Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa

Globalization and Health (Impact Factor: 2.25). 11/2009; 5(1):16. DOI: 10.1186/1744-8603-5-16
Source: PubMed


Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked. Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use. More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care), must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.

Download full-text


Available from: Greg Martin
  • Source
    • "More interventional research on alcohol harm reduction among sex workers is required, examining, for example, the effects of ‘brief interventions’ on unsafe sex in sex work settings [26,49,55]. In addition, applying more complex multilevel interventions would simultaneously aim to shift individual behaviours and the social norms around drinking. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa. A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression. Participants had high levels of hazardous (17.3%, 69/399) and harmful drinking (9.5%, 38/399), while 36.1% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4.1-fold higher sexual violence (95%CI adjusted odds ratio [AOR] = 1.9-8.9) and 8.4 higher odds of physical violence (95%CI AOR = 3.9-18.0), while hazardous drinkers had 3.1-fold higher physical violence (95%CI AOR = 1.7-5.6). No association was detected between AUDIT category and pregnancy, or infection with Syphilis or Trichomonas vaginalis. The adjusted hazard ratio of HIV incidence was 9.6 comparing women with hazardous drinking to non-drinkers (95%CI = 1.1-87.9). Unsafe sex, partner violence and HIV incidence were higher in women with alcohol use disorders. This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence. Experimental evidence is required demonstrating that interventions to reduce alcohol use can avert unsafe sex.
    Full-text · Article · Apr 2014 · Globalization and Health
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this article is to review the recent literature examining the intersection between alcohol and other drug use and HIV risk behaviors for South African men and women, and the implications for the development of interventions and future research. The current literature indicates that substance use in sexual contexts (i.e. before or during sex) as well as outside of the sexual context is associated with HIV risk behaviors, such as having unprotected sex and multiple sex partners. Additionally, environments where substances are used, such as drinking establishments, may be associated with HIV risk behaviors. Moreover, sexual violence is also associated with substance use. Brief HIV prevention interventions to address substance use have demonstrated promising findings - such as consistent condom use, less impaired sex, and less unprotected vaginal and anal intercourse - when compared with other interventions. Recent research findings support the previous literature concerning the link between substance use and HIV risk behaviors in South Africa and suggest the need for interventions focused on sexual risk behaviors in the context of substance use and the environments in which they are used.
    No preview · Article · Mar 2010 · Current opinion in psychiatry
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to describe alcohol consumption in Mozambique, discriminating binge drinking behaviour and the weekday variation in drinking patterns, and to quantify the association between socio-demographic characteristics and alcohol intake. A representative sample of 3265 Mozambicans aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise approach to Chronic Disease Risk Factor Surveillance (STEPS). The consumption of any type of alcoholic beverage, during life and in the previous year, was recorded. Current drinkers were also asked about the number of standard drinks consumed in each day of the previous week. The overall prevalence of current drinking was 28.9% [95% confidence interval (95% CI): 22.6-35.2] in women and 57.7% (95% CI: 49.8-65.7) in men. Forty percent of the current drinkers reported to have had at least one binge drinking occasion in the previous week. The prevalence of current drinking increased with age and education among women and with income among men. No consistent pattern was observed in binge drinking by education in both genders and by annual income among men, but it was significantly less frequent among the more affluent women. Both drinking and binge drinking peaked at the weekend. Knowing the drinking patterns in Mozambique enables the planning of interventions according to the local needs. Future surveys should also include non-adult populations as risk factors for chronic diseases occurs as early as childhood and adolescence, and are associated with increased risk of disease later in life.
    No preview · Article · Nov 2010 · Drug and alcohol dependence
Show more