1 / 15

Alcohol, Partner violence and HIV

Alcohol, Partner violence and HIV. Lori Heise , Senior Lecturer L ondon School of Hygiene and Tropical Medicine Chief Executive, STRIVE: Tackling the Structural Drivers of HIV. T rouble Brewing. HIV and Alcohol Consumption in Southern Africa.

ganit
Télécharger la présentation

Alcohol, Partner violence and HIV

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Alcohol, Partner violence and HIV Lori Heise, Senior Lecturer London School of Hygiene and Tropical Medicine Chief Executive, STRIVE: Tackling the Structural Drivers of HIV

  2. Trouble Brewing

  3. HIV and Alcohol Consumption in Southern Africa • Systematic review in SSA (n=86 studies) found alcohol consumption consistently associated with unprotected sex, multiple partners, coercive sex and transactional sex • Meta-analysis (Fisher, Bang & Kapiga, 2007) • Drinkers have 1.57 times risk of HIV compared to abstainers, • “Problem drinkers” have 2.04times the risk (CI: 1.61,1.85) • Two event level studies in SSA demonstrate significant association between alcohol consumption before sex and unprotected sex acts (Kiene et al JAIDS, 2008; Myer STDs, 2002)

  4. HIV Acquisition Alcohol consumption Risk taking personality Alcohol myopia Cognitive impairment Immune function Drinking norms Partner violence Drinking venue Partner selection Partner turnover Unprotected sex Biologic susceptibility Sexual frequency Access to info & services HIV infection

  5. Alcohol use and anal sex among US HIV+ individuals attending primary care clinics Hutton et al AIDS &Behaviour, 2012

  6. Potential impacts of alcohol on HIV+ individuals HIV positive Alcohol Alcohol HIV testing Sexual Behavior Linkage to Care Disease progression HIV Adherence Onward transmission

  7. Alcohol and HIV adherence • A meta-analysis found that ART non-adherence was almost twice as high in drinkers as in non-drinkers (Hendershot et al. JAIDS, 2009) • Self report studies likely underestimate the association • In Uganda, a highly specific biomarker for heavy alcohol consumption indicated that 15% of HIV+ people on ART reported no alcohol consumption, despite heavy drinking • Despite evidence of the role of drinking in ART adherence, alcohol is not mentioned in most ART guidelines

  8. Trouble Brewing

  9. Evidence of Impact: Partner violence 3 prospective studies link IPV with Incident HIV or STI *Strongest data comes from South Africa: Jewkes et al, The Lancet, 2010; Cross sectional data more mixed; methodological limitations Consistent association found between more severe IPV and HIV risk

  10. Gender inequality & social norms condoning some use of violence Poverty & economic stresses • Social constructions • of masculinity • Problematic • alcohol use Reduced access to info & HIV services Low or inconsistent condom use Increased probability partner has HIV and/or STI Increased likelihood that woman is HIV infected Potential pathways between IPV & women’s risk of HIV RISK FACTORS FOR PERPETRATION OF INTIMATE PARTNER VIOLENCE • Early experiences or witnessing of violence Partner physically and/or sexually violent Physical Sexual Partner has concurrent sexual partners Woman has concurrent sexual partners DETERMINANTS OF HIV RISK FROM PARTNER Genital trauma

  11. Trouble Brewing

  12. Role of alcohol and IPV STRONG • Evidence of causal link Role of alcohol long contested especially by women’s groups Alcohol is neither necessary nor sufficient to cause abuse, but where present it increases frequency and severity Drinking, especially binge drinking meets all scientific criteria of being a “contributing cause” of IPV Women & men widely associate IPV with drinking making it a natural point of entry for discussing marital relations, violence and coerced sex

  13. Ecological Model of Partner Violence The Woman IPV Woman Macrosocial Community Male Partner Relationship Conflict Arena

  14. Insights from evaluation research: Promising • Early identification and brief counselling by health workers • Shown in meta-analysis of 22 trials to significantly reduce men’s drinking at one year post intervention • Reduce alcohol availability • US and Australian studies found clear link between outlet density and domestic violence • Meta-analysis of 122 studies confirms that increasing alcohol taxes decreases harmful drinking even among dependent drinkers and youth • Community based interventions • RISHTA programme in Mumbai • PhuzaWize campaign implemented by Soul City in South Africa • Alcohol treatment has been shown to reduce domestic violence

  15. Visit us at: STRIVE.lshtm.ac.uk

More Related