Engaging the community is core to an AIDSTAR-One pilot project – in which the International Center for Research on Women (ICRW) is a partner -- that strives to curb people’s heavy use of alcohol in order to reduce their chances of becoming infected with HIV. And so far, the community of Kabila, Namibia, has been on board.
Kabila is a relatively new, informal settlement on the outskirts of Namibia’s capital city, Windhoek, and a former township where black Namibians were forced to live during apartheid. Kabila is one of Windhoek’s fastest-growing urban neighborhoods, largely due to migration from northern Namibia. And it’s a place where brewing or selling alcohol is one of the few steady sources of income for resettled families. Needless to say, there are plenty of opportunities to drink: A newly-released ICRW research report found 265 bars in a 2½-mile area, most of which operate out of people’s homes.
In partnership with Society for Family Health (SFH) in Namibia and AIDSTAR-One, ICRW in 2011 helped to launch a pilot program in Kabila that aims to fire up the community – particularly bar owners – to change Kabila’s alcohol-rich environment in order to help reduce individuals’ HIV risk. ICRW designed the program and is leading its evaluation.
The work is part of the AIDSTAR-One initiative, which is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through USAID’s Office of HIV/AIDS. AIDSTAR-One provides rapid technical assistance to USAID and US government country teams to build effective, well-managed and sustainable HIV and AIDS programs as well as promote new leadership in the global campaign against HIV.
The effort in Namibia is one of a few taking place globally that seeks to develop community-level solutions to hazardous alcohol use.
“Research is increasingly making it clear that we won’t win this battle by intervening on individuals’ behavior alone,” said Katherine Fritz, who leads the project and directs ICRW’s global health research. “In fact, community dynamics may be the most powerful determinants of alcohol-related risk in any case.”
In Kabila, those dynamics include social norms that encourage heavy or binge drinking. Such behavior is fueled by the easy availability of cheap alcohol and prevalence of aggressive ad campaigns by alcohol manufacturers. Taken together, such an environment further drives the behavior and norms, including those that promote the idea that a man is more masculine if he drinks a lot or indulges in a certain brand of beer, Fritz said.
“Gender is very important in all of this because concepts of masculinity are tied up with alcohol consumption in most cultures,” she said, adding that women and children often suffer when men, who tend to control family resources, spend money on alcohol rather than investing in their families. Men who drink heavily are also more likely to engage in risky sex and to perpetrate violence against their intimate partners.
To investigate how to change the environment in Kabila, ICRW and its partners are focusing on helping residents to think critically about how the pervasive availability of alcohol as well as its unregulated sale contribute to many social and health problems, including HIV.
For instance, as part of the project, a community action forum is coordinating events around Kabila to raise awareness and provide education to residents about the correlation between heavy drinking and poor health. The forum also is reaching out to bar owners to help them learn how to sell alcohol responsibly.
Meanwhile, 35 bar owners are enrolled in an intensive training program to learn the international standards for serving alcohol safely and the requirements of the Namibian liquor law. These bar owners continue to receive mentoring and support from SFH and the community action forum members. Finally, the project also works closely with Namibia’s Coalition on Responsible Drinking —a governmental and civil society initiative to advocate for improved policies and programs on alcohol, including revisions to and enforcement of the laws governing how and where alcohol can be sold and advertised.
Once results from the pilot project are available later this year, Fritz said that ICRW would like to conduct a larger study to explore how programs like the one in Kabila can impact a range and health and social issues, such as helping to reduce violence against women.
Ultimately, one of the goals is for the Namibia project to become a model for organizations working on HIV prevention. Fritz said she would like to see all community-based HIV prevention programs address the role of hazardous alcohol use in communities where HIV is prevalent.
“We’d also like to encourage economic development programs to support alternatives to alcohol production and selling at the community level,” she added. “National governments also need to take a look at how multi-national brewing corporations are being encouraged to do business – and at what cost to society.”
Gillian Gaynair is ICRW’s senior writer and editor.