Alcohol and Risky Sex: Breaking the Link

"Research conducted around the world, much of it in the high HIV-prevalence countries of sub-Saharan Africa, shows quite consistently that alcohol consumption is associated with risky sexual behavior..."

From the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1), this editorial explores the link between alcohol and HIV and advocates for a multilevel response. The opening section shares statistics connecting hazardous alcohol consumption with unprotected sex, more sex partners, and HIV - though, as indicated here, more research is needed to understand the causal links.

Various approaches to this perceived connection are outlined. For example:

• At the individual level: "Those who engage in hazardous drinking, such as binge drinking, need to be made aware of the risks to their health. They need opportunities to explore how alcohol may trigger their risky sexual behavior and what they can do to avert those risks by moderating their drinking....Individual and group counseling services also need to be widely available for individuals who are actually addicted to alcohol..."
• With regard to social norms: "An effective alcohol-HIV response requires programs that seek to shift social norms about drinking. These may take the form of mass media campaigns, peer education, community outreach, or edutainment at drinking venues....In most societies, alcohol and masculinity norms are...tightly linked, where the ability to drink heavily has come to represent physical strength, endurance, and sexual prowess. All of these deeply engrained norms are enthusiastically used by alcohol producers to advertise their products....But norms can also be challenged - by employers in conversation with their staff, by bartenders in conversation with their patrons, by community opinion leaders in conversation with their peers, and by parents in conversation with their children....School curricula can also be used to help children explore deeply rooted norms about drinking, imagine alternatives, and practice the skills they will need to resist societal pressure to conform....Mass media and community outreach programs, such as Soul City South Africa's Phuza Wize program, use a television soap opera and other media to relay information about hazardous drinking and explore community responses to alcohol use and violence..."
• "Finally, national and international alcohol legislation and policy represent a vitally important yet little developed avenue for reducing alcohol-related harm..."

In conclusion, the author advocates for a multilevel response to alcohol comsumption, arguing that "attending to structural drivers of ill health, such as alcohol, makes integration across health and other social programs impossible not to do, and the creative collaborations that result can serve to sharpen and strengthen everyone's toolkit."