Triple Burden of Cannabis Use, First Episode Psychosis and HIV in KwaZulu ‐Natal Province, South Africa

Aim To describe the current and lifetime patterns of substance use, particularly cannabis, and its association with clinical presentation of individuals presenting with first episode psychosis, living with and without HIV, in KwaZulu‐Natal Province, South Africa. Methods Adult patients, aged 18–45 years, diagnosed with a psychotic disorder meeting DSM‐5 criteria and screened using the Mini International Neuro‐psychiatric Interview, were recruited to the study ( N = 182). Psychiatric tools, including the Positive and Negative Syndrome Scale, International HIV Dementia Scale, Patient Health Questionnaire and the Extra‐pyramidal Symptom Rating Scale, were used to gather clinical data. Substance use was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test; HIV ELISA testing was used to assess HIV status. Results Most were males ( n = 129, 71.0%), mean age being 26.27 (SD = 7.22), with 39 individuals (21.3%) living with HIV. Those with lifetime cannabis use scored significantly higher on the Positive and Negative Syndrome Scale total score ( p = 0.009), disorganised ( p = 0.009), excitement ( p < 0.001) and positive symptom domain ( p = 0.003), and lower on the depression domain ( p = 0.002). People living with HIV and having lifetime cannabis use scored significantly higher on the positive ( p = 0.023) symptom domain. HIV‐negative participants with lifetime cannabis use scored significantly higher on the excitement symptom domain ( p = 0.013) and lower on the depression domain ( p = 0.023). Conclusion There is a high prevalence of comorbid cannabis use in persons with first‐episode psychosis. An integrated mental health service program that addresses the triple diagnosis of psychosis, substance use and HIV is required to help curb the increasing disease burden.