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Miriam Hospital Researchers Analyze Alcohol Use Disorders, Sexual Behavior Among South African Men – May Partially Explain High HIV Rates In South Africa


Unique study finds alcohol use disorders high among South African men who drink in alcohol-serving venues; integrated alcohol, HIV interventions needed

Lori Scott-Sheldon, PhD
Lori A. Scott-Sheldon, PhD

In a study of South African men who drink alcohol in informal drinking environments or “shebeens,” researchers from The Miriam Hospital have found a high prevalence of Alcohol Use Disorder (AUD) that directly correlates to unprotected sex. Findings support the need for interventions targeting both alcohol and HIV-risk behaviors among South African men who drink alcohol in alcohol-serving venues. The study and its findings are published in the July issue of Drug and Alcohol Dependence.

Lori A. Scott-Sheldon, PhD, lead author and researcher at The Centers for Behavioral and Preventive Medicine at The Miriam Hospital, and her colleagues examined the extent to which alcohol consumption among patrons of shebeens meets criteria for AUD, a treatable, manageable chronic condition. Shebeens in South Africa are settings in which alcohol use and sexual behavior often co-occur, and the prevalence of AUDs among men frequenting public drinking venues may in part explain South Africa’s high rates of HIV.

“The HIV/AIDS epidemic remains a major public health concern in South Africa, home to the largest number of people living with HIV in the world,” said Scott-Sheldon. “Not only do South Africans bear the heaviest HIV burden, they also have the highest levels of alcohol consumption per adult drinker worldwide.”

Rates of hazardous or harmful drinking (defined as a pattern of drinking that increases the risk of adverse health events or consequences) are also high with one-third of South African adult drinkers reporting hazardous or harmful alcohol use. Prior research in sub-Saharan Africa shows that alcohol use is associated with increased sexual risk behaviors that put people at risk for HIV. Consequently, alcohol consumption, as a contributing factor of HIV infection as well as other health consequences, is a major public health concern in South Africa.

Scott-Sheldon led a study of 763 men with an average age of 30 years old. They were recruited from townships in Cape Town, South Africa, and completed a self-administered survey that assessed alcohol use, sexual risk behaviors, and alcohol use situations and settings.

“Nearly two-thirds of men met criteria for AUD,” Scott-Sheldon concluded. “Alcohol Use Disorder was associated with HIV risk such that men with AUD reported more unprotected sex than men without AUD.

“Of the men who met criteria for an alcohol use disorder,” Scott-Sheldon added, “nearly one-third were classified as having a severe disorder. Men with an alcohol use disorder also reported engaging in unprotected sex more than men without a disorder.”

Scott-Sheldon’s primary affiliation is The Miriam Hospital. She is also an associate professor in the Department of Psychiatry and Human Behavior at The Warren Alpert Medical School of Brown University and the Department of Behavioral and Social Sciences in The Brown University School of Public Health. Other researchers in the study include Michael P. Carey, PhD, of The Miriam Hospital, Alpert Medical School and The Brown University School of Public Health; Kate B. Carey, PhD, professor of Behavioral and Social Sciences at Brown University; Demetria Cain, project manager at the Center for Health, Intervention, and Prevention at the University of Connecticut; Leickness C. Simbayi, executive director of the HIV/AIDS STIs and TB programme at the Human Sciences Research Council in Cape Town South Africa, and Seth C. Kalichman, PhD, professor of psychology in the Department of Psychology at the University of Connecticut.