Definition of the Prevention Area
Alcohol use in virtually all cultures reduces both the perception of risk and inhibitions to engage in risky behaviors. The association between alcohol use and high-risk behaviors, including inconsistent condom use with casual partners, greater number of lifetime and recent sexual partners, concurrency of sexual partners, intergenerational sex, the buying and selling of sex, and the experience of violent or coercive sex, is in turn associated with an increased risk of HIV infection.
Epidemiological Justification for the Prevention Area
Sub-Saharan Africa is home to two-thirds of all people living with HIV. South Africa has one of the highest volumes per capita of alcohol consumption in the world. There is evidence that alcohol consumption has been increasing over time in sub-Saharan Africa, where alcohol is the most commonly abused drug. Existing scientific evidence linking alcohol use with HIV sexual risk behavior already provides a compelling call to action, but more research is needed in developing countries to understand the sociocultural, psychological, and economic context of alcohol use, as well as the ways in which alcohol affects sexual behavior. In countries battling severe HIV epidemics, interventions that address problem drinking in conjunction with community-based efforts to reduce HIV risk behavior have the potential to reduce the spread of HIV.
Core Programmatic Components
Programs to change behaviors related to alcohol use and HIV risk may include population-based or venue-based interventions. School-based programs are an example of a population-based intervention. Venue-based projects target establishments, both legal and informal, where alcohol is served. Program developers and managers are challenged to go beyond mere knowledge-based programs, since knowledge about HIV risk behaviors is already high in some areas. To address the difficult situations that can arise when one or both partners have been drinking prior to sex, such as refusing sex with a partner who declines to wear a condom, many programs are providing supports and scripts that individuals can use to anticipate and handle high-risk situations, along with encouragement and support to avoid sex while intoxicated.
Current Status of Implementation Experience
Effective programs to address the intersection of risky sexual behavior and alcohol consumption are still in their infancy. Programs that specifically address alcohol and HIV in developing countries are extremely rare. However, a small number of alcohol and HIV prevention interventions have recently been developed and implemented in sub-Saharan Africa and India. Below, we highlight these programs, all of which have been shown to be acceptable and feasible to implement in diverse community settings. Some of these programs show promise in bringing about behavior change, such as reducing recent and heavy alcohol consumption, improving both attitudes toward and the use of condoms, and reducing the frequency of consuming alcohol prior to sex. The interventions fall into the following three categories:
- Prevention of Alcohol-related HIV Risk Behavior among Youth
- Prevention of Alcohol-related HIV Risk among Women
- Venue-based Prevention of Alcohol-related HIV Risk