Abstract
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 s 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.
Highlights
Towards the end of 2007 it was estimated that worldwide approximately 33.2 million people were living with HIV, approximately 2.1 million people died of AIDS-related illnesses, and some 2.5 million people contracted HIV during 2007 alone
Exclusion criteria included: (i) studies where there was no definition of alcohol use or drinking behaviour; (ii) studies where HIV status or HIV prevalence or incidence rates were not reported; (iii) studies not conducted in Africa; (iv) studies that did not consider alcohol use as a risk factor for HIV infection; (v) studies that did not include a relative measure of the association between alcohol use and HIV infection; and (vi) studies that did not involve the conducting of original, empirical research
With increasingly more evidence that alcohol consumption plays a pivotal role in HIV infection and disease progression in sub-Saharan Africa, an improved understanding of alcohol use as a behavioural risk factor related to HIV in different subpopulations is critical, in order to reduce the further spread of the epidemic
Summary
Towards the end of 2007 it was estimated that worldwide approximately 33.2 million people were living with HIV, approximately 2.1 million people died of AIDS-related illnesses, and some 2.5 million people contracted HIV during 2007 alone. In sub-Saharan Africa, the world’s most adversely affected region, it was estimated that approximately 22.5 million people were living with HIV, and in the past year, approximately 1.6 million AIDS-related deaths occurred, while approximately 1.7 million people were newly infected with HIV. Concurrent with the HIV/AIDS pandemic, many countries within sub-Saharan Africa exhibit very high levels of alcohol consumption, one of the most prevalent behavioural risk factors implicated in the transmission of HIV and other STDs (Cook & Clark, 2005; Kalichman, Simbayi, Kaufman, Cain & Jooste, 2007a). When one takes into consideration that a relatively low percentage of adults in these countries consume alcohol (55% of men and 30% of women), the annual consumption per drinker increases to 16.6 litres of absolute alcohol, the highest level for any region of the world (Rehm et al, 2003a). High-risk drinking patterns, especially binge drinking may play an intermediate role between alcohol use and sexual risk behaviour (Chersich et al, 2007)
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