Sex+and+Khat

=Khat= toc //Catha edulis//, commonly referred to as khat (also qat, chat, gat, tschat, miraa, or murungu), is a hardy evergreen shrub that grows at high altitudes primarily in the Arabian peninsula and the horn of Africa (Wabe, 2011; World Health Organization [WHO], 2006). The plant has stimulant properties, which primarily impact the nervous and gastrointestinal systems. Khat is usually ingested by chewing, though it can also be ingested by making a drink from the dried leaves of the plant or by smoking the dried leaves. Chewing the leaves and stalks slowly releases the juice, which mixes with saliva and is then swallowed. The leaves and stems are often chewed into a ball and then tucked into a cheek, creating a signature bulge. Khat chewing is typically a social activity, and khat chewing sessions may last several hours. It is also a culturally based activity, particularly among some Muslim populations, who may use khat to facilitate contact with Allah and remain alert while praying. It also is said to enhance social interactions, and plays a role in some ceremonies, such as weddings (Carrier, 2012; Wabe, 2011).

Effects of Khat
The two primary psychoactive chemicals in khat are cathinone and cathine, which are structurally similar to amphetamine and noradrenaline, respectively (Wabe, 2011). Cathinone, categorized a schedule I drug in the United States, is present in fresh leaves less than 48 hours after being picked (National Drug Intelligence Center, 2003). After about 48 hours, cathinone degrades into cathine, categorized a schedule IV drug. Khat may induce mild to moderate psychological dependence (WHO, 2006). Effects include arousal, alertness, euphoria, intellectual efficiency, hyperactivity, excitement, sexual effects, anxiety, manic behavior, elevated blood pressure, tachycardia, decreased hunger, constipation, and rarely, psychosis (Wabe, 2011; Wolters Kluwer Health, 2009). The stimulating effects are described as being somewhere between caffeine and amphetamine. After the stimulating effects subside, a depressive phase may follow, leading to insomnia, dysphoria, malaise, and irritability. = = =Ethiopia= Ethiopia has a long history of government and military upheaval. Unlike some of its neighboring nations of East Africa, Ethiopia was never colonized by a Western nation, despite a brief Italian occupation from 1936-1941 (Central Intelligence Agency [CIA], 2015). After this occupation, Emperor Haile Selaisse ruled until 1974, when he was overthrown by the Derg, a military junta that instated a socialist state until 1991. At that point, the Ethiopian People's Revolutionary Democratic Front took over, adopted a constitution in 1994, and held Ethiopia's first multiparty election in 1995. Ethiopia remains a federal parliamentary republic. Religiously, a little less than half of the population of about 100 million is Ethiopian Orthodox Christian while another third is Sunni Muslim (Global Security, 2011). Ethiopia's economy is largely agriculturally based, its highest valued exports including coffee, khat, and gold (CIA, 2015). The Ethiopian government is aiming to become a middle-income status nation by the year 2025, and has made improvements in child mortality, water availability, primary education, HIV/AIDS, and malaria (The World Bank, 2015). The economy has grown by over 10% in the last decade. there has been a 9.1% decrease in the poverty rate, and HIV has gone from an adult prevalence rate of 10.6% in 1999 to 1.3% in 2012 (CIA, 2015; The World Bank, 2015). = Khat in Ethiopia =

History and Use
Khat is historically rooted in Ethiopian culture, with the earliest written record of khat cultivation emerging in this area in the 1300s (Carrier, 2012). It has been used for Islamic prayer, for spirit possession ceremonies, and for recreational social activities. In some of the nations of east Africa such as Kenya and Uganda, women who chew khat are considered immoral, though this view may be influenced by the long standing belief that women cannot control their sexuality (Beckerleg, 2010). However, in Ethiopia, where khat chewing has such a long history and tradition, it is acceptable for women to chew khat recreationally and socially, particularly as part of religious observation. Khat is also being increasingly used by young people. For example, a study of 1,890 Ethiopian high school students found a prevalence of 24.2% (Reda, Moges, Biadgilign, & Wondmagegn, 2012). Similarly, a study of Ethiopian university students found a lifetime prevalence of 24%, with 12.7% of the sample identifying as current khat users (Gebrehanna, Berhane, & Worku, 2014). These young people identify enjoying khat for its amphetamine-like effects, which enhance studying and can also create a convivial atmosphere when going out.

Impact
Khat is a valuable export of Ethiopia, and has brought significant income to rural farmers (CIA, 2015; Gebissa, 2008). However, khat consumers often spend one-third to one-half of their income on the plant (Gebissa, 2008). Some view khat as making workers less productive, or even leading to unemployment (Carrier, 2012). In addition, khat is taking the place of many other crops, which is increasing the need to import those goods. Overall, the Ethiopian population views khat as culturally and economically beneficial, but there is conflicting discourse on the physical and social effects, leading to some debates around legality. =Khat and Sex= Across the horn of Africa, there are conflicting reports of the sexual effects of khat chewing. Some say chewing khat increases libido, performance, and fertility while others claim the opposite (Beckerleg, 2010; Berhanu, Go, Ruff, Celentano, & Bishaw, 2012; Carrier, 2012). The results of lab studies have been just as contradictory (Beckerleg, 2010), though some have found lower sperm count in men who use khat consistently over time (see e.g. Abdulla, 2008). It may be that the sexual effects depend on quantity of use over time, as well as type of khat that is chewed (Carrier, 2012). In fact, Berhanu et al. (2012) found users reported over 25 different varieties of khat, all with different effects. The video below shows a reporter interviewing a number of people representing various differing views about the effects of khat in Yumbe district of Uganda. media type="youtube" key="SKrzXHcs1Wc" width="420" height="315" align="center"

Many Ethiopian people believe that khat chewing is conducive to casual sex. In a community-based sample of more than 4,000 Ethiopian people, 38% endorsed this belief (Dawit et al., 2006). There is an extensive public health literature that links khat use with sex risk behaviors, such as early sexual initiation and unprotected sex (see e.g., Berhanu et al., 2012; Kebede et al., 2005; Mulugeta & Berhane, 2014; Tilahun & Ayele, 2013). However, according to the study conducted by Dawit et al. (2006), there was no significant difference in condom use or non-use between those who reported khat prior to engaging in casual sexual activity and those who did not. =Different Perspectives= Khat is historically and culturally rooted in Ethiopia, but there are ongoing debates regarding its legality (Gebissa, 2010). Many Western nations, including the United States, have labelled khat a drug of abuse and have made it illegal since the battle of Mogadishu in 1993, when khat was becoming increasingly linked with Islamic terrorism because of its association with immigrants from countries that traditionally use khat - countries with large Muslim populations (Gebissa, 2010). However, given the lack of significant evidence of harm as well as the cultural and economic benefits khat brings these countries, making khat illegal is neither feasible nor desirable. The social function of khat my have particular importance in Ethiopia as African nations lean more towards a collectivist concept of self, placing value in groups rather than individuals (Storti, 1999). Even the belief held by some that khat makes people lazy and unproductive may not be of striking importance in Ethiopia, as African nations are also oriented towards polychronic time, being more lax towards deadlines and schedules than many Western nations (Storti, 1999). Carrier (2012) sums up the two sides of the legality debate: "on the one hand khat is like coffee, and on the other it is like cocaine" (para. 2). Even so, given the influence of Western nations on the economies of these countries as well as the substantial aid they provide for HIV prevention and care - amounting to over $930 million between 2004 and 2011 from the United States alone (U.S. State Department, n.d.) - and the link being made in the public health literature between khat use and sex risk behavior, the decision to side with culture and tradition may begin to sway. The context of cultural spaces, as well as the how this context is impacted by external influences, becomes crucial in examining the debate over legality. It is important to consider the cultural, religious, and in many cases, sexual implications making khat illegal would have on the Ethiopian people, as only in examining drug use and sexuality in their cultural context can they be truly understood. = = //Added by Lindsay Lock// //12/3/15// =References=

Abdulla, N. A. (2008). The physiological effect of chewing khat leaves on human spermatogenesis. //Iraqi Journal of Medical Sciences, 6//(1), 38-44.

BBC News. (2013). [Untitled photograph of bundles of khat leaves, online image]. Retreived from @http://www.bluelight.org/vb/content/84-UK-Herbal-Stimulant-Khat-to-be-Banned

Beckerleg, S. (2010). East African discourses on khat and sex. //Journal of Ethnopharmacology, 132//(3), 600-606. Retrieved from @http://www.druglawreform.info/images/stories/documents/East_African_discourses_on_khat_and_sex.pdf

Berhanu, D., Go, V. F., Ruff, A., Celentano, D. D., & Bishaw, T. (2012). Khat use among HIV voluntary counselling and testing centre clients in Ethiopia. //Culture, Health & Sexuality, 14//(10), 1197-1212. doi: 10.1080/13691058.2012.722684

Carrier, N. (2012). Khat: A lingering controversy. //Afrikan Sarvi, 4//. Retrieved from @http://afrikansarvi.fi/issue4/42-artikkeli/117-khat-a-lingering-controversy

Central Intelligence Agency. (2015, October 22). //The world factbook: Ethiopia.// Retrieved from @https://www.cia.gov/library/publications/the-world-factbook/geos/et.html

Dawit, A., Debella, A., Dejene, A., Abebe, A., Mekonnen, Y., Degefa, A., & Ketema, L. (2006). Is khat-chewing associated with HIV risk behaviour? A community-based study from Ethiopia. //African Journal of AIDS Research, 5//(1), 61-69.

Gebrehanna, E., Berhane, Y., & Worku, A. (2014). Khat chewing among Ethiopian university students – a growing concern. //BMC Public Health, 14//(1), 1-14. doi: 10.1186/1471-2458-14-1198

Gebissa, E. (2008). Scourge of life or an economic lifeline? Public discourses on khat (Catha edulis) in Ethiopia. //Substance Use & Misuse, 43//(6), 784-802. doi: 10.1080/10826080701738950

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Khat usage map – Africa [Online image]. Retrieved from @https://simonsblogpark.com/legalhigh/simons-khat-guide/

Mulugeta, Y., & Berhane, Y. (2014). Factors associated with pre-marital sexual debut among unmarried high school female students in bahir Dar town, Ethiopia: Cross-sectional study. //Reproductive Health, 11//(1), 1-13. doi: 10.1186/1742-4755-11-40

Naluyimba, F. (2013, October 27). //Khat/Mairungi for Family Planning?// [Video file]. Retrieved from @https://www.youtube.com/watch?v=SKrzXHcs1Wc

National Drug Intelligence Center. (2003, May). Intelligence bulletin: Khat (Catha edulis). Retrieved from @http://www.justice.gov/archive/ndic/pubs3/3920/3920p.pdf

Reda, A., Moges, A., Biadgilign, S., & Wondmagegn, B. (2012). Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: A cross-sectional study. //PLoS ONE, 7//(3), 1-5. doi: 10.1371/journal.pone.0033946

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The World Bank. (2015, September 23). //Ethiopia: Economic overview//. Retrieved from @http://www.worldbank.org/en/country/ethiopia/overview

Tilahun, M., & Ayele, G. (2013). Association of khat and alcohol use with HIV infection and age at first sexual initiation among youths visiting HIV testing and counseling centers in Gamo-Gofa, Zone, south west Ethiopia. //BMC International Health & Human Rights, 13//(1), 10-17. doi: 10.1186/1472-698X-13-10

U.S. State Department. (n.d.). //The United States President's emergency plan for AIDS relief: Partnership to fight HIV/AIDS in Ethiopia.// Retrieved from @http://www.pepfar.gov/countries/ethiopia/index.htm Wabe, N. T. (2011). Chemistry, pharmacology, and toxicology of khat (Catha edulis forsk): A review. //Addict Health, 3//(3-4), 137-149. Retreived from @http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905534/

Wolters Kluwer Health. (2009). //Khat.// Retrived from @http://www.drugs.com/npp/khat.html

World Health Organization. (2006, March 28). //WHO Expert committee on drug dependence: Thirty-fourth report.// Retrieved from @http://www.who.int/medicines/areas/quality_safety/WHO_TRS_942.pdf?ua=1