STRIVE Tackling the structural drivers of HIV

What's the issue?

Harmful alcohol use causes an enormous burden of death and disease globally. The threat is most severe among younger age groups (20-39 years old) among whom 25% of annual deaths can be linked to harmful alcohol use. Alcohol misuse is increasingly seen to contribute to the spread and progression of infectious diseases, including HIV and tuberculosis.

Excessive alcohol use by male partners is strongly connected with women’s experience of partner violence, a key factor in HIV vulnerability. Binge drinking is associated with risky behaviors including: unprotected sex, multiple partners, commercial sex, violence against women and girls.

Alcohol use among adolescents is a growing problem. Multiple exposures to advertising together with easy availability of alcohol have been shown to promote early and unhealthy drinking behaviour. 

What have we found?

1. Hazardous alcohol use contributes to the acquisition of HIV and speeds the progression of disease
   Numerous studies have shown that alcohol use increases sexual risk behaviours, such as unprotected sex, and speeds the progression of disease among those living with HIV. Alcohol reduces adherence to medication in general and to ARVs specifically. Alcohol users also have lower rates of HIV testing. Alcohol use causes greater delay in engaging with medical care after testing positive and delays and lowers retention in HIV treatment. 

2. Unfettered alcohol availability, low prices, and heavy advertising in low- and middle-income countries plays a powerful role in increasing risky behavior
   Strategies exist to successfully reduce the harms caused by hazardous alcohol use, including HIV, but these have focused on individual-level interventions while neglecting the powerful role of unfettered alcohol availability, low prices and heavy advertising and promotion in low- and middle-income countries. STRIVE research shows that young people are negatively affected by growing up in environments where heavy drinking is normalised, alcohol advertisements represent aspirational images of accomplishment, alcohol is cheap and under-age restrictions are weakly enforced.

3. Long-term and sustainable reductions in hazardous alcohol use require structural interventions free of influence from the alcohol industry and with buy-in from multiple sectors 
   These structural interventions have potential to yield returns across a range of SDG targets and goals and are thus a ‘best buy’ for achieving long-term population-level improvements in health and economic wellbeing.

What impact have we had?

In Tanzania, STRIVE researchers collaborated with NGOs and advocacy groups to raise awareness against the lobbying efforts of the liquor industry to maintain the practice of packaging spirits in cheap plastic sachets known as viroba. As a result, the Tanzanian government legally banned sachets on 1 March 2017.

In South Africa, evidence generated by STRIVE helped to clarify the ways young people are influenced by aggressive alcohol marketing, youth friendly packaging and pricing and unfettered expansion of licensed and unlicensed alcohol outlets. Research findings were synthesised into a policy brief and shared at a media briefing that resulted in numerous print and television stories.

Key resources

• Technical brief: Alcohol and HIV risk
• Evidence brief: Alcohol availability, marketing and sexual health risks to youth in South Africa
• Evidence brief: Youth, alcohol use and HIV in Tanzania
• Impact case study: Alcohol Policy in Tanzania
• Impact case study: Youth voices in alcohol policy processes in South Africa
• Measurement brief: Measuring alcohol-related HIV risk
• Policy brief: Alcohol marketing, youth and sexual health risks