A three-year program in Namibia that aimed to reduce people’s risky sexual behavior by curbing their alcohol use showed promising results that may be applicable in other settings in sub-Saharan Africa, a new report by AIDSTAR-One finds.
The report was part of an AIDSTAR-One initiative, in collaboration with the Gen Pop and Youth Technical Working Group of USAID’s Office of HIV/AIDS. AIDSTAR-One provides rapid technical assistance to USAID and U.S. government country teams and is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). On behalf of AIDSTAR-One, the International Center for Research (ICRW) led the effort in partnership with the Society for Family Health (SFH) in Namibia.
Namibia is experiencing a severe, generalized HIV epidemic and has very high rates of alcohol consumption. The program was based Kabila, an informal settlement on the outskirts of Namibia’s capital city, Windhoek., The Kabila neighborhood, which encompasses about 2 sq miles, has a significant concentration of informal, home-based bars – 256 in total – that provide one of the few steady sources of income for community members. Drinking helps residents cope with stress associated with poverty, and going to a bar is among the few forms of entertainment for them.
ICRW and SFH worked with bar owners, patrons and community leaders to design, implement and evaluate a program to encourage the community to address hazardous alcohol use and make bars less risky environments for HIV transmission.
Among the findings from the evaluation:
- Binge drinking decreased from 54 percent to 25 percent
- Bar patrons who had the most exposure to program activities consumed less alcohol during bar visits
- Heavy drinkers were more likely to be exposed to the program’s activities and were significantly more likely to discuss condoms with a partner, buy condoms and refuse to have sex without a condom
- Bar owners found it feasible to change their bar’s environment by having shorter hours and displaying educational materials about alcohol. Sixty-four percent of patrons noticed the former, and 33 percent noted the shift in hours.
The effort in Namibia was one of a few taking place globally that seeks to develop community-level solutions to hazardous alcohol use. Most existing evidence around alcohol and HIV prevention programming is from sub-Saharan Africa, and focuses on individual drinking and risky behavior – not whole communities or the dynamics of bars that enable heavy drinking.
“The findings from this project in Namibia provide a significant contribution to the small, but growing body of evidence on how to tackle alcohol consumption as a contributor to HIV risk,” said Katherine Fritz, director of ICRW’s global health research and programs and a leading expert on the link between alcohol use and HIV. “The experience demonstrated that with community support, bar owners are willing to alter their establishment’s environment and intervene when they witness alcohol-induced risky behaviors.”
Fritz said the experience from the Kabila study can be built upon there and in other similar settings. To do so, the report offers several recommendations, including targeting binge drinking, which has been shown to contribute significantly to harmful behaviors; and encouraging bar staff to talk to patrons about safe sex practices, among other recommendations.
ICRW continues to gather evidence and identify innovative solutions to tackle social forces – like heavy alcohol consumption – that increase people’s vulnerability to HIV infection. ICRW is a member of STRIVE, a global research consortium that is investigating the social norms and inequities that drive HIV. Among efforts in this partnership, ICRW is addressing the correlation between alcohol, drug abuse and HIV among youth participating in an expanded version of Parivartan, a sports-based program in India.
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