This project will conduct a multilevel prospective analysis of alcohol-related HIV/AIDS risks among women who drink in alcohol serving establishments (shebeens, taverns and bottle stores) in Cape Town South Africa. As many as one in five South Africans is HIV positive and there are an estimated 1,500 new HIV infections in South Africa each day. Research consistently shows that alcohol is closely related to HIV transmission risks in southern Africa, although most research in drinking establishments has focused on men. Our proposed multilevel analysis is grounded in Social Action Theory and incorporates factors derived from three levels of analysis: structural/environmental, social/interpersonal, and individual. We propose collecting environmental level data from two informal drinking places (shebeens), two larger drinking places (taverns), and businesses that sell and do not serve alcohol (bottle stores) in two racial/cultural communities (Black Africans of Xhosa heritage and mixed racial background Coloured), for a total of 12 drinking establishments. Data will be collected from key informants (n=20), alcohol serving business owners, managers and servers (n=60), interviews (n=240) and cross-sectional surveys (n= 900) of men and women drinkers, and a prospective cohort of women (n=300). Assessments at the structural/environmental, social/interpersonal, and individual levels will be collected at 4 time points: baseline, 4-, 8-, and 12-months. We will test the associations of alcohol serving establishment characteristics, socioeconomic conditions, gender dynamics, social norms and collective efficacy, and individual risk characteristics including alcohol expectancies and risk reduction self-efficacy of women who drink in the target settings. We will use multilevel modeling to test whether contextual factors, including socioeconomic conditions and drinking setting characteristics, directly predict social interactions and social dynamics of women's risks for HIV/AIDS. We will also examine characteristics of drinking settings, propensity for gender violence, and men's gender attitudes in relation to women's alcohol-related HIV risks. We also propose conducting a series of intervention development activities that will be informed by our multilevel study, providing a new intervention model as the study end-product available for subsequent testing. The proposed study will therefore directly meet the urgent need for new multilevel HIV prevention intervention models for women who drink in alcohol serving establishments in South Africa.

Public Health Relevance

Alcohol is associated with sexual risks for HIV/AIDS in South Africa. Research has shown that men who drink at alcohol serving establishments are at high risk for HIV transmission, but little research has focused on South African women who drink in these settings. Structural/environmental, social/interpersonal, and individual level factors influence alcohol use and risk behavior, although the complex interplay of these factors has not been examined among women who drink. This study will test a multilevel model of alcohol and HIV risks among African and Coloured women in South Africa using a prospective study design. Multilevel risk factors will be examined at small informal alcohol serving establishments (shebeens), larger more formal drinking places (taverns), and alcohol sales business (bottle stores). Guided by Social Action Theory, we will examine structural, social, and individual level influences on women's drinking and HIV risks. ? ? ?

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-F (52))
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Bryant, Kendall
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University of Connecticut
Schools of Arts and Sciences
United States
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Velloza, Jennifer; Watt, Melissa H; Abler, Laurie et al. (2017) HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention. AIDS Behav 21:144-154
Watt, Melissa H; Eaton, Lisa A; Dennis, Alexis C et al. (2016) Alcohol Use During Pregnancy in a South African Community: Reconciling Knowledge, Norms, and Personal Experience. Matern Child Health J 20:48-55
Pitpitan, Eileen V; Kalichman, Seth C; Eaton, Lisa A et al. (2016) Men's Behavior Predicts Women's Risks for HIV/AIDS: Multilevel Analysis of Alcohol-Serving Venues in South Africa. Prev Sci 17:472-82
Abler, Laurie; Sikkema, Kathleen J; Watt, Melissa H et al. (2015) Traumatic stress and the mediating role of alcohol use on HIV-related sexual risk behavior: results from a longitudinal cohort of South African women who attend alcohol-serving venues. J Acquir Immune Defic Syndr 68:322-8
Choi, Karmel W; Watt, Melissa H; Skinner, Donald et al. (2015) ""Wine you get every day, but a child you can't replace"": The perceived impact of parental drinking on child outcomes in a South African township. J Child Adolesc Ment Health 27:173-87
Velloza, Jennifer; Watt, Melissa H; Choi, Karmel W et al. (2015) HIV/AIDS-related stigma in South African alcohol-serving venues and its potential impact on HIV disclosure, testing and treatment-seeking behaviours. Glob Public Health 10:1092-106
Watt, Melissa H; Sikkema, Kathleen J; Abler, Laurie et al. (2015) Experiences of forced sex among female patrons of alcohol-serving venues in a South African township. J Interpers Violence 30:1533-52
Choi, Karmel W; Abler, Laurie A; Watt, Melissa H et al. (2014) Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences. BMC Pregnancy Childbirth 14:97
Eaton, Lisa A; Kalichman, Seth C; Pitpitan, Eileen V et al. (2014) The relationship between attending alcohol serving venues nearby versus distant to one's residence and sexual risk taking in a South African township. J Behav Med 37:381-90
Watt, Melissa H; Eaton, Lisa A; Choi, Karmel W et al. (2014) ""It's better for me to drink, at least the stress is going away"": perspectives on alcohol use during pregnancy among South African women attending drinking establishments. Soc Sci Med 116:119-25

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