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Perceived effects of alcohol use on sexual encounters among adults in South Africa

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... Men are significantly more likely to expect that alcohol will increase their sexual desires, whereas women expect the opposite effects of alcohol on sexual desires. In addition, sexual enhancement expectations are related to greater numbers of sex partners and the number of times people regret having had sex (Morojele et al. 2004). The most widely studied personality disposition related to both alcohol use and sexual risk behavior is sensation seeking (Hoyle et al. 2000). ...
... Drinking alcohol as a means of coping with stress is also related to engaging in higher risk behaviors for HIV transmission (Jones et al. 2005;Wechsberg et al. 2005). Lifestyles that are characterized by alcohol use, especially heavy drinking, can therefore compound HIV risk through multiple channels (Morojele et al. 2004). ...
... Businesses and venues that serve alcohol are often the very places that link alcohol use with risk for HIV infection. Informal alcohol serving establishments, such as private homes where alcoholic beverages are sold and served, are also often the same places where sex partners meet (Morojele et al. 2004). Drinking before sex is more common with non-regular than with regular sex partners (Myer 2002). ...
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Human Immunodeficiency Virus (HIV) is endangering humanity. Many people at risk of or infected with the HIV are heavy drinkers. Both HIV infection and heavy alcohol use adversely affect the immune system and central nervous system (CNS) function. However, little research has addressed the effects of heavy alcohol use on the severity and progression of HIV disease, including the development of HIV associated CNS disease. Animal and in-vitro studies suggest that alcohol impairs various aspects of the immune system and increases the susceptibility to HIV infection, but may not accelerate progression of HIV disease. However, heavy alcohol use may interfere with the patient's adherence to antiretroviral treatment regimens. Neuropathological and neuropsychological studies have indicated that certain brain areas are affected by both HIV infection and chronic alcohol abuse. Magnetic resonance spectroscopy studies of both HIV positive and HIV negative people who were either heavy or light drinkers found that chronic alcohol abuse exacerbates some metabolic injury in the brains of HIV infected people, although this effect may be less pronounced in patients receiving effective antiretroviral therapy. Present study has been done on an endogamous group, Dhankut, living in Dhankuttypura of Bahraich district of Uttar Pradesh, India. The object of present paper is to see how alcohol impairs various aspects of the immune system and increases the susceptibility to HIV infection amongst this group. The paper also analyses the effects of heavy alcohol use on the severity and progression of HIV infection, including the development of HIV associated CNS disease with the help of various studies done on the subject.
... Not only do they cause physical suffering, but they also disturb the sense of security and the ability to feel adequate self-esteem as a sexual partner, which results in significant loss. They also evoke feelings of disappointment and regret, due to, e.g., accidental intercourse with an unknown person [53], establishing an intimate relationship with someone whom a person normally does not desire [54], a belief that the decision about intercourse resulted only from the fact of being intoxicated [55], and also because of the failure to use a condom and potential harm this entails [56]. It must not be forgotten that one of the unpleasant consequences of risky sexual experiences, especially contacts with unknown partners, is a reduced chance of their co-responsibility for the undesirable effects of the activity (e.g., HIV infection, pregnancy). ...
... The threats associated with the experiences assigned to the D cluster are primarily related to the risk of contracting a sexually transmitted infection, unplanned pregnancy, the problem of finding a partner in case of the resulting consequences, and especially the feeling of regret and disappointment because of accidental intercourse with an unknown person [53], establishing an intimate relationship with a partner whom a person normally does not desire [54], not using a condom and anticipated damages resulting from this neglect [56]. ...
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In Poland, there is little research on university students’ risky sexual behaviours. Additionally, existing studies analyse the behaviours selectively and do not group them into clusters. Hence, effective prevention is impossible. The research aims to gather information regarding the prevalence, forms and clusters of students’ risky sexual experiences. In 2019, a cross-sectional study was conducted in 12 universities in south-eastern Poland on a random sample (n = 2764). Fifteen risky sexual experiences, both condom-protected and unprotected, were analysed; they were mainly unprotected vaginal, oral, anal contacts; protected and unprotected sexual experiences while intoxicated and with unknown persons. Thanks Ward’s hierarchical method, four inseparable clusters of students with similar risky experiences were distinguished. Their dominant features were: (A) (24% of interviewees)—drunk partners, (B) (4.8%)—partners intoxicated with drugs, (C) (3.1%)—partner abuse and exceeding partner sexual norms, (D) (17.8%)—the anonymity of partners and going beyond the convention. It was stated that 60.3% of the respondents do not belong to any of the identified clusters. Sex education and the promotion of student sexual health should be intensified; the development of attitudes of avoiding risky sexual behaviours and dealing with their consequences should be considered.
... Furthermore, the association between alcohol consumption and sexual risk-taking is consistent with findings from previous studies, most of which have been conducted in younger populations [15,28,29]. In a prior study that explored the relationship between alcohol use and sexual behavior in South Africa, there was a consistent association observed between quantity of alcohol consumption and increased sexual risk-taking [15,29]. ...
... Furthermore, the association between alcohol consumption and sexual risk-taking is consistent with findings from previous studies, most of which have been conducted in younger populations [15,28,29]. In a prior study that explored the relationship between alcohol use and sexual behavior in South Africa, there was a consistent association observed between quantity of alcohol consumption and increased sexual risk-taking [15,29]. Our study adds to these findings and confirms that these relationships are also present in people aged 40 and older. ...
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We sought to characterize the relationship between alcohol consumption and sexual risk-taking in an aging population in rural South Africa. A cross-sectional analysis was conducted using baseline data from the Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community (HAALSI) cohort. We elicited information on sexual risk behavior and self-reported frequency of alcohol consumption among 5059 adults ≥ 40 years old. Multivariable models showed that more frequent alcohol consumption is associated with a higher number of sexual partners (β: 1.38, p < .001) and greater odds of having sex for money (OR: 42.58, p < .001) in older adults in South Africa. Additionally, daily drinkers were more likely to have sex without a condom (OR: 2.67, p = .01). Older adults who drank more alcohol were more likely to engage in sexual risk-taking. Behavioral interventions to reduce alcohol intake should be considered to reduce STI and HIV transmission.
... However, given that the majority of research into alcohol expectancies has been conducted in Western populations, it is unclear whether the insights from those studies are applicable to the African setting. Several studies conducted in sub-Saharan Africa have found alcohol-related expectations to play a role in sexual behaviour in sub-Saharan Africa (Gálvez-Buccollini et al., 2008;Morojele et al., 2004), however these studies focused predominantly on selective and high-risk populations. One's sexual expectations about the effects of alcohol may be an important component in the association between alcohol use, highrisk sexual behaviour, and HIV/AIDS. ...
... Our study provides data on alcohol use and high-risk sexual behaviour in a population-based sample of adults living in urban Kampala, and provides further evidence for a behavioural mechanism linking alcohol use to increased risk of HIV infection. According to behavioural models by Morojele et al. and others, alcohol use may lead to high-risk sexual behaviour through various pathways, including increased sexual desire and arousal, or decreased inhibitions and judgement and reasoning skills due to the physiological effect of alcohol (Morojele et al., 2006;Morojele, Kachieng'A, Nkoko et al., 2004). Alcohol use may also affect the ability to use a condom effectively or negotiate its use. ...
Article
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Alcohol consumption, a risk factor for HIV transmission in sub-Saharan Africa, is considered high in Uganda. A cross sectional study was conducted to determine whether sex-related expectations about the effects of alcohol explain the association between alcohol use and risky sexual behaviours in a population-based sample of adults in Kampala. Associations between alcohol use (current and higher risk drinking) and high-risk sexual behaviours (multiple regular partners and casual sex) were tested. In age-sex-adjusted models, having multiple regular partners was associated with current drinking (odds ratio [OR] = 2.76, 95% confidence intervals [CIs] = 1.15, 6.63) and higher risk drinking (OR = 3.35, 95% CI = 1.28, 8.71). Associations were similar but not statistically significant for having a causal sex partner. Sex-related alcohol outcome expectancy was associated with both alcohol use and high-risk sexual behaviour and attenuated relationships between multiple regular partners and both current drinking (OR = 1.94, 95% CI = 0.57, 6.73) and higher risk drinking (OR = 2.44, 95% CI = 0.68, 8.80). In this setting sexual behaviours related with alcohol consumption were explained, in part, by sex-related expectations about the effects of alcohol. These expectations could be an important component to target in HIV education campaigns.
... ). Specifically, alcohol use frequency, quantities consumed and problem drinking are associated significantly with the number of sexual partners a person has had and engagement in sex that was later regretted (Morojele et al. 2004a,b, 2006). ...
... These patients were more likely to have symptomatic HIV infection (Olley et al. 2005). Specifically, alcohol use frequency, quantities consumed and problem drinking are associated significantly with the number of sexual partners a person has had and engagement in sex that was later regretted (Morojele et al. 2004aMorojele et al. ,b, 2006). Based on data from SABSSM II (Shisana et al. 2006), HIV positive persons were more likely hazardous or harmful drinkers and binge drinkers than HIV negative persons. ...
Article
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
... Alcohol use and abuse is associated with increased sexual risk throughout the world, [1][2][3][4][5] regionally among populations in sub-Saharan Africa [6][7][8], and specifically in South Africa. [9,10] Additionally, characteristics of the outlets themselves (e.g. music, dim lights, lack of condoms) [11] and the network of people who typically frequent outlets (e.g. ...
... decision-making, and feelings of reduced sexual control. [8,10,[32][33][34] These disruptions to the normal constraints on risky activity lead to increased sexual risk. [35,36] In conjunction, characteristics typical of alcohol outlets (limited supervision, music, dim lights, unisex toilets, lack of condoms) may directly create favorable environments for risky sexual activity. ...
Article
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Background: Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk. Methods: In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption. Results: Visiting alcohol outlets was associated with having more sex partners [adjusted odds ratio (aOR), one versus zero partners (95% confidence interval (CI)): 1.51 (1.21, 1.88)], more unprotected sex acts [aOR, one versus zero acts (95% CI): 2.28 (1.52, 3.42)], higher levels of transactional sex [aOR (95% CI): 1.63 (1.03, 2.59)], and HSV-2 infection [aOR (95% CI): 1.30 (0.88, 1.91)]. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex. Conclusions: Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2. Trial registration: HIV Prevention Trials Network HPTN 068.
... First Morojele et al. (2004) reported on the findings of their household survey of adult, township residents in South Africa. They found that alcohol use frequency, quantities consumed and problem use were significantly associated with number of sexual partners and engagement in regretted sex, but not significantly related to inconsistent condom use (Morojele et al., 2004). ...
... First Morojele et al. (2004) reported on the findings of their household survey of adult, township residents in South Africa. They found that alcohol use frequency, quantities consumed and problem use were significantly associated with number of sexual partners and engagement in regretted sex, but not significantly related to inconsistent condom use (Morojele et al., 2004). Kiene et al. (2006) subsequently reported on the findings of their study conducted among patients living with HIV/ AIDS (PLWHA) in clinical care in KwaZulu Natal province of South Africa. ...
Article
There is now conclusive evidence of a causal linkage between heavy drinking patterns and/or alcohol use disorders and the worsening of the disease course for HIV. However, while alcohol usage is consistently associated with the prevalence and incidence of HIV, further research is needed to substantiate causality in terms of the acquisition of this disease. The burden attributable to alcohol use in South Africa in 2004 has been estimated to be 1.3 million years in terms of years lost though premature death caused by alcohol and years lived with an alcohol-related disability (or just over 6% of all years lost from all causes). Of all years lost through death and disability that can be attributed to alcohol, 10% for men and 28% for women can be directly attributed to alcohol’s impact on the progression of HIV in infected individuals. The implications of the above will be discussed in terms of research gaps that need to be addressed and broader policy responses that are needed in the health and social services sectors. In addition, emphasis will be given to specific practices that should be considered for rollout by agencies involved in substance abuse and HIV/AIDS treatment and prevention.
... Furthermore, substance use is associated with an increase in risky sexual behaviours in the African region-a precursor for the HIV infection (Morojele, Kachienga, Nkoko, Moshia et al., 2004). South Africa has one of the highest HIV prevalence rates in the world (Commonwealth Secretariat, 2006). ...
... South Africa has one of the highest HIV prevalence rates in the world (Commonwealth Secretariat, 2006). The misuse of alcohol is increasingly being recognized as a key determinant of sexual risk behaviour, and consequently, an indirect contributor to HIV transmission in sub-Saharan countries (Morojele et al., 2004). The ...
... In fact, Eshbaugh and Gute's (2008) study of sexually active college women indicated that sexual intercourse with a partner only once and engaging in sexual intercourse with someone known for less than 24 hours were predictive of sexual regret. Other common reasons for regretted sexual experiences include engaging in sexual activity with someone they normally would not have desired (Workman, 2001), failure to use a condom (Morojele et al., 2004), or realizing that alcohol influenced the decision to have sex (Oswalt, Cameron, & Koob, 2005). Regarding the prevalence of sexual regret, as many as 194 of 270 (72%) sexually active college students report at least one regretted sexual experience in their lifetime (Oswalt et al., 2005). ...
... Over a relatively short 4-week period, 9% of undergraduates report regretting a sexual experience that occurred after consuming alcohol (Kypri, Paschall, Langley, Cashell-Smith, & Bourdeau, 2009), and 21% of college students report an alcohol-related regretted sexual experiences in the past year (Mallett, Lee, Neighbors, Larimer, & Turrisi, 2006). Specifically, individuals who report alcohol-related regretted sex, compared to peers without such an experience, are more likely to engage in high levels of weekly (Mallett, Bachrach, & Turrisi, 2008) and monthly drinking (Morojele et al., 2004). Alcohol is also commonly involved in sexual "hookups" (Armstrong et al., 2010;Paul et al., 2000). ...
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The prevalence of alcohol-related regretted sex in college students warrants a better understanding of the characteristics of students who report such experiences. Therefore, the present study examined correlates of regretted sexual experiences involving alcohol use among 2 specific high-risk college student samples: students mandated to alcohol intervention (n = 522) and volunteer 1st-year students transitioning to college (n = 481). Results indicated that alcohol-related regretted sex occurred at similar rates in mandated and volunteer students, with approximately 25% of the students reporting at least 1 occurrence in the past month. Women were more likely to report alcohol-related regretted sex compared with men. The belief that alcohol use would result in "liquid courage" was associated with alcohol-related regretted sex among college students, even after accounting for greater alcohol use and problem alcohol use behaviors. These findings have significant implications for intervention efforts and future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
... The link between alcohol use and RSB is well documented [8,37]; however, another study discovered that, despite being well-informed about the risk of unprotected sexual behaviour, young people continued to participate in RSB and alcohol consumption [30]. This has emerged as a major public health concern in South Africa and globally, particularly among young adults aged 18 to 25 [44][45][46]. Young adults in this age group are the most susceptible to engaging in risky drinking behaviours. ...
Article
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The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.
... Alcohol consumption has consistently been associated with risky sexual behaviour (Bello et al., 2017). However, there remains a paucity of research that explores the relation between sexual behaviour and alcohol consumption in South Africa (Morojele et al., 2004;Pithey & Morojele, 2002). Given that the age group of 18-25 years has been identified as most susceptible to risky drinking practices (SACENDU, 2019), it is imperative to explore the link between alcohol consumption and risky sexual behaviour within this cohort. ...
Article
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The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke’s (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.
... Heavy drinking in the 3 months before conception was also more common in women with unintended pregnancies than in women with intended pregnancies (Naimi et al., 2003). Moreover, alcohol use and regretted sex also frequently co-occur (Kypri et al., 2009;Mallett et al., 2006;Morojele et al., 2004;. Alcohol can also impair the sexual experience in the moment. ...
Article
Objective: Alcohol-related sexual consequences are common among young adults, yet there is no standard measure to comprehensively assess this construct. To fill this gap, the current study evaluated a 41-item measure of alcohol-related sexual consequences in a sample of at-risk young adults. Method: A subsample (n = 318; 54% female; 71% White; mean age = 22.52 years) of young adults from a larger intervention study was identified for analyses based on recent drinking and sexual behavior. Participants were asked whether each of 41 sexual consequences occurred in the past month as a result of drinking alcohol. More than half of the sample reported vaginal sex without a condom, oral sex without a condom, and having sex without discussing condom use. Results: Only 1 of 41 items evidenced sex differences: men were more likely than women to report oral sex with someone they just met. Count regression models were conducted to determine unique associations among alcohol-related (e.g., alcohol use, expectancies) and sex-related variables (e.g., sexual behavior, expectancies) and alcohol-related sexual consequences and general alcohol consequences. Findings supported the alcohol-related sexual consequences measure as related to, but distinct from, general alcohol consequences, as it was more strongly related to sex-specific constructs. Conclusions: This study provides preliminary support for the Alcohol-Related Sexual Consequences Scale, a novel measure of alcohol-related sexual consequences, which may be useful for generating personalized feedback and assessing the efficacy of interventions targeting risky sexual behavior and drinking.
... Furthermore, common beliefs surrounding alcohol use and sexual behaviour appear to influence individuals' perceptions of sexual regret. For example, the belief that alcohol provides 'liquid courage' is strongly associated with increased sexual risk behaviour and regretted sex (Orchowski, Mastroleo, and Borsari 2012) as are beliefs that alcohol increased one's sex appeal (Morojele et al. 2004) and/or help individuals enjoy sexual activity more (Barnett et al. 2014). This suggests a self-defeating cycle in which 'both men and women appear to be using alcohol to bolster sexual interaction … but many, particularly women, regret the sexual contact that results' (Barnett et al. 2014, 111). ...
Article
Research identifies sexual regret as the most common source of regret in the USA; however, few studies have explored this phenomenon. This study utilised a mixed-methods approach to explore sexual regret in a sample of 189 US college students. Quantitative analyses assessing who is most likely to experience sexual regret revealed no significant differences in experiences of sexual regret based on most demographics; however, individuals involved in fraternity and sorority life and/or college athletics were significantly more likely to report experiences of sexual regret. Additionally, students who reported experiences of sexual victimisation were more likely to report experiences of sexual regret. Qualitative analyses attempting to determine students’ reasoning for experiencing sexual regret revealed five distinct content areas: 1) altered judgement, 2) motivations, 3) partner characteristics, 4) social judgement, and 5) unsatisfying or unpleasant sexual experiences. Results from both quantitative and qualitative analyses demonstrate significant overlap between experiences of sexual regret and sexual victimisation, highlighting the importance of future research and programming regarding sexual regret to increase understanding of the complex relationships between sexual consent and sexual behaviour.
... The prevalence for AUD has also been shown to be higher among men than women [22,23]. For example, among 977 HIV-positive individuals in the Eastern Cape, South Africa, a higher prevalence of alcohol dependence (39.0%) and alcohol abuse (19.0%) was found among men compared to women (alcohol dependence: 19.1%, alcohol abuse: 6.0%) using the MINI [23]. ...
Article
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We evaluated the effectiveness of the Alcohol Use Disorder Identification Test (AUDIT) in screening for alcohol use disorder (AUD) among 500 men and women seeking HIV testing. Receiver operating characteristic (ROC) curve analysis was used to determine the utility of the AUDIT in discriminating between AUD caseness and non-caseness. For men, a cut-off score of 10 on the AUDIT predicted AUD with 81% sensitivity and 77% specificity. For women, a cut-off score of 7 yielded optimal sensitivity (82%) and specificity (82%). For men, the AUDIT yielded a positive predictive value (PPV) of 49% and a negative predictive value (NPV) of 94%; for women the PPV and NPV were 49 and 96%, respectively. While the AUDIT can be used to rapidly screen large numbers of men and women seeking HIV testing, the instrument's low PPV indicates that individuals who screen positive may need to undergo further evaluation to detect cases of AUD.
... [11] Studies have shown that HIV-positive patients who are suffering from AUD symptoms may delay testing for HIV, accessing appropriate medical care, and initiating ART, which may hasten disease progression to full-blown AIDS. [3,4,6] Studies have also shown that individuals who drink are significantly more likely to become HIV-positive [12] ; people who drink more heavily and report being intoxicated in sexual situations also report less condom use and more concurrent sex partners, demonstrating higher risk for HIV [13,14] ; and HIV-positive people undergoing treatment concurrent with AUD often render the treatment ineffective because they frequently fail to adhere to the strict treatment regimens necessary to achieve control of the infection. ...
Article
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Background: Patients who have tested positive for the human immunodeficiency virus (HIV) and who also experience alcohol use disorder (AUD) symptoms have worse clinical outcomes when compared with those who do not have AUD symptoms. The objective of the present study was to determine the effect of rational emotive health therapy (REHT) on AUD among community-dwelling, HIV-positive patients in the Southeastern region of Nigeria. Methods: The research design included a pretest/post-test control group with a total of 124 community-dwelling, HIV-positive patients with AUD symptoms participating in the study. The measures employed for data collection included Alcohol-related Irrational Beliefs Scale (AIBS) and Alcohol Use Disorder Scale (AUDS). Repeated measures analysis of variance was used for statistical analysis. Results: The result obtained at the initial assessment indicated that AUD was severe. Furthermore, REHT intervention led to a significant reduction in AUD symptoms, as shown by a reduction in AUDS and AIBS scores with time in the treatment group compared to those in the waitlist control group after the intervention. Also, the effect of REHT was positively maintained in the treatment group participants at follow-up assessment. Conclusion: The presence of HIV symptoms alone does not cause HIV-positive patients to be dependent on alcohol; rather, irrational beliefs about the infection may contribute to unhealthy feelings and abuse of alcohol. Rational emotive health therapy is an effective approach that can be employed by therapists and health counselors in helping HIV-positive patients to think rationally about themselves and work to be able to overcome HIV-related, as well as alcohol-related, irrational beliefs.
... In a meta-analysis of studies examining the associations between alcohol use and risky sex in Southern Africa, Kalichman and colleagues found that the quantity of alcohol was more influential than the frequency of use [10]. In a study of community residents in South Africa, Morojele et al. found that quantity of alcohol consumed was related to having more sexual partners, while frequency of use was not associated with any reported sexual risk behaviors [11]. Using daily diary monitoring, Kiene and colleagues found that alcohol use was related to unprotected sex among HIV-infected South African men and women in the community but only when alcohol use was moderate or heavy [12]. ...
Article
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Approximately 71% of HIV-infected individuals live in sub-Saharan Africa. Alcohol use increases unprotected sex, which can lead to HIV transmission. Little research examines risky sex among HIV-infected individuals in East Africa who are not sex workers. The study purpose was to examine associations with unprotected sex in a high-risk sample of 507 HIV-infected sexually active drinkers in western Kenya. They were enrolled in a trial to reduce alcohol use. Past-month baseline alcohol use and sexual behavior were assessed using the Timeline Followback. A zero-inflated negative binomial model examined associations with occurrence and frequency of unprotected sex. Results showed heavy drinking days were significantly associated with unprotected sex occurrence across gender, and with unprotected sex frequency among women. Among women, transactional sex, alcohol-related sexual expectations, condom use self-efficacy, drinking-and-protected-sex days and age were associated with unprotected sex occurrence while alcohol-related sexual expectations, depressive symptoms and condom use self-efficacy were associated with unprotected sex frequency. Among men, alcohol-related sexual expectations, condom use self-efficacy, and age were associated with unprotected sex occurrence, while drinking-and-protected-sex days were associated with unprotected sex occurrence and frequency. Findings suggest robust relationships between heavy drinking and unprotected sex. Further research is needed elucidating the temporal relationships between drinking and unprotected sex in this population.
... Several studies have verified an increase in South Africans of 15 years and older drinking large amounts of alcohol and with noted increase in life-time drinking especially among young, black African males and females ( Parry 2005). Morojele et al. 2004 found strong links between drinking and engagement in risky sexual behaviours that made a significant impact on the number of sexual partners and the amount of regretted sexual engagements. Risky sexual behaviour and drinking are clearly linked to the spread of HIV and contribute to various other health complications emotionally and physically. ...
... In one of only two investigations of the correlates of regretted sexual experiences (RSE), which the researchers defined as "a negative emotion involving self-blame" that results from behaviors "the individual feels he or she should not have done and results in an undesired outcome, " Orchowski et al. (2012) found that the expectation that alcohol will provide "liquid courage" is significantly associated with having regretted sexual experiences. These findings were consistent with an earlier expectancy study using noncollege adult participants (Morojele et al., 2004), which found that RSE was associated with expectancies that alcohol would increase one's sex appeal. Other alcohol-sex expectancies (e.g., "When drinking alcohol, I say and do romantic things, " "When drinking alcohol, I am likely to initiate sex") also have been found to be associated with the risk of sexual consequences, particularly when those expectancies involved perceived increased sexual drive from alcohol (Patrick & Maggs, 2009). ...
Article
This study explored the relative impact of college alcohol beliefs (CABs; i.e., the extent to which the student views alcohol as part of the fabric of college life), descriptive norms, injunctive norms, positive alcohol expectancies, and sensation seeking on college students' (N = 415) risk for engaging in regretted sexual encounters (RSE). Overall, 12% of our sample reported having experienced RSE within the past 30 days. When pitted against the other traditional predictors of college student drinking and its consequences, such as positive alcohol expectancies, descriptive and injunctive norms, and sensation seeking, CABs emerged as the strongest correlate of RSE other than drinking itself, and explained significant additional variance in RSE beyond these other predictors. Mediation analyses revealed that CABs had a significant indirect effect on RSE through typical weekly drinking. This pattern of findings indicates that college alcohol beliefs are, from a public health perspective, dangerous beliefs, that warrant serious consideration in the development of new approaches to college student drinking and its consequences.
... Alcohol usage is consistently associated with prevalence and incidence of HIV and almost to the point of causality . There is now conclusive evidence of a causal linkage between heavy drinking patterns and/or alcohol use disorders and the worsening of the disease course for HIV (Morojele et al. 2004 ;Parry et al. 2010 ). The burden attributable to alcohol use in South Africa in 2004 has been estimated to be 1.3 million years in terms of years lost though premature death caused by alcohol and years lived with an alcohol-related disability (or just over 6 % of all years lost from all causes) (Schneider et al. 2007 ). ...
Chapter
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Today, 1.8 billion adolescents stand at the challenging crossroads between childhood and the adult world. Nine out of ten of these young people live in the developing world and face especially profound challenges, including HIV. Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. HIV incidence remains highest among 15–24 years olds, with approximately 40 % of horizontal transmission occurring within this age group. Furthermore, as access to highly active antiretroviral therapy (HAART) improves globally, the population of vertically infected adolescents is expected to grow. While youth aged 10–19 accounted for 1 % of the total number of patients receiving HAART in South Africa in 2008, this proportion will grow to approximately 5 % by 2020, mainly as a result of vertically infected children surviving into adolescence. Moreover, South Africans between 13 and 19 years comprise roughly 30 % of the population, so treatment and care for HIV-positive adolescents will become increasingly important over the next decade. Although most adolescents navigate this challenging developmental stage successfully, it can be especially difficult if there are additional stressors to overcome, such as HIV. HIV adds a significant burden to adolescent development, including issues of stigma, orphanhood and bereavement, increased poverty and food insecurity, adherence and disclosure challenges, high sexual risk taking behavior, and especially, increased risk for poor mental health outcomes. In addition, public health services are confronted with the host of psychosocial issues this population brings, as young people transition more independently to adult clinics. These complications will be explored in this chapter using Bronfenbrenner’s ecological model of human development as a framework from which to understand adolescent health and development.
... First Morojele et al. (2004) reported on the findings of their household survey of adult, township residents in South Africa. They found that alcohol use frequency, quantities consumed and problem use were significantly associated with number of sexual partners and engagement in regretted sex, but not signifi cantly related to inconsistent condom use (Mo rojele et aI., 2004). ...
Article
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There is now conclusive evidence of a causal linkage between heavy drinking patterns and/or alcohol use disorders and the worsening of the disease course for HIV. However, while alcohol usage is consistently associated with the prevalence and incidence of HIV, further research is needed to substantiate causality in terms of the acquisition of this disease. The burden attributable to alcohol use in South Africa in 2004 has been estimated to be 1.3 million years in terms of years lost though premature death caused by alcohol and years lived with an alcohol-related disability (or just over 6% of all years lost from all causes). Of all years lost through death and disability that can be attributed to alcohol, 10% for men and 28% for women can be directly attributed to alcohol's impact on the progression of HIV in infected individuals. The implications of the above will be discussed in terms of research gaps that need to be addressed and broader policy responses that are needed in the health and social services sectors. In addition, emphasis will be given to specific practices that should be considered for rollout by agencies involved in substance abuse and HIV/AIDS treatment and prevention.
... Prior studies of the CSG have found that cash transfers improve children's school attendance and nutrition and reduce child hunger, child labor, and risky behaviors among adolescents (DSD-SASSA-UNICEF 2012; Samson, Heinrich, and Regalia 2011). Researchers have described an "enormous risk associated with adolescence in South Africa," due to the high prevalence of HIV and alcohol use among young people that is consistently associated with sexual risk taking and sexual coercion (Kalichman and Kaufman 2007;Morojele et al. 2004). A growing body of evidence also suggests that risky behaviors, particularly sexual activity, vary with household consumption expenditures and income shocks, which implies a role for cash transfer programs in helping to mitigate risky behavior, as well as poverty and hunger (Robinson and Yeh 2011). ...
Article
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The study of administrative burden—experienced in individual encounters with government—is being renewed with new theoretical developments and policy applications. Building on recent developments, this article aims to broaden the conceptual framing of administrative burden and extend its empirical investigation beyond concerns about access to and efficiency of public services to questions of individual and societal impacts. It also expands beyond the typical US or developed country context to examine this phenomenon in the setting of a large social protection program in South Africa, where the “bite” of administrative burden may potentially be bigger. The empirical analysis uses data from the South African Child Support Grant (CSG) evaluation to investigate how CSG program rules and requirements affected administrative burdens and erected barriers to grant receipt. The findings show that 60% of CSG recipients experienced an interruption or disconnection in grant receipt that appears to be associated with administrative burden, with 80% of those stoppages in error. The resulting loss of monthly benefits has significant negative implications for the outcomes of adolescents targeted by the program.
... standard drinks for men, 4 ? standard drinks for women in the last 7 days) was 10.8 % for females and 10.6 % for males [20]. The higher levels of alcohol use observed in our study may be attributed to differences in definitions of frequent drinking and heavy drinking and differences in the study methodology. ...
Article
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This study evaluated the correlates of three alcohol measures using a cross-sectional survey conducted among patrons of alcohol-serving venues in Gaborone, Botswana from October 2012 to February 2013. Using logistic regression, we found that engaging in higher levels of sexual risk behaviors was significantly associated with frequent drinking (at least 3 times a week), heavy episodic drinking (more than 6 standard units of alcohol at least weekly) and probable alcohol dependence (AUDIT score ≥20). Additionally, having higher levels of alcohol expectancies that increase the risk of HIV infection was significantly associated with probable alcohol dependence. Although HIV knowledge was generally high in this population, there is need for HIV prevention and alcohol harm reduction efforts to address the role of alcohol in increasing HIV risk and encourage the adoption of safer drinking patterns and the modification of alcohol expectancies.
... 16,17 Alcohol use is also associated with unplanned pregnancies, and is more common among women whose partners also abuse alcohol. [18][19][20] Alcohol use and abuse in pregnancy contributes to children's failure to thrive, as homes are less organized and daily family routines more chaotic (E Davis, MJ Rotheram-Borus, M Tomlinson, unpublished work, 2014). Alcohol use also reduces maternal adherence to all health regimens, including HIV medications. ...
Article
Pregnant South African women with histories of drinking alcohol, abuse by violent partners, depression, and living with HIV are likely to have their post-birth trajectories over 36 months significantly influenced by these risks. All pregnant women in 24 Cape Town neighborhoods were recruited into a cluster RCT by neighborhood to either: (1) a standard care condition (n=12 neighborhoods, n=594 mothers); or (2) a home-visiting intervention condition (n=12 neighborhoods, n=644 mothers). Pregnant women residing in urban, low-income neighborhoods in Cape Town, South Africa. Home visiting included prenatal and postnatal visits by community health workers (Mentor Mothers) focusing on general maternal and child health, HIV/tuberculosis, alcohol use, and nutrition. Mothers were assessed in pregnancy and at 18 and 36 months post birth: 80.6% of mothers completed all assessments between 2009 and 2014 and were included in these analyses performed in 2014. Longitudinal structural equation modeling examined alcohol use, partner violence, and depression at the baseline and 18-month interviews as predictors of maternal outcomes at 36 months post birth. Relative to standard care, intervention mothers were significantly less likely to report depressive symptoms and more positive quality of life at 36 months. Alcohol use was significantly related to use over time, but was also related to depression and HIV status at each assessment and partner violence at 36 months. Alcohol, partner violence, and depression are significantly related over time. A home-visiting intervention improved the emotional health of low-income mothers even when depression was not initially targeted. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
... Given that we are focusing on adolescents in this study, we likewise model the impacts of the CSG on adolescent risky behaviors, as well as on their educational attainment. Researchers have described an "enormous risk associated with adolescence in South Africa," due to the high prevalence of HIV and alcohol use among young people that is consistently associated with sexual risk taking and sexual coercion (Kalichman & Kaufman, 2007;Morojele et al., 2004). In addition, a growing body of evidence suggests that risky behaviors, particularly sexual activity, vary with household consumption expenditures and income shocks, which implies a role for cash transfer programs in helping to mitigate risky behavior, as well as poverty and hunger (Yeh, 2006). ...
Article
Cash transfer programs have achieved wide-ranging success in reducing poverty, yet there is little empirical research on how program rules and administrative capacity might limit program effectiveness. We examine administrative burden and quantify its implications for grant access and impacts in the South African Child Support Grant (CSG) program, as the age of eligibility and application requirements changed over time. We find that approximately 60% of the sampled children experienced an interruption or disconnection in cash transfer receipt, and that both timing and "dosage" loss are associated with adolescent engagement in risky behaviors, and for females, lower educational attainment.
... Other studies have shown increased involvement in sexual risk behaviour among alcohol users (Kalichman, Simbayi, Kaufman, Cain & Jooste 2007; Neuman, Schneider, Nanau, Parry & Chersich 2012; Shuper, Neuman, Kanteres, Baliunus, Joharchi & Rehm 2010; Woolf-King & Maisto 2011). Previous research has suggested that the relationships between alcohol consumption and sexual risk behaviour are complex and are a function of the patterns of alcohol consumption, characteristics of consumers, and contexts/settings in which alcohol consumption takes place (Kalichman et al. 2007; Morojele, Kachieng'a, Mokoko, Nkoko, Parry, Nkowane, et al. 2006; Morojele, Kachieng'a, Nkoko, Moshia, Mokoko, Parry, et al. 2004). Bars are one setting in which alcohol is commonly associated with the initiation of (and often the engagement in) sexual encounters, many of which are risky. ...
Article
Abstract Alcohol consumption is a recognised risk factor for HIV infection. Alcohol serving establishments have been identified as appropriate venues in which to deliver HIV prevention interventions. This paper describes experiences and lessons learnt from implementing a combined HIV prevention intervention in bar settings in one city- and one township-based bar in Tshwane, South Africa. The intervention consisted of peer-led and brief intervention counselling sub-components. Thirty-nine bar patrons were recruited and trained, and delivered HIV and alcohol risk reduction activities to their peers as peer interventionists. At the same time, nine counsellors received training and visited the bars weekly to provide brief motivational interviewing counselling, advice, and referrals to the patrons of the bars. A responsible server sub-component that had also been planned was not delivered as it was not feasible to train the staff in the two participating bars. Over the eight-month period the counsellors were approached by and provided advice and counselling for alcohol and sexual risk-related problems to 111 bar patrons. The peer interventionists reported 1323 risk reduction interactions with their fellow bar patrons during the same period. The intervention was overall well received and suggests that bar patrons and servers can accept a myriad of intervention activities to reduce sexual risk behaviour within their drinking settings. However, HIV- and AIDS-related stigma hindered participation in certain intervention activities in some instances. The buy-in that we received from the relevant stakeholders (i.e. bar owners/managers and patrons, and the community at large) was an important contributor to the feasibility and acceptability of the intervention.
... While HIV transmission in the DR continues to be primarily through sexual contact, there has also been limited data in the current epidemiological literature on the role of drugs and alcohol as contributing factors to HIV risk (Aguilar-Gaxiola et al., 2006). In tourism areas, studies have documented the relationship between alcohol use and sexual behavior (Forsythe et al., 1998;Kempadoo, 1999;Schwartz, 1999) including increased HIV-related sexual risk behaviors (Kalichman, 2010), as many alcohol venues are physically designed or situated in spaces that promote sexual encounters (Fritz et al., 2002;Kalichman, Simbayi, Vermaak, Jooste, & Cain, 2008;Morojele et al., 2004;Sivaram et al., 2008). The increased availability of alcohol also has ensuing health consequences for local families. ...
Article
Expansion of the tourism industry in the Dominican Republic has had far-reaching health consequences for the local population. Research suggests families with one or more members living in tourism areas experience heightened vulnerability to HIV/STIs due to exposure to tourism environments, which can promote behaviors such as commercial and transactional sex and elevated alcohol use. Nevertheless, little is known about how tourism contexts influence family dynamics, which, in turn, shape HIV risk. This qualitative study examined family relationships through in-depth interviews with 32 adults residing in Sosúa, an internationally known destination for sex tourism. Interviewees situated HIV risk within a context of limited employment opportunities, high rates of migration, heavy alcohol use, and separation from family. This study has implications for effective design of health interventions that make use of the role of the family to prevent HIV transmission in tourism environments.
... In contrast to parts of Europe and the Americas, there has been limited research as to whether drug use plays a significant role in the spread of HIV infection in Africa. Research has shown that heavy use of alcohol is related to sexual risks for HIV transmission in South Africa, but the nature of the association is not well understood (Morojele, Kachienga, Nkoko, Moshia, Mokoko, Parry, Nkowane & Saxena, 2004;Morojele, Kachienga, Mokoko, Nkoko, Parry, Nkowane, Moshia & Saxena, in press;Simbayi, Kalichman, Jooste, Mathiti, Cain & Cherry, 2004). There is also evidence that cannabis use, the most commonly used non-alcoholic substance in South Africa (Parry, Pluddemann, Donson, Sukhai, Marais & Lombard, 2005), is related to sexual risk behaviors (Flisher, Parry, Evans, Muller & Lombard, 2003). ...
Article
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Aims: The current study examined the use of methamphetamine (Meth) in relation to HIV risks in a South African community sample. Design and setting: Street intercept methods were used to collect surveys of substance use and sexual behavior from 441 men and 521 women living in a racially mixed township in Cape Town South Africa. Findings: Results showed that 78 (18%) men and 63 (12%) women had used Meth, and 49 (11%) men and 34 (6%) women ever had used Meth in the preceding 6 months. Other than alcohol, cannabis was the most commonly used drug followed by Meth. We found that Meth use was closely associated with other drug use, indicating a pattern of poly‐substance use among Meth users. Recent Meth use was associated with being male, engaging in unprotected intercourse and having multiple sex partners in the previous 6 months. Meth users also demonstrated greater condom use than non‐users, although less than half of all intercourse occasions among Meth users were condom protected. Conclusions: Meth is used by a substantial number of people in one area of South Africa and the close association of Meth and sexual risk practices raises concern that Meth could fuel the spread of HIV infection in new South African sub‐populations.
... Many of these factors are subjective and difficult to quantify, and makes the comparative analysis between different countries or even within a given country a particularly challenging task (Heath, 2000). In addition, the effects of alcohol depend on the total cumulative quantities consumed, drinking patterns and drinking contexts, and lifestyles that are characterised especially by 'heavy alcohol use' can compound HIV risk through multiple channels (Chersich et al., 2007;Kalichman et al., 2007a;Morojele et al., 2004). Unfortunately, the distinction between alcohol use, abuse and dependence is often difficult, even though this is fundamental in the understanding of HIV risk behaviour (Kalichman et al., 2007a). ...
Article
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The purpose of this review was to identify and assess studies that have quantified the association between alcohol consumption and HIV infection in sub-Saharan Africa. PubMed, CAB Abstracts and article references were searched to identify studies published in English between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. Twenty-one eligible studies were described in detail and information on study characteristics extracted. All of the identified studies were conducted either in east or southern Africa, and varied substantially regarding study population and alcohol use definitions. Overall, users of alcohol and especially problem drinkers were more likely to be HIV seropositive (HIV+) than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence. The findings of this review of sub-Saharan African research strongly support an association between alcohol consumption and HIV infection. Although a causal relationship could not be established with certainty from the mainly cross-sectional studies, the negative consequences of such an association have profound implications for the burden of disease in this region. To confirm causality, future research should use prospective study designs, use clearly defined standardised measures of alcohol use (and problematic drinking) and an 'event-specific' approach to examine the situational links between alcohol use and HIV acquisition.
... Most drugs are smoked, but there is evidence of increasing injection use of heroin in some parts of the country (Parry, Plüddemann, & Myers, 2005). There is now also emerging evidence from a growing number of local research studies of the link between substance use and HIV/AIDS, mostly through substances' effect on sexual risk behaviour (Morojele et al., 2006;Morojele et al., 2004;Simbayi et al., 2006;Simbayi et al., 2004). ...
Article
Little has been done to improve the integration of drug use and HIV services in sub-Saharan Africa where substance use and HIV epidemics often co-exist. Data were collected using rapid assessment methods in two phases in Cape Town, Durban and Pretoria, South Africa. Phase I (2005) comprised 140 key informant and focus group drug using interviewees and 19 service providers (SPs), and Phase 2 (2007) comprised 69 drug using focus group interviewees and 11 SPs. Drug users put themselves at risk for HIV transmission through various drug-related sexual practices as well as through needle sharing. Drug users in both phases had limited knowledge of the availability of drug treatment services, and those that had accessed treatment identified a number of barriers, including affordability, stigma and a lack of aftercare and reintegration services. SPs identified similar barriers. Drug users displayed a general awareness of both HIV transmission routes and prevention strategies, but the findings also indicated a number of misperceptions, and problematic access to materials such as condoms and safe injection equipment. Knowledge around HIV treatment was low, and VCT experiences were mixed. SPs recognized the importance of integrating HIV and substance use services, but barriers such as funding issues, networking/referral gaps and additional burden on staff were reported in Phase 2. A comprehensive, accessible, multi-component intervention strategy to prevent HIV risk in drug users needs to be developed including community outreach, risk reduction counselling, VCT and substance use treatment.
... [79][80][81][82][83][84][85][86][87][88][89][90][91] For example, alcohol venues are often characterized by greater availability of commercial sex workers, on-site rooms where sex can occur, or areas where there are nearby buildings, lots, or other spaces to have sex. 92 The sex industry thus functions synergistically with alcohol venues in many Caribbean tourism areas, and indeed, in the Dominican Republic research has shown that the liquor store and the centro cervecero (a specialized store that sells and serves beer) have become new sites for the negotiation of commercial sexual transactions. 93 These local venues have particular cultural features that remain to be fully studied in relation to HIV. ...
Article
The Caribbean has the highest HIV rates outside of sub-Saharan Africa. In recent decades, tourism has become the most important Caribbean industry. Studies suggest that tourism areas are epicenters of demographic and social changes linked to HIV risk, such as transactional sex, elevated alcohol and substance use, and internal migration. Despite this, no formative HIV-prevention studies have examined tourism areas as ecologies that heighten HIV vulnerability. HIV/AIDS research needs to place emphasis on the ecological context of sexual vulnerability in tourism areas and develop multilevel interventions that are sensitive to this context. From our review and integration of a broad literature across the social and health sciences, we argue for an ecological approach to sexual health in Caribbean tourism areas, point to gaps in knowledge, and provide direction for future research.
... In addition, more men than women believe that alcohol will enhance sexual activity and desires, and so drink before sex . Thus for African women, risk for unsafe sex may be influenced more by their partners' drinking than their own (Morojele et al., 2006;Morojele et al., 2004). ...
Article
This study examines alcohol use, transactional sex (TS), and sexually transmitted infection (STI) risk among sugar plantation residents near Moshi, Tanzania, from 2002 to 2004. We compare popular discourse gathered through ethnographic methods with cross-sectional questionnaire and STI prevalence data to illuminate the close correspondence of alcohol use and TS with STI transmission. People attributed to alcohol varied consequences: some socially desirable (relaxing, reducing worries) and others (drunkenness, removing shame) thought to put alcohol abusers at risk for STIs. TS-exchanging money, food, gifts, alcohol or work for sex-was not stigmatized, but people believed that seeking sexual partners for money (or providing money to sexual partners) led to riskier sexual relationships. We explore popular discourse about how alcohol use and TS independently and in combination led to increased STI exposure. Popular discourse blamed structural circumstances-limited economic opportunities, few social activities, separated families-for risky sex and STIs. To understand individual behavior and risk, we surveyed 556 people. We measured associations between their self-reported behaviors and infection with herpes simplex virus type-2 (HSV-2), syphilis, and HIV in 462 participants who were tested. Alcohol abuse was associated with prevalent STI and HIV infection. Exchanging sex for alcohol and work were both associated with prevalent STI. Participants who both abused alcohol and participated in TS had greatest risk for STI. Findings from the two analytic methods-interrogation of popular discourse, and association between self-reported behavior and STIs-were largely in agreement. We posit explanations for discrepancies we found through the concepts of sensationalization, self-exceptionalization, and the influence of an authoritative moral discourse.
... Both qualitative and quantitative studies conducted among adolescents and young adults in Gauteng Province between 2002 and 2003 point to strong links between drinking and engagement in sexual risk behaviours. Specifically, alcohol use frequency, quantities consumed and problem drinking are associated significantly with the number of sexual partners a person has had and engagement in sex that was later regretted [17,18]. Furthermore, almost one in five HIV patients studied at a large infectious disease clinic in Cape Town in 2003 met criteria for an alcohol use disorder. ...
Article
Alcohol has played a central and often controversial role in the life of South Africa since the arrival of European settlers. Initially a refreshment station was established at what was to become Cape Town, so that passing ships could take on supplies. Drunkenness, smuggling of liquor, gambling and violence became part of the daily life among inhabitants of what was nicknamed the ‘Tavern of the Seas’. Alcohol was exchanged for cattle and labour from indigenous populations. It was also used in the education of slaves, and played a pivotal role in ‘managing’ labour in certain sectors of the economy [2,3]. The period between the 17th and 20th centuries saw the growth of large wine and brewing industries that are now important players in the global alcohol market. The growth of illegal outlets (shebeens) in the second half of the 20th century served as a form of resistance to apartheid policies instituted to repress the black majority, as did the destruction of the government-run beerhalls in the 1970s. The complex role that alcohol plays in South African society is reflected further in the national Liquor Act of 2003 that aims to promote the development of a responsible and sustainable liquor industry in a way that will facilitate black economic empowerment, while at the same time reducing social and economic costs of alcohol abuse [4].
... Campbell et al. (2002) and Campbell (2003), for example, found that men and women who drink are significantly more likely to be HIV positive, but frequency of drinking was unrelated to HIV status. Morojele et al. (2004) also found that frequency of alcohol use was not associated with sexual risk behaviors, but quantity of alcohol consumed was related to having greater numbers of recent sex partners. People who drink more heavily and report being intoxicated in sexual situations also report less condom use and more concurrent sex partners, clearly demonstrating higher risk for HIV (Dunkle et al., 2004;Mataure et al., 2002;Mnyika, Klepp, Kvale, & Ole-King'ori, 1997;Zachariah et al., 2003). ...
Article
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Alcohol consumption is associated with risks for sexually transmitted infections (STI), including HIV/AIDS. In this paper, we systematically review the literature on alcohol use and sexual risk behavior in southern Africa, the region of the world with the greatest HIV/AIDS burden. Studies show a consistent association between alcohol use and sexual risks for HIV infection. Among people who drink, greater quantities of alcohol consumption predict greater sexual risks than does frequency of drinking. In addition, there are clear gender differences in alcohol use and sexual risks; men are more likely to drink and engage in higher risk behavior whereas women's risks are often associated with their male sex partners' drinking. Factors that are most closely related to alcohol and sexual risks include drinking venues and alcohol serving establishments, sexual coercion, and poverty. Research conducted in southern Africa therefore confirms an association between alcohol use and sexual risks for HIV. Sexual risk reduction interventions are needed for men and women who drink and interventions should be targeted to alcohol serving establishments.
Article
Background: Low sensitivity (LS) to alcohol's acute effects is a known risk factor for heavy drinking and its negative consequences. However, LS could be protective due to LS drinkers being less impaired at a given level of consumption. Here, we tested whether LS is associated with differences in men's and women's reports of alcohol-related regretted sex. Methods: Eight hundred and one young adults (393 women) aged 21 to 35 (M = 23.11 years) recruited for a study of alcohol's effects on cognition completed self-report measures of alcohol sensitivity, typical alcohol use, and alcohol consequences (including regretted sex). Results: Participants whose alcohol sensitivity scores classified them as LS were more likely to experience alcohol-related regretted sex than were high-sensitivity (HS) participants. However, when controlling for typical alcohol use and experience of alcohol consequences in general, alcohol sensitivity was negatively associated with risk of alcohol-related regretted sex, but only among women. Conclusions: At a given level of consumption, and controlling for experience of alcohol consequences other than regretted sex, reduced sensitivity to certain effects of alcohol may be a protective factor for women against risk for alcohol-related regretted sexual situations. This study provides insight on the unique risks of drinking among LS and HS women.
Article
Purpose: Considering the increased risk of HIV among alcohol users, we explored the role of individual alcohol expectancies in risk behaviors among youth in the Democratic Republic of the Congo. Methods: We surveyed 1,396 adolescents (ages 15-19) and young adults (ages 20-24) on alcohol and sexual behaviors in May, 2010. We assessed expectancies of alcohol use (1) leading to sex or positive sexual experiences; (2) diminishing one's ability to resist unwanted sex; and (3) diminishing one's ability to use or negotiate use of condoms. Adjusted logistic regression models assessed the association between alcohol use and alcohol expectancies with unprotected sex and multiple sex partners (MSP). Results: Participants reporting alcohol use (36.8%) were more likely to have engaged in unprotected sex and MSP than nondrinkers (adjusted odds ratio [AOR]: 2.87, 95% confidence interval [CI]: 2.29-3.60; AOR: 3.73 95% CI: 2.94-4.72, respectively). Among alcohol users, after adjusting for drinking quantity, moderate expectancies of alcohol leading to positive sexual experiences were significantly associated with MSP among adolescent boys (AOR: 4.20, 95% CI: 1.49-11.86) and girls (AOR: 3.97, 95% CI: 1.36-11.60), whereas high expectancies were significant among young adult men (AOR: 2.70, 95% CI: 1.19-6.10). Among adolescent girls who used alcohol, adjusted odds of unprotected sex were elevated among those with expectancies of diminished ability to refuse unwanted sex (AOR: 5.13, 95% CI: 1.41-16.64) or to negotiate condom use (AOR: 16.22; 2.08-126.8). Conclusions: HIV prevention efforts for youth should acknowledge the role of alcohol expectancies in sexual risk behaviors and tailor programs to address different roles of expectancies in males and females.
Article
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South Africa currently experiences high levels of alcohol and other drug (AOD) abuse. As a result there is a need for the initiation of regional AOD abuse prevention programmes with a specific focus on youth prevention strategies. The Medical Knowledge Institute (MKI) is a non-profit organisation which develops and facilitates health information workshops to members of disadvantaged peri-urban communities in South Africa. This research investigated the views of eight local MKI health trainers on factors contributing to AOD abuse in their communities. Although the expected focus of the discussion was on prevention strategies and effective interventions, the trainers placed more emphasis on the individual and community factors influencing AOD abuse. The themes which emerged through the research included: status, government, (di)stress, gender, recreation, consequences and community. This research holds significance as it has the potential to assist further development of community-based AOD prevention workshops and to guide public health policy and service development for AOD abuse.
Article
Alcohol abuse is linked to a range of negative impacts, and, as a result, government bodies almost always try to restrict access to alcohol, through regulating where and when it can be sold. Cape Town, in the Western Cape Province of South Africa, has a large number of unregulated alcohol outlets (known as shebeens), which have been the target of a number of policy-making and regulation attempts over the past decade. Three current main discourses of alcohol and shebeens in South Africa can be identified: the public health discourse, the economic discourse and the socio-cultural discourse. These competing discourses, particularly the first two, have underpinned processes to develop regulations relating to alcohol and shebeens, such as the Western Cape Provincial Government's new Liquor Act, and the City of Cape Town's new zoning scheme, resulting in incoherent policy-making processes and policies. A more integrated view is needed, which recognizes the social, cultural and economic importance of shebeens and alcohol, but also acknowledges that abuse of alcohol imposes a large burden on the State and society as a whole. More flexible regulations that can be negotiated at the local scale are also required.
Article
Full-text available
South Africa currently experiences high levels of alcohol and other drug (AOD) abuse. As a result there is a need for the initiation of regional AOD abuse prevention programmes with a specific focus on youth prevention strategies. The Medical Knowledge Institute (MKI) is a non-profit organisation which develops and facilitates health information workshops to members of disadvantaged peri-urban communities in South Africa. This research investigated the views of eight local MKI health trainers on factors contributing to AOD abuse in their communities. Although the expected focus of the discussion was on prevention strategies and effective interventions, the trainers placed more emphasis on the individual and community factors influencing AOD abuse. The themes which emerged through the research included: status, government, (di)stress, gender, recreation, consequences and community. This research holds significance as it has the potential to assist further development of community-based AOD prevention workshops and to guide public health policy and service development for AOD abuse.
Article
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The most efficient sexual behavior for HIV transmission is unprotected receptive anal intercourse. However, it is unclear what role heterosexual unprotected anal sex is playing in the world's worst HIV epidemics of southern Africa. The objective is to examine the prevalence of heterosexual unprotected anal intercourse among men and women who drink at informal alcohol serving establishments (shebeens) in South Africa. Cross-sectional surveys were collected from a convenience sample of 5037 patrons of 10 shebeens in a peri-urban township of Cape Town, South Africa. Analyses concentrated on establishing the rates of unprotected anal intercourse practiced by men and women as well as the factors associated with practicing anal intercourse. We found that 15% of men and 11% of women reported anal intercourse in the previous month, with 8% of men and 7% of women practicing any unprotected anal intercourse. Multiple logistic regression showed that younger age, having primary and casual sex partners, and meeting sex partners at shebeens were independently associated with engaging in anal intercourse. Mathematical modeling showed that individual risks are significantly impacted by anal intercourse but probably not to the degree needed to drive a generalized HIV epidemic. Anal intercourse likely plays a significant role in HIV infections among a small minority of South Africans who patronize alcohol serving establishments. Heterosexual anal intercourse, the most risky sexual behavior for HIV transmission, should not be ignored in HIV prevention for South African heterosexuals. However, this relatively infrequent behavior should not become the focus of prevention efforts.
Article
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We investigated alcohol-related sexual risk behavior from the perspective of social norms theory. Adults (N = 895, 62% men) residing in a South African township completed street-intercept surveys that assessed risk and protective behaviors (e.g., multiple partners, drinking before sex, meeting sex partners in shebeens, condom use) and corresponding norms. Men consistently overestimated the actual frequency of risky behaviors, as reported by the sample, and underestimated the frequency of condom use. Relative to actual attitudes, men believed that other men were more approving of risk behavior and less approving of condom use. Both behavioral and attitudinal norms predicted the respondents' self-reported risk behavior. These findings indicate that correcting inaccurate norms in HIV-risk reduction efforts is worthwhile.
Article
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.
Article
HIV/AIDS is devastating southern Africa and the spread of HIV is fueled in some populations by alcohol use. Alcohol serving establishments, such as informal drinking places or shebeens, often serve as high-risk venues for HIV transmission. The current study examined the HIV risks of men (N = 91) and women (N = 248) recruited from four shebeens in a racially integrating township in Cape Town South Africa. Participants completed confidential measures of demographic characteristics, HIV risk history, alcohol and drug use, and HIV risk behaviors. Comparisons of 94 (28%) participants who reported meeting sex partners at shebeens to the remaining sample of shebeen goers, controlling for potential confounds, demonstrated a pattern of higher risk for HIV infection among persons who met sex partners at shebeens. Few differences, however, were observed between men (N = 47) and women (N = 47) who had met sex partners at shebeens, suggesting greater gender similarities than gender differences in this important subpopulation. These results indicate an urgent need for multi-level HIV prevention interventions targeting shebeens and the men and women who drink in these settings.
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