Prevention of Alcohol-Related HIV Risk Behavior
Putting It Into Practice
Summaries of Key Interventions on How to Reduce Alcohol-Related HIV Risk Behavior
Below we highlight some of the key interventions that have been identified in the literature. Some interventions that are currently operating in the field have not yet appeared in the literature. Information about these interventions will be gathered and posted at a later date.
Efficacy of an American Alcohol and HIV Prevention Curriculum Adapted for Use in South Africa: Results of a Pilot Study in Five Township Schools
AIDS Education and Prevention (2006), Vol. 18 No. 4, pp. 295-310
Karnell, P., et al.
HIV rates among South African adolescents are rising faster than any other age group. Despite high levels of knowledge and awareness of HIV, adolescents in South Africa engage in high rates of sexual risk behavior, such as unprotected sex with casual partners. The severity of the epidemic among youth in South Africa calls for an immediate response. School-based programs proven to be successful in other countries can quickly and inexpensively be adapted for use in South Africa. This article presents the results of one such project--the HIV and Alcohol Prevention in Schools Project (HAPS), organized through the South Africa Human Sciences Research Council. The HAPS project conducted a pilot study in which an American alcohol and HIV prevention curriculum (Project Northland) was adapted and implemented for ninth grade students in five township schools located in the KwaZulu-Natal Province of South Africa. Three schools were randomly assigned to receive the intervention while the remaining two schools served as comparisons. Behavioral surveys were conducted with students at baseline and five months post-intervention to measure the program’s effectiveness in reducing sexual risk behaviors and alcohol use/abuse. The intervention consisted of a series of audio monologues in which four fictional teenaged township characters talk about the dilemmas they face in deciding whether to use alcohol and/or have sex. The monologues were a jumping-off point for class discussions and group assignments. Class discussions were led by peers who had been elected by students and trained to act as discussion leaders. The study found that the intervention reduced the frequency of alcohol use before or during sex among those who became sexually active during the intervention (p<.05). Additionally, female students in the intervention group reported feeling more confident to refuse sex (p<.05). Among students who were sexually active at baseline, intentions to use a condom also increased (p<.01). The intervention had no effect on alcohol use or alcohol-related problems, nor did the intervention affect students’ perceived social norms regarding sex, attitudes toward condoms or condom-use self-efficacy. The findings of the study suggest that interventions developed in one country/culture can be successfully adapted for use in another country/culture with positive effects on the co-occurrence of alcohol use and sex.
Substance Use and Sexual Risk Prevention in Cape Town, South Africa: An Evaluation of the Healthwise Program Prevention
Science (2008), Vol. 9, No. 4, pp. 311-321
Smith, E. A., et al.
Much previous research suggests that sexual risk behavior and alcohol or other substance abuse tend to occur together. Interventions to address these co-occurring behaviors are urgently needed for South African youth. The majority of 11th grade students have had sex and among those who are sexually active, one tenth report having had a sexually transmitted infection. Alcohol and substance use among youth is high. Twenty-five percent of 8th to 11th graders report binge drinking in the past month, while thirteen percent report having tried marijuana. This article describes the South Africa Healthwise Program—a school-based program consisting of 12 lessons in grade 8 followed by 6 booster sessions in grade 9. The intervention combines life skills training and sexual risk prevention education with a particular focus on helping youth better manage their leisure time. The leisure time training component of Healthwise is based on the Timewise Program developed in the United States, which teaches students how to become better at managing their leisure time including how to avoid boredom, develop personal interests and take personal responsibility for making healthy choices. In a randomized, controlled trial of the intervention in which over 2,000 low-income students were surveyed, the program was found to be moderately effective in reducing students’ substance use. Girls and boys in the program reported less recent alcohol use, including heavy alcohol use. Students in the Healthwise Program were also more confident and more knowledgeable about how to use condoms, compared to students who had not received the program. Unfortunately, the program showed no effect on students’ sexual onset, nor did it decrease sexual risk behavior among those students who were sexually active.
Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria.
AIDS and Behavior (2006), Vol. 10 No. 2, pp. 131-137
Wechsberg, W. M., et al.
For South African women who engage in sex work, a confluence of factors including frequent unprotected sex, alcohol/substance abuse, and the threat of violence lead to sustained vulnerability to HIV. This article describes a pilot study in which an intervention first developed for crack-abusing women in the United States was adapted and tested with Black South African sex workers who use cocaine. The Pretoria Women’s Co-op Project intervention consisted of two private one-on-one sessions between a participant and an interventionist. The sessions included personalized assessment of drug use and sexual risk, risk reduction planning, violence prevention strategies and how to access community resources. The intervention placed particular emphasis on cultural, gender-based, and lifestyle influences affecting women’s risk within the context of sex work. Ninety-three women were randomly assigned to either the intervention or a comparison intervention. The comparison intervention was an adaptation of the NIDA Standard Intervention in which two one-hour HIV education and risk-reduction skills building sessions were provided to participants over a two-week period. A behavioral survey was conducted at baseline and at one month post-intervention. In both the intervention and comparison groups, women reported decreases in unprotected sex with clients, in daily use of alcohol and cocaine, and in use of alcohol and drugs during sex work. These decreases were greater among women in the intervention group, but the differences were not statistically significant. Women in the intervention group did report a statistically significant increase in condom use with their boyfriends when compared with the comparison group. Women in both groups significantly increased their use of the female condom. Women in both groups continued to experience violence, including being robbed, beaten and raped. Women in the intervention group experienced a greater drop in violence, but the difference was not statistically significant. Overall, the pilot study showed the feasibility of adapting a U.S.-based intervention for South African women and of recruiting women to participate. Because of the small sample size, it was not possible to show statistically significant impacts on most outcome measures; however, all trends in the data point to this intervention as a promising strategy for assisting women to reduce harm associated with sex work.
Development of an Opinion Leader-Led HIV Prevention Intervention among Alcohol Users in Chennai, India.
AIDS Education and Prevention (2004), Vol. 16 No. 2, pp. 137-149
Sivaram, S., et al.
India has the highest number of adult HIV infections in the world. The Indian government’s National AIDS Control Organization has recommended targeted community-based interventions as a vital strategy for controlling the epidemic. This article describes the development and pilot testing of one such intervention implemented in wine bars in the city of Chennai in Southern India. The intervention recruited and trained community popular opinion leaders (CPOLs) to become advocates for HIV risk reduction at drinking venues. The CPOL approach is rooted in Diffusion of Innovation Theory and hypothesizes that people popularly seen as leaders within their social circles can influence the opinions and actions of their peers. In previous research, the CPOL intervention was proven effective in reducing sexual risk behavior among gay men attending bars in the United States. Through formative research, this model was adapted for wine bars in Chennai. Ethnographic research revealed the important role wine bars play in the establishment and maintenance of personal and social networks. These networks also functioned to assist men in identifying and procuring the services of female sex workers. Men indicated that alcohol helped them enjoy themselves, build courage to visit a sex worker, and have satisfying sex. Following the ethnographic research, the CPOL training curriculum used in the United States was adapted and a training-of-trainers was conducted in Chennai. A pilot test of the intervention was initiated in four wine bars. CPOLs were identified using participant observation, peer nominations and nominations from wine bar staff members. The recruitment and training of the pilot CPOLs showed this is a feasible intervention model. A full randomized, controlled trial of the impact of this intervention model is underway, with results expected in 2009.
Randomized Trial of a Community-Based Alcohol-Related HIV Risk-Reduction Intervention for Men and Women in Cape Town South Africa.
Annals of Behavioral Medicine (2008), Oct 4 Epub ahead of print
Kalichman, S. C., et al.
South Africans living in urban townships and informal settlements experience some of the world’s highest rates of HIV transmission. Within these neighborhoods, attendance at informal drinking venues (called shebeens) is a common leisure activity. Attendance is associated with HIV risk-taking, as these are also locations where commercial sex is sought and alcohol use exacerbates sexual risk-taking. This article describes a community-based intervention, based on an adaptation of the World Health Organization’s (WHO) brief alcohol intervention model, to reduce HIV sexual risk behavior among men and women who patronize shebeens in a township near Cape Town. Participants (117 men and 236 women) were recruited from four shebeens and randomly assigned to either the intervention or comparison group. The intervention group received a 3-hour HIV-alcohol risk-reduction skills intervention based on Social Cognitive Theory. The comparison group received a one-hour alcohol education intervention devoid of motivation and behavioral skills building. The 3-hour intervention included HIV information/education and sexual communications skill building, as well as motivational interviewing techniques to explore how alcohol can act as a trigger to lapses in safer sex behavior. The Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol dependency for each participant and was followed by education on the hazards of drinking. The impact of the intervention was measured by comparing the intervention group with the comparison group at three and six months after the start of the intervention. At the time of the 3-month follow-up, many significant effects of the intervention were detected including frequency and consistency of condom use and reduction of drinking before sex/meeting a sex partner at the shebeen. These positive results were most dramatic among those with the lowest levels of problem drinking. However, at the time of the 6-month follow-up, few of these impacts remained except drinking before sex and meeting a partner at the shebeen. Overall, the study showed that brief community-based interventions are feasible to implement in low-income communities and may have significant short term effects.
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