Prevention of Alcohol-Related HIV Risk Behavior
What We Know
Summaries of Select Background Research on Alcohol’s Relationship to HIV Risk
The following selected articles highlight research findings on the relationship between alcohol consumption and HIV risk behavior in developing countries.
Alcohol Use and Sexual Risks for HIV/AIDS in sub-Saharan Africa: Systematic Review of Empirical Findings
Prevention Science (2007), Vol. 8 No.2, pp. 141-151
Kalichman, S. C., et al.
Sub-Saharan Africa is home to two-thirds of all people living with HIV, and to widespread and increasing alcohol consumption. A literature review reveals that in southern Africa, alcohol use increases the risk of contracting HIV or another sexually transmitted infection (STI). The quantity of alcohol consumed, more so than the frequency of consumption, is associated with sexual risk behavior. The stress of poverty has been linked both to alcohol use and to transactional sex, both of which increase risk of HIV infection. Men who use alcohol are likely to believe it will enhance their sexual desires, and are more likely to perpetrate sexual violence against women. Both alcohol use and sexual risk are greater in the context of alcohol-serving establishments, which could be venues for interventions ranging from condom availability to efforts to influence social norms. Other interventions to reduce alcohol-related sexual risk behavior include individual-level counseling, and programs targeting families and social institutions such as churches and schools.
Alcohol Use Before Sex and HIV Acquisition: A Longitudinal Study in Rakai, Uganda.
AIDS (2006), Vol. 20 No. 8, pp. 1191-1196
Zablotska, I. B., et al.
Building on cross-sectional data from previous studies, this study used data from an open community cohort of adults aged 15-49 in Rakai, Uganda to determine if alcohol use before sex was associated with increased risk of HIV acquisition, and/or with sexual risk behaviors. Alcohol use was found to be associated with increased risk of acquiring HIV for both men and women. The risk of HIV infection was significantly higher when one partner consumed alcohol before sex, and when both partners consumed alcohol before sex. Alcohol use was also associated with increased risk behaviors including inconsistent condom use, more partners, and more extramarital sex.
A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana
PLoS Medicine (2006), Vol. 3 No. 10, pp. e392
Weiser, S. D., et al.
Given the strong scientific evidence associating alcohol use with a variety of HIV risk behaviors in sub-Saharan Africa, this study sought to understand the extent to which alcohol may be fueling the HIV epidemic in Botswana. While previous research has been limited by its dependence on samples drawn from clinics or drinking venues, this study examined alcohol use and sexual risk behavior in a national probability sample of 1,268 adults drawn from the five districts of Botswana where HIV prevalence is highest.. Analysis of the data showed that both men and women with the highest rates of problem drinking were more than three times as likely to have a history of unprotected sex with a non-primary partner (AOR=3.28 for women and 3.48 for men). Alcohol use also predicted paying for sex among men and selling sex among women (AOR=3.65 for men and 8.50 for women). This study supports the findings of previous research showing associations between alcohol use and sexual risk behavior and illustrates that the trends hold within a large population-based sample.
The Association between Alcohol Use, Sexual Risk Behavior, and HIV Infection among Men Attending Beerhalls in Harare
AIDS and Behavior (2002), Vol. 6 No. 3, pp. 221-228
Fritz, K. E., et al.
Drinking in beerhalls in Zimbabwe is described as an integral part of the social lives of men, differing from nightclubs in that they are places for friendly conversation and the communal consumption of inexpensive local beer. This article describes a research study conducted with a cross-sectional sample of 324 beerhall patrons in Harare, Zimbabwe. Study participants were interviewed about their drinking patterns and sexual behavior and also received HIV testing and counseling. Results of the study indicated that HIV prevalence increased with increasing frequency of drinking (p<.001). HIV prevalence was also significantly associated with meeting a sex partner at the beerhall (p=.038), having sex while intoxicated (p=.048) and paying for sex in the past six months (p=.022). Men who had sex while intoxicated reported 20 times more episodes of unprotected sex and 27 times more episodes of paying for sex compared to men who had not had sex while intoxicated. Having sex while intoxicated in last 6 months was also significantly associated with recent HIV seroconversion as measured using the less-sensitive EIA (STARHS). Information collected from this study demonstrated the strong link between alcohol use and HIV risk behavior as well as the feasibility of conducting HIV prevention interventions and research in beerhalls.
Alcohol Use and Sexual Behavior among Risky Drinkers and Bar and Shebeen Patrons in Gauteng Province, South Africa
Social Science and Medicine (2006), Vol. 62, pp. 217-227
Morojele, N. K., et al.
Both HIV and heavy alcohol consumption are major health concerns in South Africa. Qualitative assessments including key informant interviews, observations in drinking establishments, focus group discussions and in-depth interviews with risky drinkers provided information about the association between alcohol use and risky sexual behavior. Men described drinking as an important part of their social lives to “pass the time.” Binges were more common among men than women, while women reported drinking most often at parties and concerts, or in cases of heavy alcohol use, as a result of personal problems. Both men and women reported that alcohol made them feel sexually disinhibited. The context of drinking seemed to have an impact on sexual risk behavior, with casual sex more often linked with shebeens and bars than with other drinking venues. Based on the information gathered, the authors propose a conceptual model to understand the interrelationships between the variables associated with alcohol use and predictors of sexual risk behavior.
Exploring “Wine Shops” as a Venue for HIV Prevention Interventions in Urban India
Journal of Urban Health (2007), Vol. 84, pp. 563-576
Sivaram, S., et al.
This small explorative study in the Southern Indian state of Chennai explored the concept of ‘wine shops’ as a venue for HIV-prevention. The research involved mapping exercises, participant observations within the venues, in-depth interviews with wine shop owners, patrons, and staff members, and a survey of wine shop patrons. Each wine shop was found to serve a wide variety of customers, primarily men, representing a cross section of society. Men reported drinking for several reasons, including that it made them relax (53%), forget their worries (58%), feel social (46%), feel confident (56%), and because drinking alcohol made them want to have sex (68%). In this setting, men were found to help each other with sexual urges by facilitating contacts with sex workers and friends. Half of the men reported being under the influence of alcohol before recent sexual encounters, and 80% of these were unprotected. At the same time, condom awareness and use of condoms with sex workers was high.
Alcohol Use by Men Is a Risk Factor for the Acquisition of Sexually Transmitted Infections and Human Immunodeficiency Virus From Female Sex Workers in Mumbai, India
Sexually Transmitted Diseases (2005), Vol. 32 No. 11, pp. 685-690
Madhivanan, P., et al.
This study is an investigation about the reported use of alcohol among men visiting female sex workers to determine whether men under the influence of alcohol were at increased risk of having HIV or another sexually transmitted infection. Cross sectional analysis was conducted on baseline data from men attending two public health clinics in Mumbai. Two-thirds of men reported being under the influence of alcohol during sex in their lifetime, with 57% reporting this behavior in the last 3 months. Men who were under the influence of alcohol when having sex with sex workers were more likely to be infected with HIV or an STI than men who were not under the influence during paid sex. The authors provide explanations for how alcohol might facilitate risk behavior: men may forget or be less likely to use a condom, or may succumb to peer pressure to seek a sex worker, as drinking often takes place in a social environment.
Alcohol Use and Sexual Risk Behaviour : A Cross-Cultural Study in Eight Countries
World Health Organization (2005).
With the increasing morbidity and mortality resulting from AIDS globally, the association of alcohol with HIV-related sexual risk behavior is a significant public health problem. This WHO report includes information from a project conducted in eight countries with two phases: a literature study and an empirical study using qualitative methods. The literature study included documents ranging from scientific publications to police and law enforcement records, collected from the eight project countries: Kenya, South Africa, Zambia, Belarus, Romania, the Russian Federation, India, and Mexico. From this primarily quantitative data, key issues emerged regarding alcohol use and HIV, including: myths about masculinity; a lack of clear and firm alcohol- related policies; the interwoven influences of alcohol use, sexual risk behaviors and STIs/HIV; the effect of modernization and the media on youth, manifesting in early drinking and early sexual activity; lack of research about alcohol and sexual risk behavior; and the importance of culture-specific and context-specific ways of dealing with alcohol use and sexual risk behaviours. Qualitative data including interviews with key informants, on-site observations, and focus group discussions were used to complement the literature study. The empirical study found psychological, socio-cultural and environmental factors were related to alcohol use-related risk behaviors. Furthermore, the influence of alcohol on sexual risk behavior differed among men and women. The association between alcohol and sexual risk behavior was ‘far from linear’; in some cases alcohol consumption occurs before risky sex, while in other cases drinking follows risky sexual activity.
Summary of the Proceedings of Meeting on ‘Alcohol, HIV Risk Behaviors and Transmission in Africa: Developing Programmes for the United States President’s Emergency Plan for AIDS Relief (PEPFAR)
African Journal of Drug and Alcohol Studies (2006), Vol. 5 No. 2, pp. 192-200
Ashley, J. W., Levine, B. & Needle, R.
Several United States government agencies convened a meeting of U.S. and African participants in Dar es Salaam in August of 2005 to discuss alcohol-related HIV risk behaviors and transmission in Africa and to inform PEPFAR programming. After hearing speakers present the increasing evidence of the link between alcohol-related risk behavior and HIV, participants concluded that intervention programs should target populations that drink heavily, and should include implementation of interventions at drinking venues. Furthermore, the meeting summary notes it is important to address, through multi-level interventions, the social and cultural norms that may increase alcohol-related HIV risk. Ethnographic research highlighted the importance of understanding social, cultural, economic, and material contexts when developing programs aimed at reducing alcohol and HIV-related risk behaviors. The meeting also highlighted the importance of focusing on particular risk behaviors associated with alcohol, as well as on specific populations. With alcohol use often linked with gender-based violence, women are at increased risk of HIV infection. Military personnel are also at increased risk of alcohol abuse due to circumstances of service, and may be more likely to frequent commercial sex workers given their distance from home and peer pressure.
NEXT>>
