Bio


I am a pediatric physician completing his residency at Stanford Lucile Packard Children’s hospital. I completed my undergraduate degree in anthropology at the University of Notre Dame and my Masters of Science in Global Health at Duke University. In graduate school, I worked at the Duke Global Health Institute in the lab of Dr. C. S. Meade exploring the co-occurrence of HIV and substance use disorders both domestically and internationally. My thesis work brought me to Cape Town, South Africa for several months to lead a joint study in conjunction with Duke University, the University of Cape Town, and the City of Cape Town exploring HIV prevalence, sexual risk behaviors, and mental health among methamphetamine users seeking treatment at a city rehabilitation clinic. I obtained my MD from Georgetown University School of Medicine where I was a coordinator of the medical school asylum clinic for refugees and later served on the national medical student advisory board for Physicians for Human Rights. In addition to South Africa, over the course of my academic career, I have worked with NGOs in Senegal, Cameroon, and Lesotho. My current research interests are in addressing both local and global healthcare disparities in pediatric hematology/oncology.

Clinical Focus


  • Pediatrics
  • Global Health
  • Residency

Professional Education


  • MD, Georgetown University School of Medicine (2019)
  • MSc, Duke University, Global Health (2015)
  • BA, University of Notre Dame, Anthropology (2013)

All Publications


  • Gender and Sex Trading Among Active Methamphetamine Users in Cape Town, South Africa. Substance use & misuse Lion, R. R., Watt, M. H., Wechsberg, W. M., Meade, C. S. 2017; 52 (6): 773–84

    Abstract

    South Africa has experienced a tremendous rise in methamphetamine use since the year 2000. Sex trading is a global phenomenon that has been observed in active drug users and has been associated with risks for HIV infection and violence.This paper describes and examines the correlates of sex trading among active methamphetamine users in Cape Town, South Africa.Through peer referral, 360 (201 male; 159 female) active methamphetamine users were recruited in a peri-urban township. Demographics, sex trading, drug use, trauma, and mental health were assessed by a structured clinical interview and computer survey. Logistic regression models were used to examine predictors of sex trading for men and women.In the past 3 months, 40% of men and 33% of women endorsed trading sex for methamphetamine or money. Among these, they reported trading with same sex partners (33%), high rates of inconsistent condom use (73%), and incidences of physical (23%) and sexual (27%) assault when sex trading. Increased drug use severity was correlated with sex trading. Women with experiences of violence and trauma were also more likely to trade sex. Conclusions/importance: The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. Targeted interventions geared towards safe sex practices may reduce risky sexual behaviors. Women need interventions that are attuned to their specific vulnerabilities. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior.

    View details for DOI 10.1080/10826084.2016.1264964

    View details for PubMedID 28379107

    View details for PubMedCentralID PMC5600888

  • HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa. AIDS and behavior Meade, C. S., Lion, R. R., Cordero, D. M., Watt, M. H., Joska, J. A., Gouse, H. n., Burnhams, W. n. 2016; 20 (10): 2387–97

    Abstract

    South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.

    View details for DOI 10.1007/s10461-016-1333-x

    View details for PubMedID 26873492

    View details for PubMedCentralID PMC4982836

  • HIV testing and sero-prevalence among methamphetamine users seeking substance abuse treatment in Cape Town. Drug and alcohol review Gouse, H. n., Joska, J. A., Lion, R. R., Watt, M. H., Burnhams, W. n., Carrico, A. W., Meade, C. S. 2016; 35 (5): 580–83

    Abstract

    Methamphetamine use is highly prevalent in parts of South Africa, and there is concern this will contribute to the country's substantial HIV epidemic. We examined the feasibility of implementing routine HIV testing at a community-based substance abuse treatment centre in Cape Town and determined the HIV sero-prevalence among methamphetamine users seeking treatment at this site.In this cross-sectional study, 293 participants completed measures of demographics, substance use and HIV treatment. HIV sero-prevalence was determined by a rapid finger-prick HIV test, and prior HIV diagnosis was confirmed via clinic records.The majority of participants were male and self-identified as 'Coloured', with a mean age of 28 years. The HIV sero-prevalence was 3.8%. Of the 11 participants who tested HIV positive, four were newly diagnosed. HIV-positive and HIV-negative participants were comparable on demographic and substance use factors. Uptake of HIV testing among all clients at the drug treatment centre increased from <5% prior to study initiation to 89% after study completion. Measures implemented to ensure high rates of HIV testing were regarded as sustainable.Our study suggests that integrating routine HIV testing into substance abuse treatment is feasible in a community-based health centre. The low HIV prevalence among this sample of treatment-seeking methamphetamine users highlights the potential benefits of supporting expanded efforts to optimise HIV prevention with this young adult population. [Gouse H, Joska JA, Lion RR, Watt MH, Burnhams W, Carrico AW, Meade CS. HIV testing and sero-prevalence among methamphetamine users seeking substance abuse treatment in Cape Town. Drug Alcohol Rev 2016;35:580-583].

    View details for DOI 10.1111/dar.12371

    View details for PubMedID 26661781

    View details for PubMedCentralID PMC4907883

  • Primary and Secondary HIV Prevention Among Persons with Severe Mental Illness: Recent Findings. Current HIV/AIDS reports Hobkirk, A. L., Towe, S. L., Lion, R. n., Meade, C. S. 2015; 12 (4): 406–12

    Abstract

    Persons with severe mental illness (SMI) have been disproportionately affected by the HIV epidemic, with higher rates of HIV prevalence and morbidity than the general population. Recent research has advanced our understanding of the complex factors that influence primary and secondary HIV prevention for those with SMI. Sex risk in this population is associated with socioeconomic factors (e.g., low income, history of verbal violence) and other health risk behaviors (e.g., substance use, no prior HIV testing). Several interventions are effective at reducing risk behavior, and reviews highlight the need for more well-controlled studies that assess long-term outcomes. Recent research has elucidated barriers that interfere with HIV treatment for SMI populations, including individual (e.g., apathy, substance use), social (e.g., stigma), and system factors (e.g., transportation, clinic wait times). Interventions that coordinate HIV care for individuals with SMI show promise as cost-effective methods for improving medication adherence and quality of life.

    View details for DOI 10.1007/s11904-015-0294-4

    View details for PubMedID 26428958

    View details for PubMedCentralID PMC4812670

  • Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study. Drug and alcohol dependence Meade, C. S., Towe, S. L., Watt, M. H., Lion, R. R., Myers, B. n., Skinner, D. n., Kimani, S. n., Pieterse, D. n. 2015; 152: 79–86

    Abstract

    Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town.Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment.Participants had used methamphetamine for an average of 7.06 years (SD=3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD=8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning.This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.

    View details for DOI 10.1016/j.drugalcdep.2015.04.016

    View details for PubMedID 25977205

    View details for PubMedCentralID PMC4498803