Alcohol and unsafe sex

Alcohol and unsafe sex

Causal links between binge drinking patterns, unsafe sex and HIV in South Africa: its time to intervene.

South Africa has a massive burden of HIV and alcohol disease, and these pandemics are inextricably linked. Much evidence indicates that alcohol independently influences decisions around sex, and undermines skills for condom negotiation and correct use. Thus, not surprisingly, people with problem drinking in Africa have twofold higher risk for HIV than non-drinkers. Also, sexual violence incidents often coincide with heavy alcohol use, both among perpetrators and victims. Reducing alcohol harms necessitates both population- and individual-level interventions, especially raised taxation, regulation of alcohol advertising and provision of Brief Interventions. Alcohol counselling interventions must include discussion of linkages between alcohol and sex, and consequences thereof. Within positive-prevention services, alcohol reduction interventions could diminish HIV transmission. A trial is needed to definitively demonstrate that reduced drinking lowers HIV incidence. However, given available evidence, implementation of effective interventions could alleviate much alcohol-attributable disease, including unsafe sex, sexual violence, unintended pregnancy and, likely, HIV transmission.

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Editor’s note: With the annual costs of direct alcohol harm in South Africa estimated at 1% of the gross domestic product, alcohol accounting for 7.9% of disease burden (almost double alcohol’s global burden of disease of 4%), and the causal pathway between alcohol use and HIV acquisition broadly accepted, HIV prevention programming clearly should include campaigns against alcohol-related harm. The 8 effective strategies described here are: raising awareness and political commitment, community action to reduce harmful use, health-sector response, drink-driving policies and countermeasures, reducing the availability of alcohol, addressing alcoholic beverage marketing, modifying pricing policies, and regulating the drinking context. These are all structural interventions, with the exception of the health sector response. It focuses on provider-initiated screening, like provider-initiated HIV testing and counselling, to identify people in need of prevention interventions to reduce consumption or treatment for alcohol dependence. These strategies can help the estimated 1 in 5 people living with HIV who are alcohol dependent as well as HIV-negative individuals for whom alcohol consumption can lead to regretted sexual relations, inconsistent condom use, condom accidents, and increased incidence of sexually transmitted infections. When addressing HIV and/or alcohol harm, both individual and structural interventions are critical – and there are strong arguments for including alcohol-reduction programmes in combination prevention in many contexts worldwide.