HIV Prevention Knowledge Base
Behavioral Interventions: Prevention of Alcohol-related HIV Risk Behavior
Alcohol Use and Sexual Risks for HIV/AIDS in sub-Saharan Africa: Systematic Review of Empirical Findings
This review of the literature uses a conceptual model to understand the association between alcohol use and sexual risk taking in Southern Africa. Gender differences that emerged from existing research include that men drink more often than women, but women tend to consume greater quantities than men. Furthermore, women reported their sex partners were much more likely to drink before sex than they were. This review also includes findings on predictors and moderating factors (economic conditions, sexual coercion) of alcohol use. While strong evidence exists of an association between alcohol use and HIV, existing studies are primarily cross-sectional, and thus cannot provide evidence of causality. There is a need for longitudinal studies to examine this relationship. Other research gaps include using standard and well-defined measures of alcohol use and using population-based samples rather than convenience samples. The authors close with the implications for HIV prevention on individual, community, and structural levels.
Exploring “Wine Shops” as a Venue for HIV Prevention Interventions in Urban India
The researchers surveyed 118 wine shop patrons, shop owners, and staff members in the southern Indian city of Chennai to determine whether wine shops could serve as a venue for HIV prevention activities. Over half of patrons reported three or more sexual partners in the past three months; similarly, over half reported that they were under the influence of alcohol before their most recent sexual encounter. Condom use was low overall, and there was little evidence that condoms were available at wine shops. Men reported drinking to help them relax and to make them more confident about having sex. Men visiting wine shops would facilitate contacts with sex workers for friends. The researchers conclude that wine shops could indeed be used as venues to reach heterosexual Indian men who may otherwise be hard to reach due to high mobility among the population.
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)
Evidence about the link between alcohol-related risk behavior and HIV transmission was presented at an Africa-wide meeting, with participants concluding that intervention programs should target populations that drink heavily and include multilevel interventions at drinking venues. Participants emphasized the need to take into account social and cultural norms that may increase alcohol-related risk behaviors. Speakers also highlighted the importance of addressing the particular risks of specific populations. For example, women may be subject to gender-based violence and may be at increased risk of HIV infection, while individuals in the military and uniformed services are at increased risk of alcohol abuse due to circumstances of service, and may be more likely to frequent sex workers given their distance from home and peer pressure. The authors recommend incorporating intervention services into existing programs, such as HIV testing and counseling programs. Because government is the “largest financial stakeholder in the alcohol industry” in many countries, program developers may find resistance to implementing interventions.
Alcohol Use and Sexual Behavior among Risky Drinkers and Bar and Shebeen Patrons in Gauteng Province, South Africa
The authors examined the association between alcohol use and risky sexual behavior by conducting in-depth interviews with risky drinkers and partners of risky drinkers and key informant interviews with bar owners, doctors, and police in Guateng Province, South Africa. They also held small focus group discussions and observed activities in different drinking venues. Men and women alike reported that alcohol made them feel sexually disinhibited. Casual sex was more often linked with bars and shebeens (private homes where alcohol is sold to be consumed on site or taken out) than with other drinking venues. Unemployed people were most likely to be heavy drinkers.
A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana
Previous research examining alcohol use and sexual risk behavior has been limited by its dependence on samples drawn from clinics or drinking venues. This study of 1,268 adults in the five districts of Botswana where HIV prevalence is highest found 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 as those who were not heavy drinkers. Male heavy drinkers were more likely to pay for sex, and female heavy drinkers were more likely to sell sex. 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.
Alcohol Use before Sex and HIV Acquisition: A Longitudinal Study in Rakai, Uganda
This is the first study to examine alcohol use in conjunction with sex and HIV acquisition in a prospective, longitudinal manner. Nearly 15,000 adults aged 15-49 years in Rakai, Uganda, were followed at 10- to 12-month intervals over an eight-year period to determine the associations between alcohol and HIV. Approximately one-third of both women and men reported that both partners consumed alcohol prior to sex. Alcohol use was positively associated with increased HIV risk behaviors, including inconsistent condom use, more partners, and more extramarital sex. Individuals who consumed alcohol prior to sex were more likely to develop HIV than those who did not. The authors suggest that both behavioral disinhibition and the immune-suppressing effects of alcohol could contribute to the association between alcohol and HIV.
Alcohol Use and Sexual Risk Behaviour: A Cross-Cultural Study in Eight Countries
This report reviews published and unpublished documents on alcohol and sexual risk behavior, ranging from scientific publications to police and law enforcement records in Kenya, South Africa, Zambia, Belarus, Romania, the Russian Federation, India, and Mexico. Cultural issues, poverty, gender, the history of colonialism, and disruption of life following the fall of communist regimes and the rise of the free market have led to a range of connections between alcohol use and HIV. Proving one’s masculinity by drinking and having multiple sex partners, for example, was universal. Although alcohol consumption was concentrated among men, it was increasingly a becoming a female phenomenon, especially in Belarus and South Africa. 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. Obstacles to HIV prevention are also reviewed.
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
This is among the first studies to assess alcohol use and risk of HIV or other sexually transmitted infection (STI) in India. Nearly 1,750 men from two STI clinics in Mumbai provided blood samples and filled out a questionnaire about their sexual and drinking histories. Fully 92% had ever had sex with a female sex worker (FSW). Compared to men who did not drink before sex, men reporting alcohol use while with a FSW had a significantly increased risk of infection with HIV or other STI and having unprotected sex with a FSW. Furthermore, having sex under the influence of alcohol was associated with unprotected sex, anal sex, and sex with more than 10 FSWs in one’s lifetime. Because the primary study was for an HIV prevention program, detailed information on quantity, frequency, and type of alcohol consumed is not available. The authors call for further investigation of how alcohol use affects HIV risk in India.
The Association between Alcohol Use, Sexual Risk Behavior, and HIV Infection among Men Attending Beerhalls in Harare, Zimbabwe
The authors interviewed 324 beer hall patrons in Harare, Zimbabwe. Each of the patrons underwent HIV testing to determine the link between drinking and HIV. The authors found that HIV prevalence increased with more frequent drinking and with each of the following: meeting a sex partner at the beer hall, having sex while intoxicated, and paying for sex in the past six months. 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 the last six months was the single greatest determinant of recent HIV seroconversion. 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 beer halls.
HIV Risks Associated with Patronizing Alcohol Serving Establishments in South African Townships, Cape Town
Research has established that use of alcohol is among the most reliable predictors of sexual risk behaviors for HIV in South Africa, where alcohol consumption per drinker is one of the highest worldwide. To examine HIV risk behaviors, the authors conducted research on patronage of shebeens—informal bars often located in residential areas—and alcohol use in eight different neighborhoods of a township in Cape Town, South Africa. They recruited 981 men and 492 women to take an anonymous cross-sectional community survey about demographic characteristics, HIV testing, frequency of alcohol use and shebeen visits, lifetime risk characteristics, and sexual risk behaviors. The results showed that 82 percent reported patronizing a shebeen in the past month; 73 percent of these patrons went at least five times weekly. For both sexes, patrons who had had a sexually transmitted infection, been forced to have sex, perpetrated violence against a sex partner, or been afraid to ask a partner to use condoms were more likely to patronize a shebeen. Being a shebeen patron was also associated with significantly greater sexual risk-taking, including higher rates of unprotected vaginal intercourse.