HIV Prevention Knowledge Base
Behavioral Interventions: Prevention of Alcohol-related HIV Risk Behavior
Randomized Trial of a Community-Based Alcohol-Related HIV Risk-Reduction Intervention for Men and Women in Cape Town, South Africa
This brief alcohol intervention focused on reducing HIV sexual risk behavior among shebeen (informal neighborhood drinking venue) patrons in Cape Town. Over 350 participants were randomly assigned to an intervention or a comparison group. The intervention group received a three-hour session teaching HIV and alcohol risk-reduction skills. The session covered HIV information/education, sexual communication skills building, and motivational interviewing to explore how alcohol can trigger lapses in safer sex. The comparison group received a one-hour alcohol education session. Three months after implementation, participants in the intervention group were more likely to practice all risk-reduction variables (increased condom use, consistent condom use, and acts completely protected by condom use; less drinking before sex, decreased likelihood of meeting a sex partner at a shebeen, etc.) compared to the comparison group. At six months, however, the only significant difference found between groups was less alcohol use before sex among the intervention arm. Furthermore, the heaviest drinkers did not benefit from the intervention. The authors conclude that such interventions are feasible to implement in low-income communities and may have significant short-term effects at the individual level.
Substance Use and Sexual Risk Prevention in Cape Town, South Africa: An Evaluation of the Healthwise Program Prevention
The South Africa HealthWise Program is a school-based program for eighth and ninth graders that combines life skills training with education on sexual risk prevention. It helps youth manage their leisure time by encouraging them to develop personal interests and take personal responsibility for making healthy choices. Among over 2,000 low-income students in Cape Town who participated in a randomized, controlled trial, students in the intervention arm reported less recent alcohol use than those in the control arm, including heavy alcohol use. Furthermore, students taking part in the intervention were also more confident and more knowledgeable about how to use condoms, compared to students who had not participated in the program. HealthWise did not have an effect on these students’ sexual debut, however, nor did it decrease sexual risk behavior among sexually active students.
Efficacy of an American Alcohol and HIV Prevention Curriculum Adapted for Use in South Africa: Results of a Pilot Study in Five Township Schools
This project adapted an American alcohol and HIV prevention curriculum for ninth grade students in five schools in KwaZulu-Natal Province. Three schools were randomly assigned to receive the intervention; two schools served as comparisons. The intervention consisted of a series of audio monologues in which four fictional teenage 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. Students filled out behavioral surveys at baseline and five months after the intervention. Among those becoming sexually active during the project, students in the intervention group reduced their frequency of alcohol use before or during sex compared to those in the control group. Furthermore, females in the intervention group reported feeling more confident to refuse sex compared to controls. The intervention had no effect on alcohol use or alcohol-related problems, however, nor did it affect students’ perceived social norms regarding sex, attitudes toward condoms, or condom-use self-efficacy.
Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria
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 can 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 emphasized 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 participants received two one-hour HIV education and risk-reduction skills-building sessions 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. The decreases were not significantly different between the two groups.
Women in the intervention group were more likely to use condoms than women in the comparison group, and women in both groups increased their use of the female condom. Both groups continued to experience violence, including being robbed, beaten, and raped. Overall, the pilot study showed the feasibility of adapting a U.S.-based intervention for South African women and of recruiting women to participate. However, evidence of its benefits over a comparison intervention is limited.
Development of an Opinion Leader-Led HIV Prevention Intervention among Alcohol Users in Chennai, India
This article describes a community-based intervention implemented in wine bars in Chennai. Community popular opinion leaders (CPOLs) were trained to become advocates for HIV risk reduction at drinking venues. The CPOL approach is rooted in the 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. Research revealed the important role wine bars play in establishing and maintaining personal and social networks: these networks also assist men in identifying and procuring the services of female sex workers. Despite accurate knowledge of HIV transmission, use of condoms was rare among these men. 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.