Abstract
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.
Highlights
HIV and other sexually-transmitted infections (STI) account for 6.3% of the burden of disease and alcohol for 4%, similar to that caused by tobacco (4.1%) and high blood pressure (4.4%) [1]
Much of sub-Saharan Africa carries a massive burden of HIV and of alcohol disease, and these pandemics are inextricably linked
For communities and individuals in sub-Saharan Africa, interventions are needed to change the way alcohol is used, so that hazardous drinking patterns are shifted to safer patterns
Summary
HIV and other sexually-transmitted infections (STI) account for 6.3% of the burden of disease and alcohol for 4%, similar to that caused by tobacco (4.1%) and high blood pressure (4.4%) [1]. Reducing alcohol harms necessitates both population and individual-level interventions, which will have marked health and social benefits beyond a reduction in the burden of HIV, sexual violence and unintended pregnancy Policies such as increased taxation and limitations on the availability of alcohol, which are highly effective in lowering alcohol harm, are often strongly contested by the alcohol industry [29]. The term "Brief Intervention" refers to time-limited, patient-centred counselling that focuses on changing patient behaviour and has been shown to empower people to control their alcohol use and its effects on sexual behaviour [36] Such services are an important component of primary health care, and can be configured to include specific discussion of links between alcohol and unsafe sex and consequences thereof. A large trial assessing this is warranted, given the major policy implications of such a finding
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