Effective, long-term programmes for alcohol and sexual risk reduction are yet to be shown

HIV-alcohol risk reduction interventions in sub-Saharan Africa: a systematic review of the literature and recommendations for a way forward.

Carrasco MA, Esser MB, Sparks A, Kaufman MR. AIDS Behav. 2015 Oct 29. [Epub ahead of print]

Sub-Saharan Africa bears 69% of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and synthesize the findings of HIV-alcohol risk reduction interventions implemented in the region and reported in peer-reviewed journals. Of 644 citations screened, 19 met the inclusion criteria for this review. A discussion of methodological challenges, research gaps, and recommendations for future interventions is included. Relatively few interventions were found, and evidence is mixed about the efficacy of HIV-alcohol risk reduction interventions. There is a need to further integrate HIV-alcohol risk reduction components into HIV prevention programming and to document results from such integration. Additionally, research on larger scale, multi-level interventions is needed to identify effective HIV-alcohol risk reduction strategies.

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Editor’s notes: Alcohol and risk of HIV have been shown to be linked, yet little is known about which programmes are best at reducing this risk. This paper features a systematic review updating a previous review published by the authors in 2011. While this update found several more programmes aimed at reducing risky behaviour caused by alcohol use and in more countries than just the one previously, South Africa, the results of the review are largely the same. Most programmes had limited follow-up time of participants and found a dissipating effect over time. Additionally, older models of behaviour change were primarily used as the frameworks upon which these programmes were built. These models focus only on individual behaviour and not on the structural factors further affecting consumption of alcohol and risky sexual behaviour. On a positive note, some studies found moderate success based on location of the programme, clinic versus bar or tavern setting for instance. This review clearly demonstrates the need for further efforts to integrate alcohol risk reduction components into HIV prevention programmes, particularly for populations in which alcohol consumption is common.

Angola, Nigeria, South Africa, Uganda, Zambia, Zimbabwe
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