HIV This Week

Kalichman SC, Simbayi LC, Vermaak R, Cain D, Jooste S, Peltzer K, Habilis D. HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town, South Africa. J Acquir Immune Defic Syndr 2007 Feb 22; [Epub ahead of print]

HIV is ravaging southern Africa, and HIV transmission risk behaviours are facilitated by alcohol use in sexual contexts. There are no known interventions that directly target HIV risk behaviour among people who drink and are at risk for HIV in Africa. Kalichman and colleagues test a behavioural risk reduction counselling intervention for use in sexually transmitted infection (STI) clinics in southern Africa. A randomized intervention trial was conducted with 143 STI clinic patients in Cape Town, South Africa. Participants received an experimental 60-minute HIV and alcohol risk reduction behavioural skills intervention or a control 20-minute HIV education condition. Participants were followed for 3 and 6 months after the intervention, with 73% retention. Overall, the experimental intervention demonstrated more than a 25% increase in condom use and a 65% reduction in unprotected intercourse over the 6-month follow-up period, with risk reduction significantly greater for the experimental condition than for the control condition at both follow-ups. Alcohol use in sexual contexts [F(1,94) = 6.2; P < 0.05] and expectancies that alcohol enhances sexual experiences [F(1,94) = 8.3; P < 0.01] were also significantly lower for the experimental condition at the 3-month follow-up. The authors conclude that an HIV prevention counselling intervention reduced HIV transmission risks for up to 6 months in this STI clinic population. Effects may be sustained with structural interventions to reduce alcohol use in sexual contexts and support risk reduction behaviour changes over the long-term.

Editors’ note : Alcohol can have a major mediating effect on sexual behaviour – ‘disinhibition’ is the correct term to use for one of alcohol’s effects. Alcohol may explain some of the discordance observed in alcohol drinking populations between knowledge and behaviour. A combination of risk reduction skills development and structural interventions to address the environmental context holds promise, just as it has done so with making excessive drinking and driving unacceptable.