Alcohol Consumption, Sexual Partners, and HIV Transmission in Namibia

This 104-page report, produced for review by the United States Agency for International Development (USAID) presents the results of a qualitative research study undertaken to examine the impact of alcohol consumption on sexual partnerships and the implications for HIV transmission. The report presents its findings on aspects including multiple concurrent partnerships, condom use, underage drinking, and transactional sex before concluding with possible interventions focused largely on behaviour change and condom promotion. According to the research findings, almost all informants, regardless of gender or site, said positive things about the use of condoms, with most reporting regular condom use. Nearly everyone in a boyfriend/girlfriend relationship uses condoms regularly or all the time, but many people often do not consistently use condoms after drinking.

Using a variety of methods, including observation, and informal and structured interviews, researchers looked at sexual history, and sexual risk taking and alcohol consumption among people in bars and households in four research sites in central and northern Namibia. Research found that due to migration to economic centres in the country, it was common to have a long-distance, steady partner, while also having one or more concurrent partners nearby. Research also showed a relationship between unprotected casual sex and alcohol consumption. In additin, underage drinking was common and particularly risky for school girls as young as 14 years of age who often willingly or unwillingly engaged in transactional sex with older men in exchange for alcohol.

Based on the research's findings, the report concludes that concurrency and alcohol consumption are likely drivers of Namibia's HIV epidemic and are prevalent enough to warrant serious investment in intervention programmes. They suggest that these interventions focus on reducing concurrent sexual partnerships, alcohol consumption, transactional sex and underage drinking while increasing condom availability and use.

While the report includes recommendations specific to each of the aforementioned areas, broad suggestions include the following:

• Take existing awareness campaigns, such as the Coalition on Responsible Drinking’s (CORD) "Alcohol aids HIV" campaign and the "Take Control" campaign, into shebeens and drinking spots, to encourage responsible drinking.
• There is a need to educate young people about the risks of exchanging alcohol for sex in bars to reduce HIV vulnerability. This should include encouraging girls who drink at bars to bring their own money or to drink with friends who have money, and educating girls to realise that if they accept drinks from men, that these men will expect sex in exchange
• Campaigns promoting healthy, committed relationships should focus on reducing levels of concurrency and limiting partner turnover.
• Given that many informants said they go to bars to socialise and for amenities not available at home (such as television), bar owners should be encouraged to carry reduced price non-alcoholic drinks and low-alcohol-content drinks (such as light beer). Social marketing would need to encourage consumption of these low price/low alcohol products as one way for people to moderate their alcohol consumption.
• Social marketing programmes are widespread and major condom distributors in Namibia. These programmes should increase condom distribution in bars and suggest ways bar tenders/owners can increase patrons’ access to condoms. Programmes may also want to sponsor competitions in bars to support owners who encourage free condom use among patrons, thus incentivising owners who may have previously preferred to sell condoms for profit at their bars.
• Based on the number of informants who mentioned obtaining their HIV information from in-school programmes, such as the "My Future, My Choice" programme, school-based initiatives could be used to educate youth about the link between excessive alcohol consumption and HIV risk. Additionally, once young people have left school they become an untapped reservoir of HIV/AIDS knowledge and could be utilised as volunteer community educators and condom distributors.
• Faith-based organisations (FBOs), including church choirs, are some of the few organisations operating in informal settlements. With respondents citing willingness to reach out to these organisations for advice, FBOs are in a position to increase counselling for those who abuse alcohol and support for children whose parents may expose them to alcohol at an early age.