My dear readers, today I would like to address a topic that I hinted on last weekend.
I must say upfront that I am of sober habits and doing this topic also lays my personal footprint and bias to the fore but because of that I should think this article should make for beautiful reading to those of you who are my brothers for life (of similar sober habits) and those of you who are contemplating change. I also can assure the so called social drinkers that you will not feel offended at all by this article but it will challenge you personally to consider change. It will also go where many of the faint hearted dare not because it will challenge the shebeen kings and queens of our times, starting from the high and mighty to labolovucu who are nothing more than victims of the trade that they are involved in. Fasten your seat belts.
Alcohol has long been recognised as an important contributor to illness and injury, accounting for 4% of the global burden of disease. Yet alcohol remains conspicuously absent from the larger field of research and programming to combat the spread of HIV as a contributing factor in complicating the response.
Perhaps because of its ubiquity, alcohol use remains an easily overlooked backdrop of HIV epidemic worldwide. Research shows that a pattern of hazardous alcohol consumption prevails in countries with the most severe HIV epidemics. Of note is that our own Swaziland Brewery or Swaziland Beverages or whatever it is called has recently been awarded some regional recognition as the best in the business in terms of brewing certain brands like Black Label and others. This should set our minds thinking long and hard about the implications of this when we still are the worst affected country in the region in terms of HIV. A look next door reveals that South Africa ,where nearly one out of five sexually active adults is HIV positive, the yearly per-capita consumption of alcohol is among the highest in the world. Similar hazardous drinking patterns also dominate in concentrated epidemics elsewhere around the world. Alcohol abuse by injecting drug users and sex workers might be an additional barrier to effective efforts to prevent HIV infection. Many studies in southern and eastern Africa have shown that alcohol use is associated with the prevalent and incident HIV infection as well as with the behaviours that lead to infection, including unprotected sex, multiple partnering, and commercial sex. Drinking venues themselves are, not surprisingly, associated with risk of HIV infection. So it is not about where the drinking takes place but what happens afterwards. The pharmacological properties of alcohol help to explain a portion of the widely observed association between alcohol use and sexual risk behaviour. A network of psychological and social influences also seems to be at play. A substantial body of research implicating alcohol consumption in sexual risk behaviour provides a compelling call to action.
Lessons learned from the small amount of intervention research on alcohol-related HIV infection risk closely mirrors many of the key messages by Steffanie Strathdee and colleagues published in The Lancet. It is important to also consider the structural and
environmental influences that shape risk practices and vulnerability to HIV infection. Because alcohol is a legal commodity in most countries and is typically consumed in public social environments, alcohol-serving venues (both formal and informal) create dynamic opportunities for structural interventions to prevent HIV infection.
These venues can offer an ideal environment for HIV and AIDS interventions to use. Bar patrons themselves as agents of change to shift community norms and behaviour has worked wonders in the 1990s in US gay bars but unfortunately have not been replicable in other countries. More successful interventions have infused HIV infection prevention services into high risk drinking venues, with use of multilevel models that attempt to simultaneously change individual behaviour, shift social norms, and change HIV infection prevention policies. Before the MD of Swaziland Beverages gets hot under the collar, let me make it clear that I have no intention to discredit the achievements made by our one and only company but to challenge him to realise the massive potential the company holds in contributing effectively in turning the tide against HIV infection in Swaziland. I cannot overemphasise the need to partner with the ministry of health amongst other important stakeholders in ensuring that venues where alcohol is sold become venues which protect the very customer that pays his hard earned cash to purchase the drug. One example of a multilevel venue-based intervention was tested in the Philippines with sex workers in bars, discos, and night clubs.
Peer counselling, focused on condom use and sexual negotiation skills, formed the basis for change in individual and social norms. Changes to the bar environment were achieved by working with bar managers to implement HIV infection prevention practices. The combination of individual, social, and environmental intervention elements showed a significant effect on condom use and reductions in subsequent sexually transmitted infections. While interventions aimed at social and physical structures within drinking environments have not been utilised to good effect in terms of protecting the patrons, they have also not addressed broader social factors underlying alcohol abuse that is associated with HIV infection risks, such as disproportionate gender power imbalances. Hazardous alcohol use is often assumed mainly to affect men, but women are harmed in large numbers by alcohol abuse either their own or that of their partners. Women are at risk of alcohol related sexual risk behaviour in several ways. Women who sell and serve alcohol in bars, hotels, and other venues are at increased risk of drinking alcohol themselves, engaging in unprotected sex with their clients, and HIV infection. Women’s risk of gender-based and sexual violence is also increased by their partner’s alcohol consumption. Without addressing gender, efforts to reduce alcohol-related sexual-risk behaviour might only be partly successful. Programmes that combine alcohol reduction and gender-transformative approaches are needed to reduce sexual-risk behaviour and HIV infection incidence, particularly in resource constrained settings characterised by episodic binge drinking, gender in equalities, and high rates of HIV infection. More research, by gender and alcohol is needed to determine methods of integrating gender into programmes that are focused on reducing alcohol-related sexual-risk behaviour, and might offer valuable lessons for the wider field of HIV and substance abuse. Why should we not consider providing separate drinking holes for women only if drunken women are still taken advantage of, raped and abused by men? Just a thought! Why should there be no limit of the amount of alcohol one can consume per drinking session if we still see fellows who drink themselves to a stupor lying by the side of the road on Sunday morning? Just a thought!
How harmful to health is widespread heavy drinking in a population? I can only sum it up using one word…dramatic. Although dramatic in my own description the results are a far cry from the truth as they are not an indicator of the total harm to the society, since they exclude many social problems from drinking and harm to people other than the drinker.
Even in modern societies with well-developed health-care systems, pervasive heavy
drinking can result in a public health crisis. MaSwati lamahle, let us do something before the nation is plunged into doldrums. I rest my case!