Randomized Trial of a Community-based Alcohol-related HIV Risk-reduction Intervention for Men and Women in Cape Town South Africa
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
HIV is devastating southern Africa and alcohol use is closely related to HIV transmission risks.
The current study tested the efficacy of a brief single-session HIV–alcohol risk-reduction intervention for men and women who drink at informal alcohol serving establishments (i.e., shebeens) in South Africa.
A randomized community field trial recruited men (N = 117) and women (N = 236) through outreach and chain referrals. Participants received either: (a) 3-h theory-based behavioral HIV–alcohol risk-reduction intervention that focused on skills training for sexual negotiation and condom use or (b) 1-h HIV–alcohol information/education control group. Participants were followed up for 3 and 6 months post-intervention with 89% retention.
The risk-reduction intervention demonstrated significantly less unprotected intercourse, alcohol use before sex, numbers of sex partners, partners met at drinking establishments and greater condom use relative to the control group. However, intervention effects were moderated by alcohol use; lighter drinkers demonstrated significantly more intervention gains than heavier drinkers in the risk-reduction condition. Intervention effects occurred at 3 months follow-up and dissipated by 6 months.
A brief HIV risk-reduction intervention reduced sexual-risk behaviors among drinkers in South Africa. However, intervention effects were weakest for those who drink heaviest. Our results provide a basis for establishing HIV prevention in alcohol serving establishments in South Africa. Research is needed to identify multi-level intervention models that can reduce risks among heavier drinkers and sustain behavior changes over time.
- Shisana O, Rehle T, Simbayi L, et al. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2005. Cape Town: Human Sciences Research Council; 2005.
- Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol and HIV/AIDS risk behaviors in Southern Africa: Systematic review of empirical findings. Prev Science. 2007; 8: 141–151. CrossRef
- Weir SS, Morroni C, Coetzee N, Spencer J, Boerma JT. A pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town, South Africa. Sex Transm Infect. 2002; 78Suppl I: 106–113. CrossRef
- Lewis JJ, Garnett GP, Mhlanga S, Nyamukapa CA, Donnelly CA, Gregson S. Beer halls as a focus for HIV prevention activities in rural Zimbabwe. Sex Transm Dis. 2005; 32: 364–369. CrossRef
- Fritz KE, Woelk GB, Bassett MT, et al. The association between alcohol use, sexual risk behavior, and HIV infection among men attending beer halls in Harare, Zimbabwe. AIDS Behav. 2002; 6: 221–228. CrossRef
- Weir SS, Pailman C, Mahlalela X, Coetzee N, Meidany F, Boerma JT. From people to places: Focusing AIDS prevention efforts where it matters most. AIDS. 2003; 17: 895–903. CrossRef
- Kalichman SC, Simbayi LC, Vermaak R, Cain D, Jooste S, Peltzer K. HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town South Africa. JAIDS. 2007; 44: 594–600.
- Kincaid DL. From innovation to social norm: Bounded normative influence. J Health Commun. 2004; 9Suppl 1: 37–57. CrossRef
- Jemmott JB, Jemmott LS, Fong GT. Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention. Am J Public Health. 1992; 82: 372–377. CrossRef
- Kalichman SC, DiFonzo K, Kyomugsha F, Simpson D, Presser K, Bjordstrom B. When briefer can be better: Single session approaches to HIV risk reduction interventions. Interam J Psychol. 2001; 35: 41–58.
- Kalichman SC, Williams E, Nachimson D. Brief behavioral skills building intervention for female controlled methods of STD–HIV prevention: Outcomes of a randomized clinical field trial. Int J STD AIDS. 1999; 10: 174–181. CrossRef
- Kalichman SC, Cherry C. Polyurethane male condoms do not enhance brief HIV risk reduction interventions for inner-city African–American men: A randomized test of concept. Int J STD AIDS. 1999; 10: 548–553. CrossRef
- Crepaz N, Horn A, Sima R, et al. The efficacy of behavioral interventions in reducing HIV risk sex behaviors and incident sexually transmitted disease in Black and Hispanic sexually transmitted disease clinic patients in the United States: A meta-analytic review. Sex Transm Dis. 2007: 319–332.
- Bandura A. Self-efficacy: The Exercise of Control. Freeman: New York; 1997.
- Carey MP, Maisto SA, Kalichman SC, Forsyth A, Wright I, Johnson BT. Enhancing motivation to reduce risk for HIV infection for economically disadvantaged urban women. J Consult Clin Psychol. 1997; 65: 531–541. CrossRef
- Kalichman SC, Cherry C, Brown-Sperling F. Effectiveness of a video-based motivational skills-building HIV risk reduction intervention for inner-city African–American men. J Consult Clin Psychol. 1999; 67: 959–966. CrossRef
- Baunders JB, Aasland OG, Babor TF, DeLaFuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addictions. 1993; 88: 791–804. CrossRef
- Conigrave KM, Hall WD, Saunders JB. The AUDIT questionnaire: Choosing a cut-off score. Addictions. 1995; 90: 1349–1356. CrossRef
- Bekker D, Van Velden DP. Alcohol misuse in patients attending a defense force general medical clinic. South African Fam Pract. 2003; 45: 10–15.
- Schroder K, Carey MP, Vanable P. Methodological challenges in research on sexual risk behavior: I Item content, scaling, and data analytic options. Annals Behav Med. 2003; 26: 104–123. CrossRef
- Catania JA, Gibson D, Chitwood D, Coates TJ. Methodological problems in AIDS behavioral research: Influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990; 108: 339–362. CrossRef
- Weinhardt L, Carey MP. Does alcohol lead to sexual risk behavior? Ann Rev Sex Res. 2001; 12: 125–157.
- Brown S, Goldman MS, Inn A, Anderson L. Expectancies of reinforcement from alcohol: Their domain and relation to drinking patterns. J Consult Clin Psychol. 1980; 48: 419–426. CrossRef
- Goldman M, Darkes J. Alcohol expectancy multiaxial assessment: A memory network-based approach. Psychol Assess. 2004; 16: 4–15. CrossRef
- Goldman M, Del Boca F, Darkes J. Alcohol expectancy theory: The application of cognitive neuroscience. In: Leonard KE, Blane HT, eds. Psychological Theories of Drinking and Alcoholism. 2nd ed. New York: Guilford; 1999: 203–246.
- Carey MP, Morrison-Beedy D, Johnson B. The HIV-knowledge questionnaire: Development and evaluation of a reliable, valid, and practical self-administered questionnaire. AIDS Behav. 1997; 1: 61–74. CrossRef
- Kalichman SC, Simbayi L, Jooste S, et al. Development of a brief scale to measure AIDS-related stigmas in South Africa. AIDS Behav. 2005; 9: 141–152. CrossRef
- Winer BJ. Statistical Principles in Experimental Design. New York: McGraw Hill; 1971.
- Jurs SG, Glass G. The effect of experimental mortality on the internal and external validity of the randomized comparative experiment. J Exp Educ. 1971; 40: 62–66.
- Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1998.
- Allen S, Tice J, Van de Perre P, et al. Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. Br Med J. 1992; 304: 1605–1609. CrossRef
- Kelly JA, Murphy D, Sikkema K, et al. Outcomes of a randomized comparisonled community-level HIV prevention intervention: Effects on behavior among at-risk gay men in small U.S. cities. Lancet. 1992; 350: 1500–1505. CrossRef
- Sweat M, Denison J. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS. 1995; 9Suppl A: S251–S257.
- Randomized Trial of a Community-based Alcohol-related HIV Risk-reduction Intervention for Men and Women in Cape Town South Africa
Annals of Behavioral Medicine
Volume 36, Issue 3 , pp 270-279
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- South Africa
- Industry Sectors
- Author Affiliations
- 1. University of Connecticut, Storrs, CT, USA
- 3. Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
- 2. Human Sciences Research Council, Cape Town, South Africa