Alcohol use has been closely linked with HIV risk behaviors in South Africa. The places where people drink are often the same settings in which they meet new sex partners and may contribute ...independently to sexual risk. This current study examines the independent effects of patronizing alcohol serving establishments (shebeens) and alcohol use in predicting HIV risk behaviors. Men (
n
= 981) and women (
n
= 492) were recruited from inside shebeens and surrounding areas proximal to shebeens in eight separate neighborhoods in a Township in Cape Town, South Africa. Anonymous community surveys measured demographic characteristics, alcohol use, shebeen attendance, and sexual risk behaviors. Comparisons of 1210 (82 %) participants who patronized shebeens in the past month with 263 (18 %) participants who did not patronize shebeens demonstrated higher rates of alcohol use frequency and quantity, more sexual partners, and higher rates of vaginal intercourse without condoms for the patrons. Multiple linear regression analysis found shebeen attendance in the past month predicted greater sexual risk for HIV beyond demographic characteristics and alcohol use. Social influences and environmental factors in shebeens could be contributing to sexual risk behavior independently of alcohol consumption. Further research is needed to understand the environmental factors of shebeens that promote and influence HIV risk behaviors.
Abstract Objective This study examined the association between alcohol use and sexual behaviors among South African adults who reported current drinking. Method Street-intercept surveys were ...administered to adults residing in neighborhoods in a South African township. Results Analyses were restricted to participants reporting current drinking ( N = 1285; mean age = 32; 27% women; 98% Black). Most participants (60%) reported heavy episodic drinking (i.e., 5 or more drinks on a single occasion) at least once per week in the past 30 days. Compared to non-heavy episodic drinkers, participants who reported heavy episodic drinking were more likely to drink before sex (79% vs. 66%) and have sex with a partner who had been drinking (59% vs. 44%). Overall, drinking before sex (self or partner) and heavy episodic drinking was associated with multiple sexual partners, discussing condom use with sexual partner(s), and proportion of protected sex. The frequency of condom use varied among participants with steady, casual, or both steady and casual sexual partners. Conclusions Alcohol use among South African adults is associated with sexual risk behaviors, but this association differs by partner type. Findings suggest the need to strengthen alcohol use components in sexual risk reduction interventions especially for participants with both steady and casual sex partners.
Concurrent sexual relationships facilitate the spread of HIV infection, and sex with non-primary partners may pose particularly high risks for HIV transmission to primary partners.
We examined the ...sexual and alcohol-related risks associated with sex partners outside of primary relationships among South African men and women in informal drinking establishments.
Men (n=4959) and women (n=2367) with primary sex partners residing in a Xhosa-speaking South African township completed anonymous surveys. Logistic regressions tested associations between having outside partners and risks for sexually transmitted infections (STI)/HIV.
Forty-four percent of men and 26% women with primary sex partners reported also having outside sex partners in the previous month. Condom use with outside partners was inconsistent for men and women; only 19% of men and 12% of women used condoms consistently with outside sex partners. Multivariable regressions for men and women showed that having outside partners was significantly associated with having been diagnosed with an STI, consuming alcohol in greater frequency and quantity, alcohol use during sex, meeting sex partners in alcohol-serving venues, and higher rates of unprotected sex.
Having outside sex partners was associated with multiple risk factors for HIV infection among South African shebeen patrons. Social and structural interventions that encourage condom use are needed for men and women with outside partners who patronise alcohol-serving venues.
South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of ...individuals about collective efficacy in the community’s ability to prevent HIV and their personal HIV risk behaviors. Men (n = 1,581) and women (n = 718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.
South Africa is known to have particularly high levels of intimate partner violence (IPV) against women. This study aims to examine the association between men's hostile sexist attitudes toward women ...and men's self-report perpetration of IPV. This study was a retrospective cross-sectional survey. A total of 829 men, aged 18 years or older, were recruited in informal drinking establishments, known as shebeens, in a Cape Town township and asked to complete an anonymous behavioral survey. Linear regression analysis was used to assess associations between hostile sexism and the variables of interest. Higher hostile sexism was associated with recent IPV (prior 30 days) and having a history of sexually transmitted infections (STI), while a lower hostile sexism was associated with communication with a male friend about violence against women, higher negative attitudes toward risky sexual behavior, and higher rates of condom use. Furthermore, being married was also associated with lower hostile sexism. Higher hostile sexism is associated with IPV, and therefore addressing sexist attitudes men hold about women can help strengthen interventions focused on IPV among men in South Africa. This study suggests that engaging men in the effort to change sexist attitudes is vital to curbing IPV.
South African townships have among the highest rates of HIV infection in the world. Considerable research on understanding the high rates of HIV transmission in this country has identified alcohol ...use as a critical factor in driving the HIV epidemic. Although the relationship between alcohol use and sexual risk-taking is well documented, less is known about how other factors, such as food insecurity, might be important in understanding alcohol’s role in sexual risk-taking. Furthermore, prior research has highlighted how patterns of alcohol use and sexual risk-taking tend to vary by gender. We examined how food insecurity is related to both alcohol use and sexual risk-taking. We administered anonymous community surveys to men (
n
= 1,137) and women (
n
= 458) residing within four contiguous Black African townships outside of Cape Town, South Africa. In multivariate linear regression, we found that food insecurity was related to having higher numbers of male sex partners and condom-protected sex acts among women only. These relationships, however, were fully mediated by women’s alcohol use. Among men, we found that food insecurity was negatively related to unprotected sex; that is, men with greater food security reported more unprotected sex acts. Unlike the results found among women, this relationship was not mediated by alcohol use. Food insecurity appears to be an important factor in understanding patterns of sexual risk-taking in regards to gender and alcohol use, and may serve as an important point of intervention for reducing HIV transmission rates.
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