Alcohol Use, Sexual Relationship Power, and Unprotected Sex Among Patrons in Bars and Taverns in Rural Areas of North West Province, South Africa

Nkosi, Sebenzile; Rich, Eileen; Morojele, Neo K.

doi:10.1007/s10461-014-0764-5

Cited by 19 publications

(19 citation statements)

References 33 publications

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“…Older men who had an income were much more likely to drink than younger unemployed men, and thus were probably able to purchase drinks for women and offer them transactional sex. The very strong association between transactional sex and alcohol use supports the assertion that alcohol is linked with sexual and other exchanges between men and women in this population [13, 48, 49]. In one study in Cape Town, South Africa, women with food insecurity had higher sexual risk behaviours than other women, with the associations between food and risky sex being fully mediated through women’s alcohol use [49].…”

Section: Discussionmentioning

confidence: 69%

“…Opportunities for drinking and for sexual encounters often co-exist in particular physical locations and the social dynamics that are generated in these locations [13, 53]. Patrons of drinking venues similar to those in the study site reported entering these places with an expectation of securing casual sex [3].…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol alters the brain’s gamma-aminobutyric acid receptors and changes the body’s serotonin levels, resulting in disinhibition – reducing anxiety about the consequences of one’s actions [12]. Assertions about alcohol and sexual behaviour causality are strengthened by studies demonstrating links between drinking contexts and the likelihood of sexual risk behaviours [13]. Meta-analyses have noted that certain drinking contexts, such as bars and other public spaces, portend unprotected sex [14].…”

Section: Introductionmentioning

confidence: 99%

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Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa

et al. 2017

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BackgroundAlcohol misuse is a key factor underlying the remarkable vulnerability to HIV infection among men and women in sub-Saharan Africa, especially within urban settings. Its effects, however, vary by type of drinking, population group and are modified by socio-cultural co-factors.MethodsWe interviewed a random sample of 1465 men living in single-sex hostels and 1008 women in adjacent informal settlements in inner-city, Johannesburg, South Africa. Being drunk in the past week was used as an indicator of heavy episodic drinking, and frequency of drinking and number of alcohol units/week used as measures of volume. Associations between dimensions of alcohol use (current drinking, volume of alcohol consumed and heavy episodic drinking patterns) and sexual behaviours were assessed using multivariate logistic regression.ResultsMost participants were internal migrants from KwaZulu Natal province. About half of men were current drinkers, as were 13% of women. Of current male drinkers, 18% drank daily and 23% were drunk in the past week (women: 14% and 29% respectively). Among men, associations between heavy episodic drinking and sexual behaviour were especially pronounced. Compared with non-drinkers, episodic ones were 2.6 fold more likely to have transactional sex (95%CI = 1.7–4.1) and 2.2 fold more likely to have a concurrent partner (95%CI = 1.5–3.2). Alcohol use in men, regardless of measure, was strongly associated with having used physical force to have sex. Overall effects of alcohol on sexual behaviour were larger in women than men, and associations were detected between all alcohol measures in women, and concurrency, transactional sex and having been forced to have sex.ConclusionsAlcohol use and sexual behaviours are strongly linked among male and female migrant populations in inner-city Johannesburg. More rigorous interventions at both local and macro level are needed to alleviate alcohol harms and mitigate the alcohol-HIV nexus, especially among already vulnerable groups. These should target the specific dimensions of alcohol use that are harmful, assist women who drink to do so more safely and address the linkages between alcohol and sexual violence.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa

et al. 2017

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“…Studies suggest that condom use is lower in relationships in which women have less relationship power [550, 551]. Women who report lower ability to refuse sex or insist on condom use are also more likely to report being in concurrent partnerships [207, 208], which suggests an association between relationship power and concurrency.…”

Section: Discussionmentioning

confidence: 99%

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

Johnson

Kubjane

Moolla

2018

Preprint

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Executive summary Background and objectives South Africa has one of the highest HIV incidence rates in the world. Although much research has focused on developing biomedical strategies to reduce HIV incidence, there has been less investment in prevention strategies that address the social drivers of HIV spread. Understanding the social determinants of HIV is closely related to understanding high-risk populations (‘key populations’), since many of the factors that place these key populations at high HIV risk are social and behavioural rather than biological. Mathematical models have an important role to play in evaluating the potential impact of new HIV prevention and treatment strategies. However, most of the mathematical modelling studies that have been published to date have evaluated biomedical HIV prevention strategies, and relatively few models have been developed to understand the role of social determinants or interventions that address these social drivers. In addition, many of the mathematical models that have been developed are relatively simple deterministic models, which are not well suited to simulating the complex causal pathways that link many of the social drivers to HIV incidence. The frequency-dependent assumption implicit in most deterministic models also leads to under-estimation of the contribution of high-risk groups to the incidence of HIV. Agent-based models (ABMs) overcome many of the limitations of deterministic models, although at the expense of greater computational burden. This study presents an ABM of HIV in South Africa, developed to characterize the key social drivers of HIV in South Africa and the groups that are at the highest risk of HIV. The objective of this report is to provide a technical description of the model and to explain how the model has been calibrated to South African data sources; future publications will assess the drivers of HIV transmission in South Africa in more detail. Methods The model is an extension of a previously-published ABM of HIV and other sexually transmitted infections (STIs) in South Africa. This model simulates a representative sample of the South African population, starting from 1985, with an initial sample size of 20 000. The population changes in size as a result of births and deaths. Each individual is assigned a date of birth, sex and race (demographic characteristics). This in turn affects the assignment of socio-economic variables. Each individual is assigned a level of educational attainment, which is dynamically updated as youth progress through school and tertiary education, with rates of progression and drop-out depending on the individual’s demographic characteristics. Each individual is also assigned to an urban or rural location, with rates of movement between urban and rural areas depending on demographic characteristics and educational attainment. The model assigns to each individual a number of healthcare access variables that determine their HIV and pregnancy risk. These include their ‘condom preference’ (a measure of the e...

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“…South Africa has some of the highest levels of inequality in the world (Bond 2013); experiences some of the highest levels of violence in the world (Estes 2014); entertains endemic levels of inter-related alcohol abuse (Choi et al 2013) and bears the consequences thereof, such as rape or genderbased violence, (Wood et al 2007, Jewkes et al 2010). In addition, the country is currently battling with one of the highest burdens of HIV/AIDS in the world (SANAC 2012) and the alcohol-sex exchange is known to problematically contribute to this burden (Nkosi et al 2014). This is the empirical reality that many young people are negotiating on a daily basis.…”

Section: Introductionmentioning

confidence: 99%

Re-imagining decision making: addressing a discrete social driver of HIV/AIDS through the lens of complexity science

Burman

Moerschell

Mamabolo

et al. 2015

African Journal of AIDS Research

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This article argues that decision making is a discrete social driver that can be associated with the HIV/AIDS epidemic in the Limpopo province in South Africa. The authors argue that complexity science can inform future research and interventions by presenting two decision making frameworks arising out of complexity science that have the potential to enable young people to better negotiate decision-making contexts whilst simultaneously opening spaces of dialogue that can mitigate the impact of HIV-risk in specific, punctuated contexts. The methodological design was prompted by findings from youth-oriented community engagement projects that include Communication Conversations and Sex & Relationships Education. The proposed methods have the potential to exploit the phenomenon of leadership emergence as a product of decision making at critical moments. This has the potential to promote the growth of home-grown leadership skill sets that make sense to young people and to enable them better manage their own health, thus reducing risk and vulnerability to HIV infection and sexual violence.

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Alcohol Use, Sexual Relationship Power, and Unprotected Sex Among Patrons in Bars and Taverns in Rural Areas of North West Province, South Africa

Cited by 19 publications

References 33 publications

Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa

Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

Re-imagining decision making: addressing a discrete social driver of HIV/AIDS through the lens of complexity science

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