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.
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.
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