Current HIV/AIDS Reports

, 8:172

Adding Fuel to the Fire: Alcohol’s Effect on the HIV Epidemic in Sub-Saharan Africa

  • Judith A. Hahn
  • Sarah E. Woolf-King
  • Winnie Muyindike
Article

Abstract

Alcohol consumption adds fuel to the HIV epidemic in sub-Saharan Africa (SSA). SSA has the highest prevalence of HIV infection and heavy episodic drinking in the world. Alcohol consumption is associated with behaviors such as unprotected sex and poor medication adherence, and biological factors such as increased susceptibility to infection, comorbid conditions, and infectiousness, which may synergistically increase HIV acquisition and onward transmission. Few interventions to decrease alcohol consumption and alcohol-related sexual risk behaviors have been developed or implemented in SSA, and few HIV or health policies or services in SSA address alcohol consumption. Structural interventions, such as regulating the availability, price, and advertising of alcohol, are challenging to implement due to the preponderance of homemade alcohol and beverage industry resistance. This article reviews the current knowledge on how alcohol impacts the HIV epidemic in SSA, summarizes current interventions and policies, and identifies areas for increased research and development.

Keywords

Alcohol consumption HIV Sub-Saharan Africa Unprotected sex HIV acquisition HIV transmission Alcohol biomarkers Antiretrovirals Antiretroviral adherence HIV disease progression Alcohol treatment Alcohol policy 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    UNAIDS 2010 Report on the global AIDS epidemic 2010.Google Scholar
  2. 2.
    • Global Status Report on Alcohol and Health. Geneva: World Health Organization. 2011. This report summarizes recent data on the consumption of alcohol, patterns of drinking, health consequences, and policy responses in the six WHO regions. Of particular relevance to this review, it highlights the high level of heavy episodic drinking among current drinkers in SSA. Google Scholar
  3. 3.
    Peltzer K, Davids A, Njuho P. Alcohol use and problem drinking in South Africa: findings from a national population-based survey. Afr J Psychiatry (Johannesbg). Mar 2011;14(1):30–7.Google Scholar
  4. 4.
    The Future of the Global Muslim Population. Projections for 2010–2030: The Pew Forum on Religion & Public Life. 2011.Google Scholar
  5. 5.
    Michalak L, Trocki K. Comments on surveying alcohol in Africa. Addiction. Jul 2009;104(7):1155–6.Google Scholar
  6. 6.
    Rehm J, Klotsche J, Patra J. Comparative quantification of alcohol exposure as risk factor for global burden of disease. Int J Methods Psychiatr Res. 2007;16(2):66–76.PubMedCrossRefGoogle Scholar
  7. 7.
    Martinez P, Roislien J, Naidoo N, Clausen T. Alcohol abstinence and drinking among African women: data from the World Health Surveys. BMC Public Health. 2011;11:160.PubMedCrossRefGoogle Scholar
  8. 8.
    Morris CN, Levine B, Goodridge G, Luo N, Ashley J. Three-country Assessment of Alcohol-HIV Related Policy and Programmematic Responses in Africa. Afr J Drug Alcohol Stud. 2006;5(2):170–84.Google Scholar
  9. 9.
    Hahn JA, Bwana MB, Javors MA, Martin JN, Emenyonu NI, Bangsberg DR. Biomarker Testing to Estimate Under-Reported Heavy Alcohol Consumption by Persons with HIV Initiating ART in Uganda. AIDS Behav. Dec 2010;14(6):1265–8.Google Scholar
  10. 10.
    Babor T, Higgins-Biddle J, Saunders J, Monteiro MG. The Alcohol Use Disorders Identification Test: Guidelines for use in primary care: World Health Organization, Department of Mental Health and Substance Dependence. 2001.Google Scholar
  11. 11.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.PubMedCrossRefGoogle Scholar
  12. 12.
    Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol Use and Sexual Risks for HIV/AIDS in Sub-Saharan Africa: Systematic Review of Empirical Findings. Prev Sci. Jan 31 2007.Google Scholar
  13. 13.
    •• Woolf-King SE, Maisto SA. Alcohol use and high-risk sexual behavior in Sub-Saharan Africa: a narrative review. Arch Sex Behav. 2011;40(1):17–42. This article is the most up-to-date review of empirical studies on the association of alcohol and high-risk sexual behavior in SSA.PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher JC, Bang H, Kapiga SH. The Association Between HIV Infection and Alcohol Use: A Systematic Review and Meta-Analysis of African Studies. Sex Transm Dis. Nov 2007;34(11):856–63.Google Scholar
  15. 15.
    Pithey A, Parry C. Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection. SAHARA J. Dec 2009;6(4):155–69.Google Scholar
  16. 16.
    Shuper PA, Joharchi N, Irving H, Rehm J. Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: review and meta-analysis. AIDS Behav. Dec 2009;13(6):1021–36.Google Scholar
  17. 17.
    Chersich MF, Rees HV, Scorgie F, Martin G. Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa. Global Health. 2009;5:16.PubMedCrossRefGoogle Scholar
  18. 18.
    Kiene SM, Simbayi LC, Abrams A, Cloete A, Tennen H, Fisher JD. High rates of unprotected sex occurring among HIV-positive individuals in a daily diary study in South Africa: the role of alcohol use. J Acquir Immune Defic Syndr. 2008;49(2):219–26.PubMedCrossRefGoogle Scholar
  19. 19.
    Myer L, Mathews C, Little F. Condom use and sexual behaviors among individuals procuring free male condoms in South Africa: a prospective study. Sex Transm Dis. Apr 2002;29(4):239–41.Google Scholar
  20. 20.
    Girardi E, Sabin CA, Monforte AD. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. Sep 2007;46 Suppl 1:S3–8.Google Scholar
  21. 21.
    Brinkhof MW, Boulle A, Weigel R, et al. Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. PLoS Med. 2009;6(4):e1000066.PubMedCrossRefGoogle Scholar
  22. 22.
    Mills EJ, Bakanda C, Birungi J, et al. Mortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda. AIDS. 2011;25(6):851–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Treating HIV-infected people with antiretrovirals significantly reduces transmission to partners. Findings result from NIH-funded international study: National Institutes of Health: National Institute of Allergy and Infectious Diseases. 2011.Google Scholar
  24. 24.
    Zarkin GA, Bray JW, Babor TF, Higgins-Biddle JC. Alcohol drinking patterns and health care utilization in a managed care organization. Health Serv Res. 2004;39(3):553–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Towards universal access: scaling up priority HIV/AIDS interventions in the health sector : Progress report 2009. Geneva: World Health Organization/UNAIDS/UNICEF. 2009.Google Scholar
  26. 26.
    Matovu JK, Makumbi FE. Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007. Trop Med Int Health. Nov 2007;12(11):1315–22.Google Scholar
  27. 27.
    Peltzer K, Mlambo G, Phaweni K. Factors determining prenatal HIV testing for prevention of mother to child transmission of HIV in Mpumalanga, South Africa. AIDS Behav. 2010;14(5):1115–23.PubMedCrossRefGoogle Scholar
  28. 28.
    Luseno WK, Wechsberg WM. Correlates of HIV testing among South African women with high sexual and substance-use risk behaviours. AIDS Care. 2009;21(2):178–84.PubMedCrossRefGoogle Scholar
  29. 29.
    Msuya SE, Mbizvo E, Uriyo J, Stray-Pedersen B, Sam NE, Hussain A. Predictors of failure to return for HIV test results among pregnant women in Moshi, Tanzania. J Acquir Immune Defic Syndr. 2006;43(1):85–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Abaynew Y, Deribew A, Deribe K. Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study. AIDS Res Ther. 2011;8(1):8.PubMedCrossRefGoogle Scholar
  31. 31.
    Kigozi IM, Dobkin LM, Martin JN, et al. Late-disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in Sub-Saharan Africa. J Acquir Immune Defic Syndr. 2009;52(2):280–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Mugavero MJ. Improving engagement in HIV care: what can we do? Top HIV Med. Dec 2008;16(5):156–61.Google Scholar
  33. 33.
    Giordano TP, Gifford AL, White Jr AC, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56.PubMedCrossRefGoogle Scholar
  35. 35.
    Krebs DW, Chi BH, Mulenga Y, et al. Community-based follow-up for late patients enrolled in a district-wide programme for antiretroviral therapy in Lusaka, Zambia. AIDS Care. 2008;20(3):311–7.PubMedCrossRefGoogle Scholar
  36. 36.
    McGuire M, Munyenyembe T, Szumilin E, et al. Vital status of pre-ART and ART patients defaulting from care in rural Malawi. Trop Med Int Health. 2010;15 Suppl 1:55–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Ochieng-Ooko V, Ochieng D, Sidle JE, et al. Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya. Bull World Health Organ. 2010;88(9):681–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180–202.PubMedCrossRefGoogle Scholar
  39. 39.
    Van Geertruyden JP, Woelk G, Mukumbi H, Ryder R, Colebunders R. Alcohol and antiretroviral adherence? What about Africa? J Acquir Immune Defic Syndr. 2010;54(4):e10.CrossRefGoogle Scholar
  40. 40.
    Beyene KA, Gedif T, Gebre-Mariam T, Engidawork E. Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia. Pharmacoepidemiol Drug Saf. 2009;18(11):1007–15.PubMedCrossRefGoogle Scholar
  41. 41.
    Bhat VG, Ramburuth M, Singh M, et al. Factors associated with poor adherence to anti-retroviral therapy in patients attending a rural health centre in South Africa. Eur J Clin Microbiol Infect Dis. 2010;29(8):947–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Dahab M, Charalambous S, Hamilton R, et al. “That is why I stopped the ART”: patients’ & providers’ perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme. BMC Public Health. 2008;8:63.PubMedCrossRefGoogle Scholar
  43. 43.
    Dahab M, Charalambous S, Karstaedt AS, et al. Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study. BMC Public Health. 2010;10:430.PubMedCrossRefGoogle Scholar
  44. 44.
    Do NT, Phiri K, Bussmann H, Gaolathe T, Marlink RG, Wester CW. Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana. AIDS Res Hum Retroviruses. 2010;26(6):685–91.PubMedCrossRefGoogle Scholar
  45. 45.
    Etienne M, Hossain M, Redfield R, Stafford K, Amoroso A. Indicators of adherence to antiretroviral therapy treatment among HIV/AIDS patients in 5 African countries. J Int Assoc Physicians AIDS Care (Chic). 2010;9(2):98–103.CrossRefGoogle Scholar
  46. 46.
    Fitzgerald M, Collumbien M, Hosegood V. “No one can ask me ‘Why do you take that stuff?’”: men’s experiences of antiretroviral treatment in South Africa. AIDS Care. 2010;22(3):355–60.PubMedCrossRefGoogle Scholar
  47. 47.
    Gmel G, Shield KD, Rehm J. Developing a method to derive alcohol-attributable fractions for HIV/AIDS mortality based on alcohol's impact on adherence to antiretroviral medication. Popul Health Metr. 2011;9(1):5.PubMedCrossRefGoogle Scholar
  48. 48.
    Jaquet A, Ekouevi DK, Bashi J, et al. Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West Africa. Addiction. Aug 2010;105(8):1416–21.Google Scholar
  49. 49.
    Kip E, Ehlers VJ, van der Wal DM. Patients’ adherence to anti-retroviral therapy in Botswana. J Nurs Scholarsh. 2009;41(2):149–57.PubMedCrossRefGoogle Scholar
  50. 50.
    Nachega JB, Knowlton AR, Deluca A, et al. Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults. A qualitative study. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S127–133.PubMedGoogle Scholar
  51. 51.
    Byakika-Tusiime J, Oyugi JH, Tumwikirize WA, Katabira ET, Mugyenyi PN, Bangsberg DR. Adherence to HIV antiretroviral therapy in HIV + Ugandan patients purchasing therapy. Int J STD AIDS. 2005;16(1):38–41.PubMedCrossRefGoogle Scholar
  52. 52.
    Farley J, Miller E, Zamani A, et al. Screening for hazardous alcohol use and depressive symptomatology among HIV-infected patients in Nigeria: prevalence, predictors, and association with adherence. J Int Assoc Physicians AIDS Care (Chic). 2010;9(4):218–26.CrossRefGoogle Scholar
  53. 53.
    El-Khatib Z, Ekstrom AM, Coovadia A, et al. Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg. South Africa—a prospective cohort study. BMC Public Health. 2011;11:88.PubMedCrossRefGoogle Scholar
  54. 54.
    Giday A, Shiferaw W. Factors affecting adherence of antiretroviral treatment among AIDS patients in an Ethiopian tertiary university teaching hospital. Ethiop Med J. 2010;48(3):187–94.PubMedGoogle Scholar
  55. 55.
    Hahn JA, Maier M, Byakika-Tusiime J, Oyugi JH, Bangsberg DR. Hepatotoxicity during nevirapine-based fixed-dose combination antiretroviral therapy in kampala, Uganda. J Int Assoc Physicians AIDS Care. 2007;6(2):83–6.CrossRefGoogle Scholar
  56. 56.
    Szabo G, Mandrekar P. A recent perspective on alcohol, immunity, and host defense. Alcohol Clin Exp Res. 2009;33(2):220–32.PubMedCrossRefGoogle Scholar
  57. 57.
    Naude CE, Bouic P, Senekal M, et al. Lymphocyte measures in treatment-naive 13-15-year old adolescents with alcohol use disorders. Alcohol. May 28 2011.Google Scholar
  58. 58.
    Lonnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C. Alcohol use as a risk factor for tuberculosis—a systematic review. BMC Public Health. 2008;8:289.PubMedCrossRefGoogle Scholar
  59. 59.
    Rehm J, Samokhvalov AV, Neuman MG, et al. The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health. 2009;9:450.PubMedCrossRefGoogle Scholar
  60. 60.
    Fergusson DM, Boden JM, Horwood LJ. Tests of causal links between alcohol abuse or dependence and major depression. Arch Gen Psychiatry. 2009;66(3):260–6.PubMedCrossRefGoogle Scholar
  61. 61.
    Lieber CS. Relationships between nutrition, alcohol use, and liver disease. Alcohol Res Health. 2003;27(3):220–31.PubMedGoogle Scholar
  62. 62.
    McGovern BH, Golan Y, Lopez M, et al. The impact of cirrhosis on CD4+ T cell counts in HIV-seronegative patients. Clin Infect Dis. 2007;44(3):431–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Pandrea I, Happel KI, Amedee AM, Bagby GJ, Nelson S. Alcohol’s role in HIV transmission and disease progression. Alcohol Res Health. 2010;33(3):203–18.Google Scholar
  64. 64.
    Modjarrad K, Vermund SH. Effect of treating co-infections on HIV-1 viral load: a systematic review. Lancet Infect Dis. 2010;10(7):455–63.PubMedCrossRefGoogle Scholar
  65. 65.
    Hahn JA, Samet JH. Alcohol and HIV disease progression: weighing the evidence. Curr HIV/AIDS Rep. 2010;7(4):226–33.PubMedCrossRefGoogle Scholar
  66. 66.
    Kaslow RA, Blackwelder WC, Ostrow DG, et al. No evidence for a role of alcohol or other psychoactive drugs in accelerating immunodeficiency in HIV-1-positive individuals. A report from the Multicenter AIDS Cohort Study. Jama. 1989;261(23):3424–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Penkower L, Dew MA, Kingsley L, et al. Alcohol consumption as a cofactor in the progression of HIV infection and AIDS. Alcohol. 1995;12(6):547–52.PubMedCrossRefGoogle Scholar
  68. 68.
    Eskild A, Petersen G. Cigarette smoking and drinking of alcohol are not associated with rapid progression to acquired immunodeficiency syndrome among homosexual men in Norway. Scand J Soc Med. 1994;22(3):209–12.PubMedGoogle Scholar
  69. 69.
    van Griensven GJ, de Vroome EM, de Wolf F, Goudsmit J, Roos M, Coutinho RA. Risk factors for progression of human immunodeficiency virus (HIV) infection among seroconverted and seropositive homosexual men. Am J Epidemiol. 1990;132(2):203–10.PubMedGoogle Scholar
  70. 70.
    Tang AM, Graham NM, Chandra RK, Saah AJ. Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J Nutr. 1997;127(2):345–51.PubMedGoogle Scholar
  71. 71.
    Veugelers PJ, Page KA, Tindall B, et al. Determinants of HIV disease progression among homosexual men registered in the Tricontinental Seroconverter Study. Am J Epidemiol. 1994;140(8):747–58.PubMedGoogle Scholar
  72. 72.
    Webber MP, Schoenbaum EE, Gourevitch MN, Buono D, Klein RS. A prospective study of HIV disease progression in female and male drug users. AIDS. 1999;13(2):257–62.PubMedCrossRefGoogle Scholar
  73. 73.
    Chandiwana SK, Sebit MB, Latif AS, et al. Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe. Cent Afr J Med. 1999;45(11):303–8.PubMedGoogle Scholar
  74. 74.
    Ghebremichael M, Paintsil E, Ickovics JR, et al. Longitudinal association of alcohol use with HIV disease progression and psychological health of women with HIV. AIDS Care. 2009;21(7):834–41.PubMedCrossRefGoogle Scholar
  75. 75.
    Cook JA, Burke-Miller JK, Cohen MH, et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008;22(11):1355–63.PubMedCrossRefGoogle Scholar
  76. 76.
    Chander G, Lau B, Moore RD. Hazardous alcohol use: a risk factor for non-adherence and lack of suppression in HIV infection. J Acquir Immune Defic Syndr. 2006;43(4):411–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Samet JH, Cheng DM, Libman H, Nunes DP, Alperen JK, Saitz R. Alcohol consumption and HIV disease progression. J Acquir Immune Defic Syndr. 2007;46(2):194–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retroviruses. 2010;26(5):511–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Peltzer K, Tabane C, Matseke G, Simbayi L. Lay counsellor-based risk reduction intervention with HIV positive diagnosed patients at public HIV counselling and testing sites in Mpumalanga, South Africa. Eval Program Plann. 2010;33(4):379–85.PubMedCrossRefGoogle Scholar
  80. 80.
    Kalichman SC, Simbayi LC, Vermaak R, et al. HIV/AIDS Risk Reduction Counseling for Alcohol Using Sexually Transmitted Infections Clinic Patients in Cape Town, South Africa. J Acquir Immune Defic Syndr. Feb 22 2007.Google Scholar
  81. 81.
    Wechsberg WM, Luseno WK, Karg RS, et al. Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: a small randomized trial in the Western Cape. Int J Drug Policy. 2008;19(2):130–9.PubMedCrossRefGoogle Scholar
  82. 82.
    Wechsberg WM, Luseno WK, Lam WK, Parry CD, Morojele NK. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria. AIDS Behav. 2006;10(2):131–7.PubMedCrossRefGoogle Scholar
  83. 83.
    Kalichman SC, Simbayi LC, 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. Oct 4 2008.Google Scholar
  84. 84.
    Fritz K, McFarland W, Wyrod R, et al. Evaluation of a Peer Network-Based Sexual Risk Reduction Intervention for Men in Beer Halls in Zimbabwe: Results from a Randomized Controlled Trial. AIDS Behav. Mar 5 2011.Google Scholar
  85. 85.
    Patel V, Araya R, Chatterjee S, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370(9591):991–1005.PubMedCrossRefGoogle Scholar
  86. 86.
    •• Papas RK, Sidle JE, Gakinya BN, et al. Treatment outcomes of a Stage 1 cognitive-behavioral trial to reduce alcohol use among HIV-infected outpatients in western Kenya. Addiction. Jun 1 2011. This randomized controlled trial assessed the feasibility of para-professional cognitive behavioral therapy among persons attending an HIV clinic in Eldoret, Kenya. There was a significant difference in the percent days abstinent and the number of drinks per day in the intervention compared to the control group 90 days after completion of the six-session intervention. Google Scholar
  87. 87.
    Gual A, Sabadini MB. Implementing alcohol disorders treatment throughout the community. Curr Opin Psychiatry. 2011;24(3):203–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Mackenzie C, Kiragu K, Odingo G, et al. The feasibility of integrating alcohol risk-reduction counseling into existing VCT services in Kenya. Afr J Drug Alcohol Stud. 2009;8(2):73–80.Google Scholar
  89. 89.
    Peltzer K, Matseke G, Azwihangwisi M. Evaluation of alcohol screening and brief intervention in routine practice of primary care nurses in Vhembe district, South Africa. Croat Med J. 2008;49(3):392–401.PubMedCrossRefGoogle Scholar
  90. 90.
    A cross-national trial of brief interventions with heavy drinkers. WHO Brief Intervention Study Group. Am J Public Health. 1996;86(7):948–55.CrossRefGoogle Scholar
  91. 91.
    Peltzer KK, Naidoo PP, Matseke GG, Zuma KK. Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary care clinics in South Africa: a cluster randomized controlled trial protocol. BMC Public Health. 2011;11(1):394.PubMedCrossRefGoogle Scholar
  92. 92.
    Global strategy to reduce the harmful use of alcohol. Geneva: World Health Organization. 2010.Google Scholar
  93. 93.
    • Babor TF, Caetano R, Casswell S, et al. Alcohol: No Ordinary Commodity: Research and public policy. Vol Second Edition. Oxford: Oxford University Press; 2010. This book provides comprehensive reviews of the evidence for and against several policies to reduce the harm associated with alcohol consumption.Google Scholar
  94. 94.
    Lachenmeier DW, Taylor BJ, Rehm J. Alcohol under the radar: Do we have policy options regarding unrecorded alcohol? Int J Drug Policy. 2011;22(2):153–60.PubMedCrossRefGoogle Scholar
  95. 95.
    Reduction Of The Harmful Use Of Alcohol: a Strategy For The Who African Region. Report of the Regional Director. Malabo, Equitorial Gunea: World Health Organization. Regional Office for Africa. 2010.Google Scholar
  96. 96.
    Morojele N, Parry C, Agossou T, et al. Report on first Pan African consultation on alcohol policy and its significance for the region. Afr J Drug Alcohol Stud. 2006;5(2):186–91.Google Scholar
  97. 97.
    Bakke O, Endal D. Vested interests in addiction research and policy alcohol policies out of context: drinks industry supplanting government role in alcohol policies in sub-Saharan Africa. Addiction. 2010;105(1):22–8.PubMedCrossRefGoogle Scholar
  98. 98.
    • Fritz K, Morojele N, Kalichman S. Alcohol: the forgotten drug in HIV/AIDS. Lancet. 2010;376(9739):398–400. This editorial highlights the need for focused research and programming to address the large impact of alcohol on the HIV epidemic. The authors discuss the utility of drinking venue–based interventions, and the need to address gender-based and sexual violence in the context of drinking and sexual risk.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Judith A. Hahn
    • 1
  • Sarah E. Woolf-King
    • 2
  • Winnie Muyindike
    • 3
  1. 1.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Center for AIDS Prevention StudiesUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Internal MedicineMbarara University of Sciences and TechnologyMbararaUganda

Personalised recommendations