Alcohol and Risky Sex: Breaking the Link

However, another critical factor is the widespread availability of cheap alcohol and drinking norms that encourage hazardous use. According to the World Health Organization, alcohol use is the world's third largest risk factor for disease and disability, contributing to a wide range of health harms, including injury, liver disease, and cancer. Research conducted in high HIV-prevalence countries, particularly in sub-Saharan Africa, has consistently shown that alcohol consumption is associated with risky sexual behavior. People who drink alcohol engage in more unprotected sex, multiple partnering, and commercial sex than non-drinkers. Studies have demonstrated that drinking alcohol before sex or being intoxicated during sex is directly linked with HIV. For example, a study in Rakai, Uganda, found that use of alcohol before sex increased HIV acquisition by 50 percent among over 14,000 women and men. Drinking venues have also been linked to HIV risk, as they bring together the opportunity to drink alcohol and meet casual sex partners. In rural eastern Zimbabwe, a population-based survey of nearly 10,000 women and men showed that visiting a beer hall in the last month was associated with both risky behavior and HIV infection. In Cape Town, South Africa, men and women who met sex partners at informal bars (shebeens) engaged in heavier drinking, had more sex partners, and had higher rates of unprotected sex compared to those who did not meet sex partners at shebeens. Research has elucidated the causal pathway underlying the association between alcohol consumption and risky sex. Alcohol decreases cognitive capacity to accurately judge risk and increases attention to sexual arousal, facilitating risk-taking among individuals who would not take the same risks while sober. Heavy episodic drinking, or binge drinking, is a common practice around the world, particularly in countries with high HIV prevalence. Binge drinking is defined as five or more drinks on a single occasion for men, or four or more drinks on a single occasion for women, generally within about two hours. Innovative programmatic approaches are being developed to respond to hazardous use of alcohol and risk of HIV infection. These programs are being delivered on a small scale and are concentrated in Eastern and Southern Africa. A main challenge is creating an effective response that requires working at several levels simultaneously. Individual-level programs aim to make those who engage in hazardous drinking aware of the risks to their health and provide opportunities to explore how alcohol may trigger their risky sexual behavior. Social norms about drinking also play a critical role in the alcohol-HIV response. Programs that seek to shift social norms about drinking may take the form of mass media campaigns, peer education, community outreach, or edutainment at drinking venues. Employers, bartenders, community opinion leaders, and parents can also challenge norms by engaging in conversations with their staff, patrons, peers, and children. School curricula can be used to help children explore deeply rooted norms about drinking and imagine alternatives. National and international alcohol legislation and policy represent a vitally important yet little-developed avenue for reducing alcohol-related harm. The World Health Assembly has endorsed a global strategy to reduce the harmful use of alcohol and is working with member states to develop policies, laws, and programs to reduce the burden of disease associated with alcohol. These include reducing the availability of alcohol through taxation and pricing policies, legislating how alcohol is marketed, and improving enforcement of underage drinking laws.