A new openness to addressing alcohol as a health risk was evident at a June 2014 meeting involving ministries of health from nine African countries. STRIVE team members presenting at the WHO/UNDP gathering noted both an encouraging shift in official attitudes and a challenge to researchers and their funders to investigate more thoroughly the associations between alcohol, HIV risk and gender-based violence.
Several of us have been going to these convenings over the last ten to fifteen years, where we have the opportunity to interact with policymakers around the associations between alcohol use and sexual risk behaviour. And that was always an uphill battle: we needed to persuade people to pay attention to it. What was interesting about this [June 2014] meeting was that everyone was totally on board with the idea that alcohol was a risk factor for all kinds of social and health harms. And it seemed very intuitive to them that violence needed to be considered when they were thinking about alcohol. From that perspective it was encouraging to see the amount of progress that’s been made.
Dr Katherine Fritz, International Center for Research on Women (ICRW)
The WHO and UNDP held the meeting in Windhoek, Namibia, from 10 to 12 June 2014. (A similar gathering was held in Moldova with representatives of Eastern European governments.) In Windhoek, NGOs and researchers presented to representatives from Botswana, the Democratic Republic of Congo (DRC), Guinea-Bissau, Liberia, Malawi, Namibia, Sierra Leone, Zambia and Zimbabwe. The goal of the meeting was to integrate and link national policies and programmes addressing harmful use of alcohol, HIV prevention, treatment and care, and gender-based violence. To this end,participants:
- reviewed the evidence to date
- presented situational analyses by country
- drafted national roadmaps
- examined WHO tools for policy-level discussion and action
The WHO meeting summary notes these facts from background papers and presentations:
- Africa has an average alcohol consumption per capita 15 years and above of 6,0 litres. This is equal to the global average.
- The proportion of non-drinkers is high in Africa, around 70%.
- Those who do drink in Africa have a high consumption level and a risky drinking-pattern.
- 3.3 million deaths worldwide are attributable to alcohol consumption. This is equal to 5.9% of deaths in all age groups globally, 7.6% for men and 4.0% for women.
- Two-thirds of all people living with HIV are in sub-Saharan Africa, which also has the highest prevalence of heavy episodic (binge) drinking in the world.
- The potential interactions between alcohol-related risky behaviours – such as unprotected sex, low or interrupted medication adherence, lower utilisation of health care services – and biological factors such as increased susceptibility to infection (particularly among young women) make alcohol consumption a facilitator for HIV transmission.
- A recent WHO/ LSHTM report confirmed that, across the world, one out of three women will experience violence in her lifetime.
- The WHO report also noted that women experiencing intimate partner violence are almost twice as likely as other women to have alcohol-use problems; are 1.5 times as likely to acquire HIV; and are almost twice as likely as other women to have alcohol-use problems.
A new openness to addressing alcohol
Discourse about alcohol at policy level involves any government in weighing risks and benefits to their economy. Up to this point, without much data on the social and health costs of alcohol to their economies, African governments have only rarely come down on the side of public health vs tax income from alcohol sales (Botswana has been an exception). Meanwhile, alcohol advertising has done a good job of saturating the world with images of drinking as convivial sociability and a marker of status. The Windhoek meeting signals the emergence of a counter-narrative from the public health perspective.
Much of the credit for this shift goes to the World Health Organisation (WHO). In the absence of a legally binding convention on alcohol – similar to that on tobacco – the WHO frames alcohol as a legal drug with health consequences. From this framing, NGOs are able to take positive action as well as alert the public to some of the alcohol industry’s efforts to lobby governments for favourable policies. The Norwegian development NGO Forut, for example, reports on contestation over the process of writing Malawi’s alcohol policy.
The challenge to researchers
A significant body of research has established the association between HIV risk behaviour and alcohol use but partner violence as the third element in this grouping requires more work.
The evidence base is not extremely strong on this association because there hasn’t been a lot of research done but what is there is intriguing and sufficient to give policy-makers reason to pay attention.
Together with the WHO, the UNDP’s gender, HIV and health cluster is developing an initiative on alcohol, partner violence and HIV risk, with the Windhoek meeting as an important early step. More and deeper research is needed to understand exactly how these associations operate, in order to inform better public-health policies and interventions.
A number of consortium partners are engaged in studies of HIV and alcohol. Resources to support this work include:
- a systematic review and meta-analysis of the prevalence of alcohol use among young people in East Africa
- A STRIVE technical brief on measuring alcohol-related HIV risk
- a Learning Lab on developing a structural intervention to delay underage alcohol use and reduce HIV risk among vulnerable youth in Kampala
- a Learning Lab on alcohol, young people and HIV risk in Tanzania
- a Learning Lab on reducing alcohol-related HIV risk
You can find other references by searching STRIVE resources. Filter by driver “alcohol”.