Morojele NK, Kachieng'a MA, Mokoko E, et al. Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa
ABSTRACT This paper describes the South Africa component of a World Health Organization multi-site rapid assessment and response project seeking to develop a methodology for studying factors associated with alcohol use-related sexual risk behaviour in diverse cultural settings. This report focuses on the qualitative assessments that were conducted in order to profile alcohol use and sexual behaviour in the communities concerned, ascertain the relationships between alcohol use and sexual behaviour, and develop a conceptual model of the relationships between alcohol use and sexual risk behaviour. The participants consisted of adults aged between 25 and 44 years in a township and city site in Gauteng province. The assessments involved conducting 18 key informant interviews, observations in seven drinking venues, six focus groups and 16 in-depth interviews of 'risky drinkers' and their partners. Most participants felt that there were high levels of alcohol consumption and unprotected sex among some members of their communities, with the latter occurring mainly among casual sexual partners. The findings also pointed to strong links between alcohol consumption and sexual risk behaviour. A conceptual model of the association between alcohol use and risky sexual behaviour is proposed. This study suggests a need for multi-faceted HIV intervention strategies for reducing levels of alcohol abuse in general, and enhancing protective sexual behaviours among alcohol-using populations.
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- "In addition, other unmeasured factors, such as personality characteristics or new traumatic experiences, could be driving the joint and bi-directional changes in distress and alcohol use. Finally, the sample was non-random, so caution is warranted about generalizing findings to all South African women who drink, especially women who do not attend venues, such as older women who tend to be less likely to attend venues than younger women . "
ABSTRACT: Background In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudinal relationship between psychological distress and alcohol use among South African women who attend alcohol serving venues.Methods Four waves of data were collected over the course of a year from 560 women in a Cape Town township who attended drinking venues. At each assessment wave, participants reported depressive symptoms, post-traumatic stress symptoms, and alcohol use. Multilevel growth models were used to: 1) assess the patterns of alcohol use; 2) examine how depressive symptoms uniquely, post-traumatic stress symptoms uniquely, and depressive and post-traumatic stress symptoms together were associated with alcohol use; and 3) characterize the within person and between person associations of depressive symptoms and post-traumatic stress symptoms with alcohol use.ResultsWomen reported high levels of alcohol use throughout the study period, which declined slightly over time. Post-traumatic stress symptoms were highly correlated with depressive symptoms. Modeled separately, both within person and between person depressive and post-traumatic stress symptoms were uniquely associated with alcohol use. When modeled together, significant between person effects indicated that women who typically have more post-traumatic stress symptoms, when controlling for depressive symptoms, are at risk for increased alcohol use; however, women with more depressive symptoms, controlling for post-traumatic stress symptoms, do not have differential risk for alcohol use. Significant within person effects indicated an interaction between depressive and post-traumatic stress symptoms; women reported more alcohol use than usual at times when they had higher post-traumatic stress symptoms, and this increase in alcohol use was further exacerbated for women who also had higher depressive symptoms than usual.Conclusions These findings suggest that interventions targeting post-traumatic stress, especially when post-traumatic stress is comorbid with depression, may reduce alcohol use among South African women who drink.BMC Psychiatry 08/2014; 14(1):224. DOI:10.1186/s12888-014-0224-9 · 2.21 Impact Factor
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- "For example, 93% of adults living in Cape Town townships report meeting new sex partners in shebeens and other drinking venues (e.g., bars, taverns). Sex between new or casual partners often occurs at or around drinking venues (Kalichman et al., 2008; Morojele et al., 2006; Myer et al., 2002) but less than 30% of shebeen patrons reported using a condom at last sexual occasion (Weir et al., 2003). Shebeens may facilitate the sexual transmission of HIV, in part, through sexual networks (Kalichman, 2010). "
ABSTRACT: Background Shebeens in South Africa are settings in which alcohol use and sexual behavior often co-occur. The prevalence of alcohol use disorder (AUD), and the association between AUD, situations and settings, and sexual risk behavior, in shebeens remains unknown. Methods Men (n = 763; mean age = 30; 98% Black African) were recruited from townships in Cape Town, South Africa and completed a self-administered survey that assessed alcohol use, sexual risk behaviors, and situations and settings of alcohol use. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSV-IV Version (AUDADIS-IV) was used to identify the likelihood of AUD. Bivariate regression analyses assessed whether screening for AUD predicted sexual risk behaviors. Multivariate regression analyses examined whether AUD and/or situations/settings predicted risk behaviors. Results Nearly two-thirds of men (62%) endorsed sufficient criteria for AUD; 25%, 17%, and 20% were classified as having a mild, moderate, or severe AUD, respectively. AUD was associated with HIV risk such that men with AUD reported more unprotected sex than men without AUD. Analyses indicated that (a) individual (i.e., AUD) and (b) settings (i.e., frequency of having sex with a partner in a shebeen, tavern, or bottle store) interacted to predict unprotected sex. Conclusions The prevalence of AUD among shebeen patrons was high and was associated with unprotected sex. Findings suggest the need to integrate both individual and situational/setting factors to prevent HIV among patrons of shebeensDrug and Alcohol Dependence 07/2014; 140. DOI:10.1016/j.drugalcdep.2014.04.022 · 3.42 Impact Factor
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- "Here, governance strategies are variegated along lines that rehearse the same 'deeply engraved legacies of urban segregation and fragmentation' (Pieterse, 2006, p. 285), with the number of licensed premises dwarfed by the number of unlicensed 'illegal' shebeens in townships and informal settlements (Provincial Government of the Western Cape, 2003). In some provinces, an aggressive policy of shebeen closure has consequently been sanctioned by recourse to the arguments of (1) illegality and (2) their despotic and dangerous nature, in particular as conduits for unsafe sex, violence and HIV/AIDS transmission (Kalichman, Simbayi, Vermaak, Jooste, & Cain, 2008; Morojele et al., 2006; Oxfam, 2005). While this has a legislative logic and a public health imperative, it makes little ethical sense when the social history of alcohol provision, consumption and control in South Africa has conspired to actively produce shebeens. "
ABSTRACT: In the past decade, a sense of urgency has started to pervade alcohol regulation in South Africa. The burden of alcohol-related mortality and morbidity is among the highest in the world, and its effects are made worse by persistent socio-economic and structural inequalities. Moreover, alcohol is also a principle risk factor for infectious and chronic diseases, as well as a tenacious barrier to the achievement of the Millennium Development Goals. Its consumption and negative externalities have therefore become a public health and development crisis. This is despite alcohol's significant contribution to the South African national economy and individual livelihoods signalling an entrenched site of tension in alcohol regulation. However, while liquor has indubitably pernicious consequences, it does also provide a critical vantage point to further geographical engagements with the South African city and contemporary development debates. In so doing, the novel empirical and conceptual agendas set out in the papers also contribute to a broader engagement with the cultural contexts, meanings and settings of drinking practices in rapidly changing urban spaces of the Global South.The South African geographical journal, being a record of the proceedings of the South African Geographical Society 04/2014; 96(1):1-14. DOI:10.1080/03736245.2014.896277 · 0.65 Impact Factor