The feasibility of integrating alcohol risk-reduction counseling into existing VCT services in Kenya

Mackenzie, Corey S.; Kiragu, Karusa; Odingo, George; Yassin, Rukia; Shikuku, Peter; Angala, Patrick; Sinkele, William; Akinyi, M; Kilonzo, Nduku

doi:10.4314/ajdas.v8i2.52935

Cited by 6 publications

(13 citation statements)

References 4 publications

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“…Instead of such an approach, our findings argue for a harm reduction approach featuring the introduction of safe sex norms emphasizing condom use with Kibera FSWs combined with condom placement in Kibera bars and messages promoting moderate alcohol consumption. These findings echo those from a recently completed nation-wide Kenyan pilot study linking alcohol counseling to voluntary HIV testing and counseling (MacKenzie et al 2009). Findings from the present study suggest that safe sex norms for both FSWs and male clients could be profitably added to this program, in recognition of the historic and contemporary strong linkages between alcohol and commercial sex reported for sub-Saharan African public drinking venues.…”

Section: Summary and Discussionsupporting

confidence: 83%

A Reasoned Action Model of Male Client Involvement in Commercial Sex Work in Kibera, A Large Informal Settlement in Nairobi, Kenya

et al. 2014

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Male clients of female sex workers (FSWs) are epidemiologically important because they can form bridge groups linking high- and low-risk subpopulations. However, because male clients are hard to locate, they are not frequently studied. Recent research emphasizes searching for high-risk behavior groups in locales where new sexual partnerships form and the threat of HIV transmission is high. Sub-Saharan Africa public drinking venues satisfy these criteria. Accordingly, this study developed and implemented a rapid assessment methodology to survey men in bars throughout the large informal settlement of Kibera, Nairobi, Kenya, with the goal of delineating cultural and economic rationales associated with male participation in commercial sex. The study sample consisted of 220 male patrons of 110 bars located throughout Kibera’s 11 communities. Logistic regression analysis incorporating a modified Reasoned Action Model indicated that a social norm condoning commercial sex among male peers and the cultural belief that men should practice sex before marriage support commercial sex involvement. Conversely, lacking money to drink and/or pay for sexual services were barriers to male commercial sex involvement. Results are interpreted in light of possible harm reduction programs focusing on FSWs’ male clients.

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Section: Summary and Discussionsupporting

confidence: 83%

A Reasoned Action Model of Male Client Involvement in Commercial Sex Work in Kibera, A Large Informal Settlement in Nairobi, Kenya

et al. 2014

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“…Brief interventions, ie, client-focused counseling to reduce alcohol consumption, have been highly effective in many settings [87]. In SSA, brief interventions that are integrated into HIV testing and counseling [79,88] and primary care [89][90][91] have shown feasibility, but are still in early stages of development and implementation. With increased attention being paid to "Seek, Test, and Treat" as a way to end the HIV epidemic that relies on frequent and widespread HIV testing, integration of brief interventions to reduce alcohol consumption into HIV testing programs has the potential to reach a large number of persons.…”

Section: Individual and Peer-based Interventionsmentioning

confidence: 99%

Adding Fuel to the Fire: Alcohol’s Effect on the HIV Epidemic in Sub-Saharan Africa

2011

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Alcohol consumption adds fuel to the HIV epidemic in sub-Saharan Africa (SSA). SSA has the highest prevalence of HIV infection and heavy episodic drinking in the world. Alcohol consumption is associated with behaviors such as unprotected sex and poor medication adherence, and biological factors such as increased susceptibility to infection, comorbid conditions, and infectiousness, which may synergistically increase HIV acquisition and onward transmission. Few interventions to decrease alcohol consumption and alcohol-related sexual risk behaviors have been developed or implemented in SSA, and few HIV or health policies or services in SSA address alcohol consumption. Structural interventions, such as regulating the availability, price, and advertising of alcohol, are challenging to implement due to the preponderance of homemade alcohol and beverage industry resistance. This article reviews the current knowledge on how alcohol impacts the HIV epidemic in SSA, summarizes current interventions and policies, and identifies areas for increased research and development.

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“…Because alcohol appears to play an important role in HIV transmission, reducing alcohol consumption early in the course of HIV could have an important impact on the HIV epidemic. HCT provides a point of health care contact that might be an opportune time to intervene on heavy alcohol consumption [ 27 ]. Current standard HCT guidelines, e.g.…”

Section: Introductionmentioning

confidence: 99%

Decreases in self-reported alcohol consumption following HIV counseling and testing at Mulago Hospital, Kampala, Uganda

et al. 2014

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BackgroundAlcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa. HIV counseling and testing (HCT) may provide a contact opportunity to intervene with hazardous alcohol use; however, little is known about how alcohol consumption changes following HCT.MethodsWe utilized data from 2056 participants of a randomized controlled trial comparing two methods of HCT and subsequent linkage to HIV care conducted at Mulago Hospital in Kampala, Uganda. Those who had not previously tested positive for HIV and whose last HIV test was at least one year in the past were eligible. Participants were asked at baseline when they last consumed alcohol, and prior three month alcohol consumption was measured using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) at baseline and quarterly for one year. Hazardous alcohol consumption was defined as scoring ≥3 or ≥4 for women and men, respectively. We examined correlates of alcohol use at baseline, and of hazardous and non-hazardous drinking during the year of follow-up using multinomial logistic regression, clustered at the participant level to account for repeated measurements.ResultsPrior to HCT, 30% were current drinkers (prior three months), 27% were past drinkers (>3 months ago), and 44% were lifetime abstainers. One-third (35%) of the current drinkers met criteria for hazardous drinking. Hazardous and non-hazardous self-reported alcohol consumption declined after HCT, with 16% of baseline current drinkers reporting hazardous alcohol use 3 months after HCT. Independent predictors (p < 0.05) of continuing non-hazardous and hazardous alcohol consumption after HCT were sex (male), alcohol consumption prior to HCT (hazardous), and HIV status (negative). Among those with HIV, non-hazardous drinking was less likely among those taking antiretroviral therapy (ART).ConclusionsHCT may be an opportune time to intervene with alcohol consumption. Those with HIV experienced greater declines in alcohol consumption after HCT, and non-hazardous drinking decreased for those with HIV initiating ART. HCT and ART initiation may be ideal times to intervene with alcohol consumption. Screening and brief intervention (SBI) to reduce alcohol consumption should be considered for HCT and HIV treatment venues.

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The feasibility of integrating alcohol risk-reduction counseling into existing VCT services in Kenya

Cited by 6 publications

References 4 publications

A Reasoned Action Model of Male Client Involvement in Commercial Sex Work in Kibera, A Large Informal Settlement in Nairobi, Kenya

A Reasoned Action Model of Male Client Involvement in Commercial Sex Work in Kibera, A Large Informal Settlement in Nairobi, Kenya

Adding Fuel to the Fire: Alcohol’s Effect on the HIV Epidemic in Sub-Saharan Africa

Decreases in self-reported alcohol consumption following HIV counseling and testing at Mulago Hospital, Kampala, Uganda

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