How can integration of the alcohol perspective

strengthen existing HIV/AIDS

strategies?Dag Endal

FORUT Norwegian Campaign for Development and Solidarity

ADD Project Coordinator(Alcohol, Drugs and Development)

A shift in approach:

Alcohol problems as only a backdrop when designing HIV/AIDS interventions

A shift in approach:

Alcohol problems as only a backdrop when designing HIV/AIDS interventions

To see alcohol consumption as an integral part of the HIV/AIDS problem – and then address also this factor in intervetions

Three categories of possible links between alcohol and HIV/AIDS:> Alcohol use increasing the risk

for HIV infection

> Alcohol boosting the development of the disease, once you are infected

> Alcohol reducing the effects of (medical) treatment

Basic 1:The level of alcohol

consumption and the drinking habits in a population are not

constant. They change over time

and between nations and groups

Basic 2:The level of alcohol

problems can be regulated through interventions by

governments and by society as a whole

Assumption:Reduction of alcohol consumption and change of drinking patterns can contribute to * reduction in HIV incidence rates* slower development from HIV to AIDS for the infected* increased effectivity of ARV

treatment

Alcohol policy advocacy as part of HIV/AIDS

prevention strategies?

Recorded consumption 2003

1,44 litres pure alcohol

per person aged 15+

WHO Global Status Report on Alcohol

2004

Distribution of consumption:

Beer 78,0%Wine 0,5%Spirits 21,5%

Carlsberg samlebåndRecorded alcohol

Unrecorded

alcohol

Total alcohol consumptionWHO Region Africa E:(litres per person aged 15+)

Recorded 3,8 (54%)Unrecorded 3,3 (46%)

Risk

group

Risk places

EMERGING MARKETS!

Challenges in AIDS prevention: * Keep general alcohol consumption low;* Maintain Malawian women as a group of non-drinkers;* Stimulate male non-drinkers to maintain their position;* Target men who have risky drinking patterns;* Target drinking places

Add the alcohol perspective to

existing HIV/AIDS strategies, not replace these

strategies

Gender dimensions and drinking habits• More men drink than women• Men drink more often than women• Men drink larger quantities than women• It is more accepted that men drink than women• Men create more problems when drunk

A universal picture…with a few exceptions and local variations

The story of Chimwemwe:Chimwemwe says that her husband is a very jealous man, and he drinks alcohol every day. When he drinks he almost always beats her; 'A week cannot pass without beating me'.

He spends much of the family's income on alcohol, money Chimwemwe feels could be used on much more useful things. Every night Moses comes home drunk, and he urinates and vomits in the bed, and when she tells him to go outside he beats her.

She does not like to sleep with her husband when he is drunk, because he stinks, he behaves badly, and she is afraid that he has been cheating on her with other women who may be HIV positive. If she refuses to have sex with him, he forces her.

THE KEY to understanding the

problem and taking efficient action

1. Construction of masculinity2. The symbolic, social

meaning of drinking3. Privileges attached to

drinking

Construction of masculinity

Drinking and drunken behaviour

= masculinity

”Being able to hold one’s drink

and to drink heavily is a sign of masculinity”

Address privileges attached to drinking:• Permission to break rules and

social conventions;• Excuse for rude and violent

behaviour;• Acceptance by other people to

behave badly;• Explanation or excuse for bad

performance.

Myth-busting:

A critical loook at existing conventional wisdom on the effects of alcohol

(strength, attractiveness, virility, intelligence etc)

Communicate basic facts on the real effects of alcohol

Gender transformative programs for HIV/AIDS prevention:

Address also drinking habits as an integral part of the masculine identity

This problem has to be adressed* by men;* by working with men;* by working for men.