Skip to main content
SpringerLink
Log in

Randomized Trial of a Community-based Alcohol-related HIV Risk-reduction Intervention for Men and Women in Cape Town South Africa

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

HIV is devastating southern Africa and alcohol use is closely related to HIV transmission risks.

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    PubMed  Google Scholar 

  8. Kincaid DL. From innovation to social norm: Bounded normative influence. J Health Commun. 2004; 9Suppl 1: 37–57.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

  14. Bandura A. Self-efficacy: The Exercise of Control. Freeman: New York; 1997.

    Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. Conigrave KM, Hall WD, Saunders JB. The AUDIT questionnaire: Choosing a cut-off score. Addictions. 1995; 90: 1349–1356.

    Article  Google Scholar 

  19. Bekker D, Van Velden DP. Alcohol misuse in patients attending a defense force general medical clinic. South African Fam Pract. 2003; 45: 10–15.

    Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Weinhardt L, Carey MP. Does alcohol lead to sexual risk behavior? Ann Rev Sex Res. 2001; 12: 125–157.

    Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Goldman M, Darkes J. Alcohol expectancy multiaxial assessment: A memory network-based approach. Psychol Assess. 2004; 16: 4–15.

    Article  PubMed  Google Scholar 

  25. 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.

    Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. Winer BJ. Statistical Principles in Experimental Design. New York: McGraw Hill; 1971.

    Google Scholar 

  29. 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.

    Google Scholar 

  30. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1998.

    Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. Sweat M, Denison J. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS. 1995; 9Suppl A: S251–S257.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Connecticut, Storrs, CT, USA

    Seth C. Kalichman Ph.D. & Demetria Cain M.P.H.

  2. Human Sciences Research Council, Cape Town, South Africa

    Leickness C. Simbayi D.Phil., Redwaan Vermaak M.A., Gino Smith B.A., Jacqueline Mthebu M.A. & Sean Jooste M.A.

  3. Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA

    Seth C. Kalichman Ph.D.

Authors
  1. Seth C. Kalichman Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leickness C. Simbayi D.Phil.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Redwaan Vermaak M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Demetria Cain M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gino Smith B.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacqueline Mthebu M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sean Jooste M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seth C. Kalichman Ph.D..

Additional information

National Institute of Alcohol Abuse and Alcoholism Grants R21-AA014820 and R01AA017399 supported this research.

About this article

Cite this article

Kalichman, S.C., Simbayi, L.C., Vermaak, R. et al. Randomized Trial of a Community-based Alcohol-related HIV Risk-reduction Intervention for Men and Women in Cape Town South Africa. ann. behav. med. 36, 270–279 (2008). https://doi.org/10.1007/s12160-008-9067-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-008-9067-2

Keywords

Search

Navigation