Along with the highest rate of HIV/AIDS in the world(2), South Africa’s (SA) per capita rate of alcohol consumption is among the highest in the world(3), It seems feasible that these two phenomena are related, but does alcohol consumption increase the risk of acquiring HIV? This paper aims to discuss the risk factors associated with HIV/AIDS and alcohol abuse.

A brief history of alcohol use in South Africa

Alcohol consumption has been part of South Africans’ way of living since the arrival of European settlers(4). Alcohol was exchanged for cattle and labour from indigenous populations. The growth of large wine and brewing industries was evident between the period of the 17th and 20th centuries and these industries are now important players in the global alcohol market(5). During the second half of the 20th century, SA saw a growth in illegal alcohol outlets among black communities, which were used as a form of resistance to apartheid systems(6). Currently the wine industry plays an important part in SA’s economy as it is the leader in exports from the agricultural sector, and is second only to minerals and motor cars. The industry supports about 275 600 employment opportunities in SA(7).

It has been estimated that in SA, the alcohol consumption per capita rate is between 10.3 and 12.4 litres(8). While this rate is substantially lower than in many other countries, the amount consumed per drinker is close to 20 litres per adult, which is among the highest in the world.(9) Currently, alcohol abuse has become a growing problem among adults in the country. Research shows that one in four male adults and one in 10 female adults show signs of alcohol problems.(10) Studies have also shown an increase in alcohol consumption among adolescents, where binge drinking was reported among one in four high school students(11).

Effects associated with alcohol consumption

Currently, alcohol plays a complex and controversial role in South African society and, as mentioned above, it also plays an important role in SA’s economy. However, despite the importance of alcohol to the economy, the use thereof has detrimental effects for the South African society. Alcohol abuse has been associated with social problems and adverse health risks and behaviours(12). These include, among others, alcohol addiction, foetal alcohol syndrome, risky sexual behaviours, violent acts, rape, murder, death, and disability(13). Despite the known negative effects of alcohol use due to competing economic and social priorities, the use thereof is difficult to regulate in SA(14).

Alcohol consumption and risk of HIV infection in South Africa

There is evidence to support a relationship between alcohol use and increased risk of infection of HIV and other sexually transmitted diseases (STDs). In 2005 for instance, 42 studies confirmed the association between alcohol consumption and sexually transmitted diseases were identified for a systematic review.(15) The association was identified among teenagers, adult men and women, married women, prostitutes, army conscripts and pregnant women.(16) Some studies also identified other factors that may contribute to the association, such as urban/rural settings,(17) use of other substances and engaging in risky drinking behaviours.(18)

Research suggests an existing relationship between alcohol abuse and an increased risk of STD’s as well as HIV/AIDS(19). A qualitative study done in Gauteng (20) as well as two quantitative studies conducted in the Western Cape(21) demonstrated that alcohol consumption is strongly linked with sexual abuse and risky sexual behaviour, including unprotected sex and having multiple sexual partners(22). The participants in the study conducted in Gauteng indicated that alcohol consumption increased people’s sexual arousal and courage while decreasing their inhibitions to disclose their sexual desires(23). Some of the male participants admitted that alcohol encouraged them to propose sex to women. Furthermore, participants mentioned that alcohol numbed their feelings in both a physical way (e.g. they would have unprotected sex in order for them to fulfil their sexual desire or ‘to feel more’), as well as in a mental way (e.g. eventual dangers and consequences of their risky sexual acts would be forgotten or ignored) (24).

Kalichman and colleagues have identified cognitive outcomes expected from alcohol consumption as critical aspects that affect risky sexual behaviour(25). These factors have demonstrated important effects on sexual risk behaviours in SA(26). The factors include: social facilitating expectancies, behavioural disinhibiting effect, sexual enhancement expectations and sexual context of drinking(27). Social facilitating expectancies refer to the expectation that alcohol consumption would ease conversation and increase friendliness. This expectation is closely related to the general behavioural disinhibiting effect – acting out and doing things one would not ordinarily do. Sexual enhancement expectations refer to expectations that alcohol will increase sexual desires and sexual pleasure. In practical terms, these are expectations that alcohol would increase sexual desire or libido and enhance experience of a sexual intercourse. The sexual context of drinking is established based on whether individuals drink before sex and whether their partners drink before sex(28). All these factors are interrelated. In another study by Kalichman and colleagues, it was concluded from the findings that alcohol outcome expectancies, particularly expectancies that alcohol will enhance sexual experiences, are related to HIV transmission risks(29).

Possible solutions to addressing alcohol-related problems

Intervention research conducted in the United States recommended counselling for people who abuse alcohol. This counselling should involve health education to reduce alcohol abuse and encourage safer sex and can be included in the programmes carried out by clinics dealing with HIV/AIDS(30). Kalichman and colleagues(31) state that alcohol abuse related to risky sexual behaviour which occurs in countries with a high prevalence of HIV/AIDS must be taken into consideration by all public health organisations. In the South African context however, further investigation is recommended before making substantial changes to existing programmes and interventions.

Concluding remarks

There is strong evidence suggesting an association between alcohol consumption and increased risk of HIV infection. This paper briefly discussed cognitive factors associated with alcohol consumption and implicated in risky sexual behaviour that may increase the risk of HIV infection. It is important to take these factors into account when carrying out interventions aimed at decreasing the rate of alcohol consumption and preventing HIV infection.

– Tshadinyana Phetoe, Consultancy Africa Intelligence’s HIV/AIDS Unit (hiv.aids@consultanyafrica.com).

This edition of the CAI HIV/AIDS Issues Newsletter is republished here with permission from Consultancy Africa Intelligence (CAI), a South African-based research and strategy firm with a focus on social, health, political and economic trends and developments in Africa. For more information, see www.consultancyafrica.com or www.ngopulse.org/press-release/consultancy-africa-intelligence. Alternatively, click here to take advantage of CAI’s free, no obligation, 1-month trial to the company’s Standard Report Series.

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Notes:

(2) UNAIDS, 2009. Global report: UNAIDS report on the global AIDS epidemic. Switzerland: UNAIDS.
(3) Parry, C.D.H., 2005. South Africa: Alcohol today. Addiction, 100, pp. 426–429.
(4) Ibid.
(5) ‘SA wine industry ‘driving jobs, GDP’’, SouthAfrica.info, 16 February 2010, http://www.southafrica.info.
(6) Ibid.
(7) Ibid.
(8) ‘Alcohol statistics in South Africa’, Addiction Action Campaign, 16 November 2011, http://www.theaac.co.za.
(9) Ibid.
(10) Parry, C.D.H., 2005. South Africa: Alcohol today. Addiction, 100, pp. 426–429.
(11) Reddy, S. P.  et al., 2003. Umthenthe Uhlaba Usamila—the South African Youth Risk Behaviour Survey 2002. Cape Town: Medical Research Council.
(12) ‘SA wine industry ‘driving jobs, GDP’’, SouthAfrica.info, 16 February 2010, http://www.southafrica.info.
(13) ‘Alcohol statistics in South Africa’, Addiction Action Campaign, 16 November 2011, http://www.theaac.co.za.
(14) Parry, C.D.H., 2005. South Africa: Alcohol today. Addiction, 100, pp.426–429.
(15) Cook, R.L. and Clark, D.B., 2005.Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sexually Transmitted Diseases, 32(3), pp.156–164.
(16) Ibid.
(17) Levine, S.B. and Coupey, S.M., 2003. Adolescent substance use, sexual behaviour, and Metropolitan Status: Is “Urban” a risk factor? Journal of Adolescent Health, 32, pp.350–355.
(18) Morojele, K. et al., 2006. Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. Social Science & Medicine, 62, pp.217–227.
(19) Cook, R.L. and Clark, D.B.  2005. Isthere an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sexually Transmitted Diseases, 32(3), pp.156–164.
(20) Morojele, N.K. et al., 2006. Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. Social Science & Medicine, 62, pp.217–227.
(21) Kalichman, S.C., Simbayi, L.C., Cain, D. and Jooste, D., 2007. Alcohol expectancies and risky drinking among men and women at high-risk for HIV infection in Cape Town South Africa. Addictive Behaviors, 32, pp.2304–2310.
(22) King, G. et al., 2004. Substance abuse and behavioural correlates of sexual assault among South African adolescents. Child Abuse & Neglect, 28, pp.683–696.
(23) Morojele, N.K. et al., 2006. Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. Social Science & Medicine, 62, pp.217–227.
(24) Ibid.
(25) Kalichman, S.C., Simbayi, L.C., Cain, D. and Jooste, D., 2007. Alcohol expectancies and risky drinking among men and women at high-risk for HIV infection in Cape Town South Africa. Addictive Behaviors, 32, pp.2304–2310.
(26) Ibid.
(27) Ibid.
(28) Ibid.
(29) Kalichman, S.C., Simbayi, L.C., Cain, D. and Jooste, D., 2007. Alcohol expectancies and risky drinking among men and women at high-risk for HIV infection in Cape Town South Africa. Addictive Behaviors, 32, pp.2304–2310.
(30) Ibid.
(31) Kalichman, S.C., Simbayi, L.C., Cain, D. and Jooste, D., 2007. Alcohol expectancies and risky drinking among men and women at high-risk for HIV infection in Cape Town South Africa. Addictive Behaviors, 32, pp.2304–2310.