a relationship with HIV/AIDS (UNAIDS, 1999). In 1995, it was estimated that 5-10% of all HIV/AIDS cases worldwide were due to injecting drugs of abuse through the use and sharing of contaminated needles and syringes (WHO. 1995). A multi-centre seroprevalence study in Canada at needle exchange sites found an overall HIV prevalence of 6.9% among lDUs between 1997 and 1998. Needle sharing occurred among 38% — 46% of the participants (Health Canada, 1997; Alary M. 1999). A two year follow-up study showed a 2-3% increase in HIV incidence (Archibald, Fiemis, Farley, & Sutherland, 1998; Health Canada, 2000; Lamothe , 1999; Millson, 2000; Patrick, 1998; Tannenbaum, 1999; Tyndall,1999; Wallace, 1999).
The number of new HIV cases among intravenous drug users in the United States rose in 2000, halting five years of steady decline in overall HIV seroprevalence (World Drug Report, 2000). People who injected drugs and their sex partners in the year 2000 represented about one-third of all those who had been infected with HIV in the United States of America since 1981. Therefore, for these populations, prevention strategies emphasized preventing drug abuse and treating drug abusers and decreasing needle-sharing (HIV,/AIDS Surveillance Report, 1998). He established that most substance abuses were in combinations and the
most vulnerable age group was 16-20 years.

Chapter 15: Gender locus of control and undergraduates‘ smoking habit by Gboyega E. Abikoye & Adetutu Fusigboye

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According to the World Health Organization’s Report on the Global Tobacco Epidemic (WHO, 2008), smoking is the single most preventable cause of death in the world. In 2008, tobacco smoking was estimated to have killed more than five million people — more than tuberculosis, HIV/AIDS and malaria combined; and by 2030, it is projected that the death toll will exceed eight million a year (WHO, 2008). The report further highlighted an obvious but commonly-overlooked fact: tobacco is the only legal consumer product that can harm everyone exposed to it
– and it kills up to half of those who use it as intended (WHO. 2008). Yet, tobacco use is common throughout the world due to many factors including low prices, aggressive and widespread marketing, lack of awareness about its dangers, inconsistent public policies against its use, person-related factors, among other factors (Center for Disease Control and Prevention: CDC, 2010a; Gilman & Xun, 2004; WHO, 2008; Wingand, 2006).
Because they are engaging in an activity that has negative effects on health, people who smoke tend to rationalize their behaviour. In other words, they develop convincing, if not necessarily logical reasons why smoking is acceptable for them to do. For example, a smoker could justify his or her behavior by concluding that everyone dies and so cigarettes do not actually change anything. Or a person could believe that smoking relieves stress or has other benefits that justify its risks. The reasons given by smokers for this activity are broadly categorized as addictive smoking, pleasure from smoking, tension reduction/relaxation, social smoking, stimulation, and habit/automatism (Berlin, Singleton, Pedarriosse, Lancrenon, Flames. Aubin, 8: Niaura, 2003}. Researchers have also reported that some people use smoking for the pleasure of handling the cigarette (Berlin et al., 2003; Wang, Yu and Zhu, 1994).

Chapter 14: Sexual victimization, partner aggression and alcohol consumption by Akanidomo Ibanga

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In recent history there has been considerable attention focused on issues of childhood sexual abuse and adult sexual victimization. This may in part be due to the efforts to address related issues of sexually transmitted infections, HIV/AIDS, commercial sexual exploitation of women, and child! human trafficking. Issue of this nature have at one level increased the need for a clearer understanding of sexual activities and behaviours particularly as it relates to individuals that may be in a vulnerable position. The new understanding that has emerged has played a central role in dispelling previously held beliefs that the sexually abused victims were to blame for their experience (Messam & Long, 1996). This shift from previously held beliefs along with the interest raised in regards to these issues has made it easier for people to disclose their own victimization. With this also is the desire to unearth the extent and nature of victimization in varied populations.

Many of the studies seeking to establish the prevalence of sexual victimization often adopt cross-sectional retrospective methods where respondents are required to report from memory any history of sexual victimization. The validity of self-reporting of sexual victimization has been drawn into question as people have been known to under-report their own experience (Fergusson, Horwood, & Woodward, 2000; Widom & Morris, 1997). It is thought that factors such as individuals responding in what is considered socially appropriate, unwillingness to disclose information, misinterpretation of the questions or sheer errors in their ability to recall the incident, could lead to this under reporting of incidents. Rohsenov, Corbett, and Devine,(l988) report that asking the question more than once aids disclosure of difficult material of this nature. In a more recent work
which improves on methods used in previous research, Barnes, Noll, Putnam, and Trickett. (2009) present evidence contrary to this, they found that individuals can accurately report retrospectively substantiated sexual victimization ISV), and at this with remarkably high test re-test assessment over a two year period. Whether this is a result of the changing culture in recent times or purely as a result of the method adopted may however be in question.

Chapter 13: Influence of self-perception of alcohol use on differential relationship maintenance among married persons by Iboro F. A. Ottu, Helen O. Osinowo, Annasthesia O. Aguiyi, Kayode O. Taiwo, Michaei O. Akinlabi & Mfon E. Inerne

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Throughout evolutionary history, the maintenance of long-term mating relationships has played an important role in human reproductive processes (Maner, Rouby &Gonzaga, 2008). Maintaining commitment to a current long-term partner has a lot of benefits (Gonzaga, Keltner, Londabl, & Smith, 2001). For example, compared to the offspring of many other mammals, human offspring have benefited from high levels of investment from both parents (Daly & Wilson, 1983) which usually requires some degree of long-term relationship investment and commitment. Also, children living with two biological parents continue to be healthier compared to children growing up in other family arrangements and when they reach adulthood, surveys show that they will have better physical health and a longer lifespan (Wood, Goesling & Avellar, 2007). Successfully maintaining relationships has also been linked to several positive outcomes including relational satisfaction and longevity (Guerrero, Eloy, and Wabnik, 1993). Moreover, staying committed to a long—term mating relationship can provide benefits through engagement in continued social alliances associated with the relationship (e.g. the presence of extended family and automatic interaction with social groups of one’s spouse)
(Maner, et. al., 2008).

Chapter 11: Influence of sensation-seeking and impulsivity on drug use among youths in Ibadan by Anastasia O. Aguiyi, Kayode O. Taiwo, Helen O. Osinowo, Mfon E. Ineme, Iboro, F. A. Ottu & Olugbenga M. Akinlabi

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Psychological drug research field has currently proposed trait and cognitive explanations in the prediction of drug misuse (Jorge, 2006). Personality traits have long been known to be associated with drug use and/or misuse. From disinhibition personality models, Impulsivity and sensation seeking personality variables were implicated. Sensation seeking (SS) and Impulsivity, two highly similar indicators of the construct of disinhibition personality traits, could better predict drug misuse patterns, across different classes of drugs.

Sensation seeking trait refers to the general need for thrills or the willingness to take risks for excitement, a preference for unpredictable situations and a need for novelty. Youths relatively high in sensation seeking may have a biologically based need for stimulation, making them more vulnerable to substance abuse and more susceptible to the reinforcing effects of pleasurable stimuli, or risk behaviours including use or misuse of drugs(Zuckerman, 2007). Many studies had demonstrated that individuals high in sensation seeking appear to be drawn to smoking, alcohol use and use/misuse of illicit drugs (Dom, Hulstijn & Sabbe, 2006; Stoops, Lile & Robbins, 2006). Impulsivity, in contrast, refers to the lack of planning and a tendency to act quickly on impulse without thinking. Impulsivity can predispose to substance abuse, and can result from it. Impulsivity is related to increased stimulus orientation and disinhibited drive-related behaviour. In turn, abused drugs increase Impulsivity by activating catecholaminergic systems related to stimulus-orientation and action. Impulsivity increases susceptibility and/or predisposes to self-administration of cocaine and other strongly reinforcing substances leading to abuse and predicted poor retention in treatment (Moeller, Dougherty, Barrett, Schmitz, Swann & Grabowski, 2001b). Studies have demonstrated that risk behaviours are significantly correlated with one another and often appear in clusters (Winters, Botzet, Fahnhorst, Baumel, & Lee, 2009). In adolescents as well as adults, individual differences in discounting have been linked to risk taking tendencies (impulsivity) such as drug use (Verdejo-Garcia, Lawrence, & Clark, 2008).

Chapter 12: Influence of gender, parental family type, residential area and locus of control on illicit drug involvement among drug users in selected motor parks in Ibadan by Abiodun M. Lawal

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Illicit drug use has been linked with a number of social problems like robbery, violence and youth restiveness experienced today in Nigeria. The National Drug Law Enforcement Agency and other empirical research findings point to the increasing number of young persons involved in drug use in Nigeria (NDLEA: 2007). The need for Governments to invest adequately in the country’s health sector by helping to address the problems of alcohol or drug misuse especially in the motor parks has been identified. A major concern about cannabis has been that its use in motor parks for example may precipitate, or increase the risk of using other more dangerous illicit drugs such as cocaine and heroin (Kleiman, 1992). Environments where young people are exposed to illicit drug are likely to experience upsurge in violent crimes such as armed robbery and social crimes including kidnapping and prostitution that are now rampant in many states in the country. A typical Nigerian garage has been identified as a den of lions and lionesses, and home for predators and vultures in human skin; and illicit drug use abound there (Oderemi, 2011).

Illicit drug use represents one of the many possible mal-adjustable ways in which an individual may react to internal or external stressors. Though programmes are being undertaken to reduce the extent of illicit drug use, these programmes are not judged to be effective. Existing programmes seem not to be working because they may be based on false assumptions. Additionally these programmes do not seem to address the motivating factors in the initiation of drug use by individuals. Some of the notable illicit drugs that are commonly used in motorparks include marijuana, cocaine, heroin, alcohol, cigarettes, among others (Bajulaiye, 2005). Cocaine and amphetamines are being mixed with local gin at motor parks and sold as drug cocktails nicknamed “shepke” and “monkey tail”. These potent stimulants are used by some individuals to stay awake. However, these drugs are illegal and have some health implications. Understanding how gender, family structure, type of residential area and locus of control influence illicit drug use is important for effective drug control and management in Nigeria.

Chapter 10: The demography, nature and extent of drug abuse and HIV/AIDS in Malawi by Thomas Bisika, Sidon Konyani & Immaculate Chamangwana

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Although Malawi is one of the countries experiencing serious HIV and AIDS epidemic, its population has grown from 9.9 million in 1998 to 13.1 million in 2008 representing a 32% increase (National Statistical Office, 2008). This is a complete defiance of the worst HIV and AIDS prognosis which indicated that the growth rate for the Malawi population will decline to 2.2% annually by 2010 (Bisika, 1993). Substance abuse is common in Malawi although the nature and extent of the problem has not yet been assessed. Recent reports based on psychiatric hospital figures indicate that the main substances of abuse in Malawi are alcohol (including home brew) and cannabis (locally known as “chamba”). The reports also indicate that Mandrax and other over-the-counter and prescription medicines like Phenobarbital, morphene and diazepam are also abused. Solvent abuse has also been reported (Parry & Pluddemann, 2003).

There has been an increase in alcohol abuse cases in treatment centres in Malawi from 15% in 1995 to 20% in 2003. It has also been observed that the problem of cannabis abuse in Southern Africa is highest in Malawi where it accounts for 88% of patients visiting treatment centres and that within the Southern Africa Development Community (SADC) region, it is only in Malawi that the situation of cannabis abuse seems to be increasing substantially (Parry & Pluddemann, 2003). In other countries, substance abuse, especially cannabis, among hospitalized psychiatric patients has also been recognized as a growing problem (katz, Durst, Shufman, Bar-Hamburger & Grunhaus, 2008).

Several reports (Bisika, 2003a, 2003b) show that alcohol consumption in the public sector was 53.3% while smoking was only 16.1%. Alcohol consumption in the private sector was 48.7% while smoking prevalence was 20.3%. In the private sector 30.6% of the people have gone for VCT and 69.7% would like to go for VCT. Furthermore, a study conducted in three districts of Malawi (Mangochi, Ntchisi and Zomba) recorded an alcohol consumption rate of 15.2% and 11.6% for smoking (Bisika, 2003). A baseline survey for the SRH project in the tourism industry showed that 38.3% of those in this industry take alcohol of whom 9.1% drink on a daily basis and 48.1% on a weekly basis. Smoking was not as common (12.8%) (Bisika, 2002).

Chapter 9: At-risk behaviours of adolescents in military schools in Lagos State by Aderinola B. Abidoye & Olufunke O. Chenube

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In the last decade, the term “at-risk” has made frequent appearances in educational, psychological, medical, social work and economics literature. Its origin is obscure and its use in various contexts indicates a lack of consensus regarding its meaning (Adegoke, 2003). Psychologists, social workers and counsellors use the term to denote a population of persons suffering emotional and adjustment problems. However, at-risk behaviour in this paper connotes a set of presumed cause and effect dynamics that places the adolescent in danger of negative future events (Adegoke, 2003). Risky behaviours put individuals at risk of physical or emotional harm which include substance misuse, cultism, bullying, antisocial behaviours, truancy and unprotected sexual activities. Adolescence is characterized by profound biological, developmental, psychological and-social changes (Olayinka &

Omoegun, 2007). Adegoke (2003) described the adolescence period as the most fascinating and complex since it marks the transition in the lifespan of a man. This period can be turbulent for most young people because of peer influence and pressure. There are a number of negative consequences associated with youth at-risk behaviour; school dropout, delinquency and crime, youth violence, future poor health, injury or death, unintended pregnancy and STDs, including HIV infection. To determine whether a specific behaviour or activity represents risk-taking, it must be viewed in the context of possible motivation and the potential dangers that may result.

Chapter 8: Alcohol related problems, family type and youth HIV/AIDS risk behaviour by Okokon O. Umoh & Udoudo J. Umoh

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Across the world. between 35 – 45 million people are living with HIV and AIDS ( United Nations Agency for International Development, UNAID report, 2005). Of this number, about 25.5 million live in the African continent. So far, more than 13million of them have died of this disease. South Africa is the region with highest (67%) HIV infection (Parry, 2010). Nigeria has the third largest population of people living with HIV/AIDS in the world after India and South Africa. The prevalence rate in Nigeria has been on the increase from 1.8% in 1991, through 5.4% in 1999, to 4.4% in 2005 (Federal Ministry of Health Sentinel Survey Report, 1999; 2005).

Youth make up the largest segment of the population that is particularly vulnerable to HIV/AIDS (World Health Organization, WHO report, 2006). Altogether, 50% of HIV transmission takes place among those aged 15-24, accounting for 5,000-6,000 youth becoming infected daily(WHO, 2006). The preceding evidence, associating a large number of youth with HIV/AIDS transmission could be explained by the higher tendency and frequency with which they get involved in HIV/AIDS risk behaviour. Youth risk behavior are those responses, actions and for activities that increase the actor(s) probability of contracting or transmitting HIV/AIDS (Umoh, 2003). Such behaviours include having unprotected sexual intercourse, having multiple sex partners, sharing injection needles and other body piercing devices.

Chapter 7: Alcohol use, gender and high risk sexual behaviour among undergraduates by Leonard C. Onwukwe, Nkwarn C. Uwaoma & Ann U. Madukwe

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Alcohol use and its influence on high risk sexual behavior has been explored by researchers (Kaiser family foundation, 2002; O’Hare, 2005; Thompson et al., 2005; Abbey et al., 2006; Amoateng, Sabiti & Narayanan, 2007; Olisah, et al., 2009). However, most of these studies were conducted in western societies especially Europe and America. There is paucity of studies from sub-Saharan African countries especially Nigeria.

Two prominent theories depict alcohol as a cause of disinhibited social behaviors: alcohol myopia and expectancy theories. Steele & Josephs (1990) have proposed that alcohol creates what amounts to a cognitive shortsightedness, or alcohol myopia, with regards to the consequences of an individual’s actions while under its influence. intoxicated individuals are less capable of attending to most situational cues just as they display a reduced ability to “process and extract meaning ” from those cues that are perceived. Simple and highly salient cues (e.g., sexual arousal) continue to be processed, whereas more distal, complex ones related to the possible negative consequences of such actions (for example, fear of pregnancy or sexually transmitted disease) are no longer adequately processed. They might be so removed from the situation as to nullify their capacity to forestall the decision to have intercourse. Consequently, alcohol creates a “myopia” in which incompletely processed aspects of immediate experience exert undue influence on behaviour and emotion. The model also suggests that alcohol is most likely to have its impact when inhibition conflict is present. inhibition conflict occurs when a specific behaviour is at once impelled by certain situational cues and inhibited by others (Velez-Blasini, 2008; Cooper, 2006).

Chapter 6: Alcohol use and risk of HIV infection among male adolescents in Uyo, Nigeria by Ediomo-ubong Nelson

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Introduction
HIV/AIDS was recognized as a global crisis by mid 1980s (Liskin, Blackbourn & Maier, 1986). By 1986, there were an estimated 100, 000 AIDS cases worldwide, and about 10 million cases of HlV infection (WHO, cited in Kiragu, 2001). Whereas projections at the time showed that the number of AIDS-related deaths would reach 1.7 million by 2006, 3 million people reportedly died of AIDS by 2001 (UNAIDS/WHO, 2001). HIV/AIDS has since spread precipitously throughout the world, ravaging the lives of millions of people, increasing health burdens and engendering very deleterious socio-economic consequences. ln 2000, the total number of deaths from AIDS globally was put at 22 million (UNAlDS, 2000), and over 40 million people were living with the virus. Around 25.8% of these people were in sub-Saharan Africa. Nigeria has about 3.5 million HIV infected persons, a figure that easily qualifies her as the third largest population of PLWHAS in the world, after India and South Africa.

Chapter 5: Influence of alcohol, gender and marital status on HIV/AIDS vulnerability by Ochinya O. Ojiji, Abayomi A. Okediji, Aladedunye Aiasin, & Enwongo A. Okediji

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Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV) (Weiss, 1993; Cecil, 1998). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors (Holmes, Losina, Walensky, Yazdanpanah, Freedberg, 2003). HIV is transmitted through direct contact of mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk (Divisions of HIV/AIDS Prevention,2003). This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids. HIV virus consists of two types: HIV – 1, the most virulent and widespread type that causes most diseases; and HIV – 2, a lesser strand that occurs in West Africa. The viruses attach to and enter T lymphocytes that bear the CD4 protein (T helper cells) on their surfaces. The CD4 protein co-ordinates, the body’s immune response and as their numbers fall during the last stages of infection, profound immune suppression occurs making the person open to many “opportunistic infections”. This is the final life threatening stage of the infection. AIDS entails that the HIV has severely damaged the immune system, making the patient susceptible to infections that the immune system would otherwise combat.

Chapter 4: Influence of alcohol consumption on sexually transmitted infections by Waheed M. Alausa, Benjamin A. Olabimitan & Muniru A. Ajala

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Studies have shown over time that people with alcohol use disorders are more likely to contract HIV than those without (Petry, 2005). Similarly, people with HIV are more likely to abuse alcohol at some time during their lives (Krupitsky, Horton Williams, Lioznov & Kuznetsova, 2005). The reason proffered for this is that alcohol consumption has the potential to strengthen a sense of vulnerability, reduce perceived importance of social norms, diminish awareness of high risk, and confound the drinker’s ability to negotiate interpersonal situations or interactions with the environment (Standerwick, Davies & Tucker, 2007). Studies have also found a positive relationship between alcohol use and incidence of sexually transmitted infections (STIs). particularly human immunodeficiency virus (Chersich, Luchters, Malonza, 2007; Fisher, Cook & Sam, 2008). And in sub-Sahara Africa alcohol has been found to be the most common form of substance
abuse (Obot, 2000; Pam/, Bhana & Myers, 2002).

Chapter 3: Prevalence and socio-demographic correlates of alcohol use disorders among HIV patients by Suwa G. Goar. Moses D. Audu, Michael T. Agbir & Edward Dachalson

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The rate of alcohol consumption is high among individuals living with HIV/AIDS. People who abuse alcohol are more likely than the general population to contract HIV (Brown & Wechsberg, 2010; Kalichman, Simbayi, Kaufman, et al., 2007; Petry, 1999). Similarly, HIV infected individuals are more likely to abuse alcohol and other substances at some time during their lives (Lefvre, Brian, Maureen et al., 1995). Studies have consistently shown that alcohol use is related to high risk sexual behaviour through multiple reasons. For example multiple sex partners, unprotected inter-course and sex with high risk partners (Audu, Bankat, Enejoh, Umar, & Goar, 2009; Avins, Woods, Lindan, et al., 2000; Boscarino, Avins, Woods, et al., 1995; Malow, Devieux, Jennings et aI., 2001). High rates of risky sexual practices have been reported among adolescents (Grunbaum, Kann, Kinchen, et al., 2002) and may be correlated with alcohol consumption (Malow et al., 2001). There may be many factors for this association, some of which include expectations regarding the effects of alcohol on sexual arousal and performance, reduced inhibitions and diminish risk perceptions (Cooper, 2002; Fromme, D’Amico, E, & Katz, 1999; McDonald, MacDonald, G., Zanna, & Fongi, 2000).

Chapter 2: ls there a causal relationship between alcohol and HIV? Implications for policy, practice and future research by Charles A. H. Parry, Jurgen Rehm & Neo K. Morojeie

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Sub—Saharan Africa (SSA) remains the region most heavily affected by HIV and AIDS. In 2008 it accounted for 67% of HIV infections worldwide, accounting for 70% of new infections and 70% of AIDS—related deaths (UNAIDS and WHO, 2009). South Africa is one country in SSA that has been substantially affected, with an adult (15-49 years) HIV prevalence rate of 18.1% in 2007 and approximately 350,000 AIDS deaths reported in that year (WHO, UNAIDS & UNICEF, 2008). SSA has a high proportion of the population that abstains from drinking, reported to be 55% of males and 69% of females, while annual per capita consumption of alcohol per drinker is very high in this region, at an estimated 19.5 litres (Roerecke, Obot, Patra, & Flehm, 2008). Average drinking pattern scores in SSA are also high, 2.9 out of 4 in Afro Region D and 3.1 out of 4 in Afro Region E, reflecting detrimental drinking patterns such as heavy episodic drinking and drinking outside of meals (Hoerecke et al., 2008). A recent review of drinking practices in 20 African countries reported that 23% of South Africans had drunk alcohol in the previous week, but of these 29% could be categorized as high consumers (that is, drinking 15 or more units of alcohol during the previous week and 48% could be categorized as heavy drinkers (that is, drinking five or more units on one or more occasions during this time period). Of the 20 countries, South Africa was ranked fourth highest in terms of the proportion of heavy drinkers as a percentage of current drinkers (Clausen, Rossow, Naidoo, & Kowal, 2009}- In this country rates of heavy drinking are four to five times higher on weekends than on weekdays (Parry, Pltiddemann, Steyn, Bradshaw, Norman, & Laubscher, 2005).
In this article We will review international research on the linkages between alcohol and HIV before presenting the results of analyses reported by Rehm, Kehoe, Fiehm, and Patra l2009b) on the burden of alcohol in terms of death and disability in South Africa. in particular we will present data quantifying the contribution of alcohol to the progression of HIV disease. The implications of this burden and also the strong association between alcohol and the acquisition of HIV will be discussed in terms of new policies and practices needed and what research is required to fill in some of the gaps in our understanding of causality and how best to intervene.

Chapter 1: Substance use and HIV/AIDS in Africa by Isidore S. Obot, Akan J. Ibanga & Andrew Zamani

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The 2010 global report on the AIDS epidemic (UNAIDS, 2010) paints a positive picture of the current situation globally and in Africa. Though levels of infections are still high, the epidemic showed signs of stabilization or decline since the 1990s, including in sub—Saharan Africa where the epidemic has been at the centre of public health concerns for more than thirty years. In 2009 22.5 million children and adults were living with HIV in the region, representing 68% of the global total of 33.3 million. Among people aged 15-49 years the prevalence rate was 5.9% in 2001 and 5% in 2009 in sub-Saharan Africa, and less than 1% in both years globally, In terms of rates of infection the worst hit countries have been in east and southern Africa (e.g., Kenya and Uganda, South Africa, but even with a lower infection rate Nigeria in West Africa has one of the largest number of people living with AIDS because of its large population.

The decline in AIDS cases in Africa is due to better targeting of risk factors through prevention efforts and the scaling up of antiretroviral therapy in many countries. However, AIDS remains one of the health and development challenges in sub-Saharan Africa today and the search for ways to sustain or accelerate the reported decline in infection rates must continue. This search needs to include greater attention to the role of risky behaviours associated with substance use and dependence, including injection drug use (which has been reported in a growing number of-countries) and harmful consumption of alcohol (a widespread problem across the region).

SUBSTANCE ABUSE AND HIV/AIDS IN AFRICA Proceeding of the Ninth Biennial International Conference on “Alcohol, Drugs and Society in Africa”

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CONTENTS

Chapter 1: Substance use and HIV/AIDS in Africa by Isidore S. Obot, Akan J. Ibanga & Andrew Zamani

Chapter 2: ls there a causal relationship between alcohol and HIV? Implications for policy, practice and future research by Charles A. H. Parry, Jurgen Rehm & Neo K. Morojeie

Chapter 3: Prevalence and socio-demographic correlates of alcohol use disorders among HIV patients by Suwa G. Goar. Moses D. Audu, Michael T. Agbir & Edward Dachalson

Chapter 4: Influence of alcohol consumption on sexually transmitted infections by Waheed M. Alausa, Benjamin A. Olabimitan & Muniru A. Ajala

Chapter 5: Influence of alcohol, gender and marital status on HIV/AIDS vulnerabilityby
Ochinya O. Ojiji, Abayomi A. Okediji, Aladedunye Aiasin, & Enwongo A. Okediji

Chapter 6: Alcohol use and risk of HIV infection among male adolescents in Uyo, Nigeria by
Ediomo-ubong Nelson

Chapter 7: Alcohol use, gender and high risk sexual behaviour among undergraduates by
Leonard C. Onwukwe, Nkwarn C. Uwaoma & Ann U. Madukwe

Chapter 8: Alcohol related problems, family type and youth HIV/AIDS risk behaviour by Okokon O. Umoh & Udoudo J. Umoh

Chapter 9: At- risk behaviours of adolescents in military schools in Lagos State by Aderinola B. Abidoye & Olufunke O. Chenube

Chapter 10: The demography, nature and extent of drug abuse and HIV/AIDS in Malawi by
Thomas Bisika, Sidon Konyani & Immaculate Chamangwana

Chapter 11: Influence of sensation-seeking and impulsivity on drug use among youths in lbadan by Anastasia O. Aguiyi, Kayode O. Taiwo, Helen O. Osinowo, Mfon E. Ineme, Iboro, F. A. Ottu & Olugbenga M. Akinlabi

Chapter 12: lnfluence of gender, parental family type, residential area and locus of control on illicit drug involvement among drug users in selected motor parks in Ibadan by Abiodun M. Lawal

Chapter 13: lnfluence of self-perception of alcohol use on differential relationship maintenance among married persons by Iboro F. A. Ottu, Helen O. Osinowo, Annasthesia O. Aguiyi, Kayode O. Taiwo, Michaei O. Akinlabi & Mfon E. Inerne

Chapter 14: Sexual victimization, partner aggression and alcohol consumption by Akanidomo Ibanga

Chapter 15: Gender. locus of control and undergraduates‘ smoking habit by Gboyega E. Abikoye & Adetutu Fusigboye

Chapter 16: Injecting drug abuse and HIV/AIDS in Kenya by David M. Ndetei, Anne W, Mbwayo & Victoria Mutiso

Chapter 17: Socio-demographic characteristics and personality pro?les of patients with substance use disorders by Mfon E. Ineme, Helen O. Osinowo, Rachel B. Asagba, Kayode O. Taiwo, Imisioluwa O. Ibikunle, Iboro F. A. Ottu, Onyeye A. Aguiyi, Michael O. Akinlabi & Akin O. Akinhanmi

Chapter 18: Sexual risk behaviours among patients admitted for substance use disorder and schizophrenia in a psychiatric hospital in Lagos, Nigeria by Veronica O. Nyamali, Olufemi Morakinyo & Rahmaan Lawal

Chapter 19: Assessment of co-occuring substance related disorders and mental illness among psychoactive substance users by Gloria S. Karuri, Gray G. Ejikeme & Andrew Zamani

Chapter 20: Substance use among mentally ill out-patients of Ndera psychiatric HIV unit and Kigali psychosocial consultation center. Rwanda by Alfred Ngirababyeyi, Vvonne Kayiteshonga, Beata Mukarusanga, Chantal Nyirarnugisha & Daniel Uwimana

Chapter 21: Prevalence and specific psychosocial factors associated with substance use and psychiatric morbidity among patients with HIV infection at Usmanu Danfodiyo University
Teaching Hospital, Sokoto State. Nigeria by Mufutau A. Yunusa, Ayodele Obembe, Taofeek Ibrahim and Chibueze H. Njoku

Chapter 22: Review of interventions to reduce alcohol use-related sexual risk behaviour in Africa by Neo K. Morojele & Chitra Ranchod

Chapter 23: Utilization of community-based outpatient addiction treatment programmes in Kenya by Clement S. Deveau, Ludovick Tengia, Carolyne Mutua, Samuel Njoroge, Lillian Dajoh & Barney Singer

Chapter 24: Use of Mobile telephone technology to enhance adherence to antiretroviral therapy by Margaret O. Afolabi, Francis J. Olatoye, Omoniyi J. Ola-Olorun,
Oluwafunmi A. Akinyemi & Adedayo I. Irinoye

Chapter 25: Ergogenic effect of varied doses of coffee-caffeine an maximal aerobic power of young black African subjects Sikiru Lamina & Danladi I. Musa

Chapter 26: Opening Address by Ahmadu Giade

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