Search

In the past decade, a sense of urgency has started to pervade alcohol regulation in South Africa. The burden of alcohol-related mortality and morbidity is among the highest in the world, and its effects are made worse by persistent socio-economic and structural inequalities. Moreover, alcohol is also a principle risk factor for infectious and chronic diseases, as well as a tenacious barrier to the achievement of the Millennium Development Goals. Its consumption and negative externalities have therefore become a public health and development crisis. This is despite alcohol's significant contribution to the South African national economy and individual livelihoods signalling an entrenched site of tension in alcohol regulation. However, while liquor has indubitably pernicious consequences, it does also provide a critical vantage point to further geographical engagements with the South African city and contemporary development debates. In so doing, the novel empirical and conceptual agendas set out in the papers also contribute to a broader engagement with the cultural contexts, meanings and settings of drinking practices in rapidly changing urban spaces of the Global South. [ABSTRACT FROM AUTHOR]

Alcohol is a major contributing factor to the burden of road traffic crashes and injuries in South Africa. There has been an increase in political interest and engagement on the issue of drink-driving in recent months following government restrictions on the sale and public consumption of alcohol during the COVID-19 lockdowns along with proposed zero-tolerance drink-driving legislation. In this paper, we critically examine global research and experiences with the adoption of zero-tolerance approaches to drink-driving along with key South African contextual considerations to provide evidence-based and contextually relevant recommendations for advancing zero-tolerance drink-driving legislation in the country. There is significant evidence to support the adoption of zero-tolerance legislation but at a blood alcohol concentration (BAC) threshold limit for the general driving population set at 0.02 g/100 mL (rather than the zero-BAC limit proposed through the Road Traffic Amendment Bill) to allow for variance in testing. Recommendations centre on the proposed legislation incorporating a gradualist approach and its location within a broader zero-tolerance approach that includes other complementary interventions to enable implementation. Significance: • The recommended blood alcohol level of 0.02 g/100 mL is lower than the best practice limit recommended by the World Health Organization of 0.05 g/100 mL, following consideration of the road safety and general alcohol consumption challenges in South Africa and evidence of success from other similar country contexts. • Broad principles and recommendations are presented to support the sustainable adoption of zerotolerance drink-driving legislation in the country. [ABSTRACT FROM AUTHOR]

Background: South Africa is marked by high rates of both HIV and alcohol use, and there is a detrimental synergistic relationship between these two epidemics. The Institute of Medicine recommends integrated care for alcohol use treatment and HIV, but implementation of integrated services remains a challenge in South Africa. This protocol describes a study designed to evaluate trainer, provider-, and patient encounter-level outcomes relating to the national rollout of a cascade train-the-trainer model of task-sharing to build capacity of the HIV workforce to deliver Screening, Brief Intervention, and Referral to Treatment (SBIRT) to address risky alcohol use. Methods: This 5 year protocol consists of two phases. First, we will finalize development of a robust SBIRT train-the-trainer model, which will include an SBIRT Trainer Manual, Provider Resource Guide, fidelity observational coding system, case vignettes, and a curriculum for ongoing consultation sessions. Materials will be designed to build the capacity of novice trainers to train lay workers to deliver SBIRT with fidelity. Second, we will recruit 24–36 trainers and 900 providers in order to evaluate the effects of the SBIRT train-the-trainer model on trainer- (e.g., fidelity, knowledge), provider- (e.g., SBIRT attitudes, confidence, acceptability), and patient encounter- (e.g., proportion receiving screening, brief intervention, referral to treatment) level variables. Data on patient encounters will be tracked by providers on programmed tablets or scannable paper forms in real-time. Providers will report on SBIRT delivery on an ongoing basis over a 6-months period. Additionally, we will test the hypothesis that trainer-level factors will account for a substantial proportion of variability in provider-level factors which will, in turn, account for a substantial proportion of variability in patient encounter-level outcomes. Discussion: This protocol will allow us to take advantage of a unique national training initiative to gather comprehensive data on multi-level factors associated with the implementation of SBIRT in HIV service settings. In the long-term, this research can help to advance the implementation of integrated alcohol-HIV services, providing lessons that can extend to other low-and-middle income countries confronting dual epidemics. [ABSTRACT FROM AUTHOR]

Background: This study was designed to give a bibliometric overview of research productivity in alcohol and substance use prevention in Africa as a response to international efforts to prevent alcohol and substance use. Methods: Original research articles authored or coauthored by investigators from African countries on alcohol and substance use prevention during the period of 2008-2018 were retrieved from Web of Science (WoS), EBSCOhost, and PubMed and reviewed. Keywords related to alcohol and substance use were used to retrieve relevant literature. Results: Our search returned 3600 hits, with 34 articles retained. Included articles were conducted in 12 countries across the five regions in Africa (Central, East, North, South, and West) and spreading over 11 years, 2008-2018. The annual published articles showed a significant rise from 2008 to 2018 with South Africa ranked number one, with a total of 9 (31%) published articles followed by Kenya 4 (13.8%). Bronwyn Myers from South Africa and Atwoli et al. from Kenya were the most prolific authors. Age and gender were the most reported risk factors in the selected studies. The most active institutions in alcohol and substance use prevention research are The Medical Research Council of South Africa, Stellenbosch University, and Moi University. Conclusions: There were few collaborations among Africans themselves, yet these collaborations would enhance future alcohol and substance use prevention research productivity. Currently, a broad spectrum of substance use prevention interventions has been implemented throughout the African continent, ranging from individual to community-based interventions. [ABSTRACT FROM AUTHOR]

This paper, the first in a series related to the Joint European South African Research Network in Anxiety Disorders programme, examines substance use trends in South Africa. Alcohol remains the substance with the greatest burden of harm. Yet, trends vary by region, with for example methamphetamine being a major driver of psychiatric and substance abuse treatment demand in the Western Cape province. Heroin use is increasing in several provinces, where rapid intervention is required to avoid an epidemic. In particular, the state (the main funder of drug services) urgently needs to provide opioid substitution treatment. Apart from an inadequate number of treatment services, barriers to treatment are high. Barriers are predominantly cost, transport and resource related. Services are also impacted by a small and inadequately trained workforce and poor integration with mental health services. To adequately intervene with substance use disorders, South Africa needs an evidence-based policy and service planning framework that forges linkages with the mental health service system. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Adolescents in South Africa are at particularly high risk for human immunodeficiency virus (HIV), as well as other sexually transmitted infections. Because rates are so high, using minimal time and resources to develop effective interventions is essential. One strategy to achieve this goal is to modify and adapt western school-based preventive interventions for application in South African schools. This study focuses on the adaptation and integration of two interventions with proven effectiveness in the United States in order to ensure cultural relevance in South Africa and its subsequent testing in eight high schools located in townships near Pietermaritzburg, KwaZulu-Natal province. The findings reported in this paper reflect data from the first cohort of students, which included 1095 9th grade learners. Participants were assessed both 4-6 months and 15-18 months following baseline data collection. Results indicated significant differences in change between students in the intervention and comparison conditions on sexual refusal self-efficacy, intentions to have sex, attitudes about sex, initiation of sex, intention to use alcohol with sex, alcohol refusal self-efficacy and attitudes about alcohol. These results suggest that, after careful adaptation for cultural differences, behavioural interventions developed in western countries may achieve effectiveness in other contexts including township schools in South Africa. [ABSTRACT FROM AUTHOR]

Introduction: South Africa lacks services to detect and address alcohol use during pregnancy, particularly outside of health-care facilities. This study aimed to explore pregnant women and healthcare providers' perceptions of the acceptability, feasibility and appeal of a community-based counselling programme for pregnant women with alcohol problems. Methods: Twenty-eight in-depth interviews with pregnant women who drink, Community Health Workers (CHWs) and antenatal service providers were conducted. Transcribed interviews were analyzed thematically using a combined deductive and inductive approach. Results: Women reported feeling uncomfortable seeking help for their alcohol use at antenatal clinics, limiting usefulness of current support services. All stakeholders perceived a community-based intervention to be acceptable and feasible as it could be integrated with other CHW-delivered services. Participants thought an intervention should facilitate early linkage to antenatal services and should include partners or family members. The feasibility of an intervention may depend on the relationship between CHWs and clinic-based antenatal staff, and their relationships with pregnant women. Clinic and community challenges to implementation were raised. Clinic-level challenges included shortage of space, staff capacity, high number of pregnant women, long waiting times, financial burden of having to travel to a clinic, lack of comfort and privacy and staff attitudes. Community-level challenges included crime, lack of privacy, lack of attention given competing interests in the home, fear due to abuse, and stigma and discrimination from other community members. Suggestions for overcoming these challenges were provided. Conclusion: Findings provide essential information to facilitate the adaptation of a community-based alcohol counselling programme for greater acceptability, feasibility and cultural appropriateness for the South African context. Intensive training, supervision and support is required to ensure the programme is delivered as planned. [ABSTRACT FROM AUTHOR]

High rates of gender violence in South Africa, including those in higher education institutions, have prompted considerable research into understanding its causes. Studies focusing on gender and sexual risk at universities have found alcohol to be a significant contributor to gender violence. In this study, I analyse alcohol-related gender violence against female drinkers from the perspectives of male students. In-depth individual interviews were conducted with ten undergraduate male students at a university residence. Findings reveal that alcohol is seen as a masculine privilege. Male students explain that men use alcohol to give them the courage to enact hegemonic heterosexual masculinities. While they see alcohol as a tool to enhance men's capacity to control women, they simultaneously attribute blame to alcohol for men's loss of control over their behaviour. Alcohol is also exploited as currency to coerce women into submission to sexual favours. When male students blame alcohol for any deviant behaviour, men's culpability in the violation of female students remains hidden. Violence prevention efforts in educational contexts must address the ways in which alcohol shapes students' experience of gender, sexuality and violence. [ABSTRACT FROM AUTHOR]

Background: South Africa (SA) has one of the highest rates of youth unemployment and youth who are not in employment, education or training (NEET), even higher among Black South Africans. SA's NEET rates are 3 times those of UK; 5.4 times of Germany; 1.3 times of Brazil; and 2.5 times of Malaysia. Given that youths between 15 and 24 years of age make up 24% of the total population, these are significant challenges for the economy and further fuel the cyclical, pervasive and enduring nature of poverty. We hypothesised that rural youth who are NEET would have a greater prevalence of mental disorders and higher rates of substance use compared to their non-NEET counterparts. The objective of the study is to determine the differences in rates of psychological distress and substance use between NEET and non-NEET rural African 14- to 24-year-old young men. Methods: The study took place in a remote and rural district municipality in KwaZulu-Natal, South Africa. We divided the district's five sub-municipalities into two clusters (large and small) and randomly selected one from each cluster for inclusion in the study. We further randomly selected wards from each sub-municipality and then rural settlements from each ward, for inclusion in the study. We recruited young men as part of a larger study to explore sociocultural factors important in gender-based violence in rural SA. We compared 15- to 19-year old and 20- to 24-year old youth NEET and non-NEET on rates of psychological distress symptoms (depression, anxiety, suicidal thoughts, hopelessness and worthlessness) and substance misuse (including alcohol, cannabis, other recreational drugs) using a Multivariate Analysis of Variance (MANOVA) statistics at p <.005 level of significance level. Results: About 23% of the 355 male participants were NEET. There were no statistically significant differences in psychological distress or substance use between youth NEET and non-NEET, controlling for age. Conclusion: The study highlights difficult transitions to post-secondary education and work for Black youth in rural SA where opportunities for employment are limited. Education, training and employment appear to offer limited benefit. [ABSTRACT FROM AUTHOR]

We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize. [ABSTRACT FROM AUTHOR]

The co-occurrence of and synergistic interactions between substance abuse, violence, and HIV, known as the "SAVA syndemic," is thought to be a driver of women's elevated risk for HIV in sub-Saharan Africa. This study uses data from the 2016 South African Demographic and Health Survey (DHS) and the 2016 South African Census to examine geospatial associations between alcohol use, intimate partner violence (IPV), unprotected sex, and HIV status among a population-based sample of 8528 South African women (age 15–49). Results support the geographic clustering of alcohol use, unprotected sex, and IPV, but not HIV, and geospatial clustering of HIV alone. This study highlights the need for geographically-tailored interventions to address syndemics through integrated interventions, such as those simultaneously focused on alcohol, IPV, and sexual risk reduction, and points to the need for more targeted research to link these factors to HIV from a place-based risk perspective. [ABSTRACT FROM AUTHOR]

Introduction: High alcohol availability is related to increased alcohol consumption and harms. Existing quantitative research provides potential explanations for this relationship but there is little understanding of how people experience local alcohol availability. This is the first review to synthesise qualitative research exploring the relationship between alcohol availability and other factors in local alcohol environments. Methods: The scoping review includes qualitative studies exploring community‐level alcohol availability and other factors, facilitating the purchase and consumption of alcohol. We included studies focusing on children and adolescents as well as adults. Study findings were brought together using thematic analysis and the socio‐environmental context model, which explains how certain environments may facilitate drinking. Results: The review includes 34 articles. The majority of studies were conducted since 2012. Most studies were conducted in the United Kingdom, Australia and South Africa. The physical availability of alcohol and proximity to local amenities and temporal aspects, like late night opening hours, may be linked to social factors, such as normalisation of drinking and permissive drinking environments. The review highlights the importance of social and cultural factors in shaping interactions with local alcohol environments. Discussion and Conclusion: This qualitative scoping review advances understanding of the pathways linking alcohol availability and alcohol harms by showing that availability, accessibility and visibility of alcohol may contribute towards permissive drinking environments. Further research is needed to better understand how people experience alcohol availability in their local environment and how this can inform alcohol control policies. [ABSTRACT FROM AUTHOR]

Background: A cross sectional study was conducted among 350 sexually active, mainly unemployed men between the ages of 18 and 35 in KwaZulu-Natal. This study examined the psychosocial determinants of the intention to be sexually active after having used marijuana or alcohol personally or in instances when the sexual partner is intoxicated. The theory of planned behaviour and cultural notions of responsible manhood were used in developing the measures.Methods: Correlation and hierarchical stepwise linear regression analyses tested determinants of the intention to avoid having sex when personally intoxicated and the intention to avoid sex when the sexual partner is intoxicated.Results: About 78 % of the participants reported regular use of alcohol and 39 % indicated ever-using marijuana. A total of 36.3 % used both alcohol and marijuana, and 73 % said that they engaged in multiple sexual partner behaviour. The intention to avoid sex when personally intoxicated as well as the intention to avoid sex when the sexual partner is intoxicated were significantly associated with subjective norms and perceptions of perceived behavioural control towards the respective behaviours, and less with attitudes towards the respective behaviours.Conclusions: These findings imply that health education interventions should focus on changing the normative beliefs as well as control beliefs of the target population either directly through education and training or indirectly by creating physical and social environments that facilitate safe sexual practices, for example by organizing positive peer support for risk prevention and by making condoms freely available in community alcohol serving establishments. [ABSTRACT FROM AUTHOR]

Harmful alcohol consumption can significantly compromise adherence to antiretroviral therapy (ART). Prior research has identified aggregate relationships between alcohol use and ART non-adherence, largely relying on concurrent assessment of these domains. There is relatively limited evidence on more nuanced day-level associations between alcohol use and ART non-adherence, despite potentially important clinical implications. We recruited adults with HIV treatment adherence challenges and harmful alcohol use (n = 53) from HIV care in South Africa. We examined relationships between alcohol use and same and next day ART adherence, accounting for the role of weekends/holidays and participant demographics, including gender. Results demonstrated that ART adherence was significantly worse on weekend/holiday days. Next day adherence was significantly worse in the context of weekend alcohol use and among men. These results suggest the importance of tailoring intervention strategies to support ART adherence during weekend drinking and for men engaged in heavy episodic drinking. [ABSTRACT FROM AUTHOR]

Crime generators are places that increase the risk of crime occurring due mainly to the fact that they attract a large number of motivated offenders and suitable targets to a particular location. Research identifying crime generators has however almost exclusively been confined to the United States and Europe with much less known about the ability of businesses, institutions, and/or public facilities to generate crime in less developed contexts, particularly in Africa. In this study we explore whether four different types of facilities act as crime generators in a setting axiomatically different to the West, namely Khayelitsha, a township located on the urban periphery of Cape Town in South Africa. Using intensity value analysis (IVA), we examine the intensity of assault, robbery and rape around four different types of facilities (schools, recreational hubs, transport interchanges, and alcohol outlets) relative to other random locations in Khayelitsha. The results of our research suggest that schools, and to a lesser extent transport interchanges and recreational hubs, may act as crime generators in the township. Possible explanations for these findings conclude. [ABSTRACT FROM AUTHOR]

Abstract: While attention to the socio-ecological and political economic influences on health grows, there remains a paucity of political ecological analyses of health (King, 2010). At the same time, the growing burden of non-communicable diseases (NCDs) in the Global South demands new conceptual and pragmatic engagements with their modifiable risk factors. Drawing on the example of South Africa, this paper argues that alcohol consumption might usefully be theorised in political ecological lexicon as a “disaster”. To do so, it draws attention to the upstream causes of vulnerability, rather than just the downstream effects of risky drinking. This reorientation is needed for sustainable, publicly acceptable alcohol policies. To realise this, it draws on Blaikie et al.’s (1994, 2003) political ecological approach to risk, vulnerability and coping and, more specifically, applies their Pressure and Release model to explore liquor as a situated “disaster” in South Africa’s Western Cape province. In so doing, it aims to mark out an under-explored research agenda that considers alcohol as a pervasive governance dilemma. In addition, it also reflects on the model’s utility as a means of communicating findings that might reorient policy discussions on alcohol control in both South Africa and countries of the Global South. [Copyright &y& Elsevier]

Abstract: Background: HIV-positive pregnant women who drink put their children at risk of both HIV and fetal alcohol spectrum disorders. The province of KwaZulu-Natal (KZN) has the highest prevalence of HIV in South Africa, but has not before been considered an area of high alcohol consumption among women. This paper analyzes a large sample of HIV+ pregnant women in KZN to examine alcohol consumption in that population. Methods: Data came from assessments of women enrolled in Prevention of Mother-To-Child Transmission programs at 8 clinics in KZN. Descriptive statistics and logistic regressions were used to examine the prevalence and correlates of alcohol consumption and binge drinking. Results: Of 1201 women assessed, 18% reported drinking during pregnancy, and 67% of drinkers usually binged when drinking (had 3+ drinks in one sitting). Over one-third of drinkers binged twice a month or more. Women living in urban and peri-urban locations were more likely to drink, as were those with indicators of higher economic status and greater social engagement. Married women were less likely to drink, while women who had poorer mental health, used tobacco, or had a greater history of sexual risk-taking were more likely to drink. Conclusion: Health care workers in KZN should be aware that pregnant women who drink are likely to do so at a level that is dangerous for their babies. Some factors associated with drinking indicate social/environmental influences that need to be counteracted by greater dissemination of information about the dangers of drinking, and greater support for abstinence or moderation. [Copyright &y& Elsevier]

• INTRODUCTION Efforts at widespread implementation of alcohol screening and brief intervention (SBI) in developing countries are now underway. This paper reviews four such projects from Brazil and South Africa. • METHODS Authors reviewed presentations from a 2008 International Society for Biomedical Research on Alcoholism symposium, written project summaries and previously-published journal articles and compared findings with similar reports from industrialized countries. • RESULTS Projects trained healthcare teams from primary care facilities, then gathered qualitative feedback from trainees and quantitative data on SBI services provided. Most programs showed modest increases in alcohol screening rates. Some showed increases in referrals to alcohol specialty treatment. Non-physicians reported greater SBI activity than physicians. In Brazil health administrators actively disseminated SBI services after seeing data on early SBI successes. Researchers worked with politicians and health officials to promote policies mandating SBI services and funding SBI training. Barriers included stigma regarding alcohol misuse, social acceptance of recreational intoxication, competing demands of other priority government health services, lack of emphasis on prevention and reluctance to provide SBI to patients without major alcohol-related consequences. • DISCUSSION Future efforts may benefit from focusing efforts on increasing intervention as welt as screening levels, addressing specific training needs of nonphysicians, linking to formal and informal treatment services, utilizing quality improvement approaches. and including SBI projects in broader efforts at alcohol policy change. Project leaders should seek avenues for promoting health policies which emphasize alcohol SBI as a top priority in primary care. [ABSTRACT FROM AUTHOR]

Estimates of participation or expenditure elasticities depend upon the assumptions made regarding the observation of zero expenditure at the household level. This research examines two single-hurdle models across two commodities for which nearly two-thirds of the observations are zero. The research shows that one hurdle model consistently outperforms the other, and does so for intuitively appealing reasons. [ABSTRACT FROM AUTHOR]

In this article, we examine the operation of shame in the alcohol use habits of pregnant women and the responses of their families and associated institutions. Using a narrative–discursive approach, we interviewed 13 women, living in a low-resource setting in South Africa, who had consumed alcohol while pregnant. Narratives showed how both the act of drinking and "inappropriately" timed pregnancy (early and out of wedlock) were judged to be unacceptable. Women who engaged in these activities were positioned as bad mothers or promiscuous. Their actions were seen as resulting in the suffering of others—the future child, the family, and even the community. These narratives were underpinned by cultural and religious discourses. Women managed the shame accruing to them through avoidance and concealment; families instructed women to self-exclude or distanced themselves from the women's behavior; and institutions subtly or overtly excluded women. The shaming of these women, and the mechanisms by which such shame was managed, did little to decrease drinking or to increase maternal health and welfare. Overall, this article demonstrates how the shame of drinking alcohol during pregnancy produces avoidance behavior, concealment, and exclusion, which are not constructive in terms of maternal health and well-being. The implications for a feminist narrative approach to drinking during pregnancy are outlined: moving beyond a focus on individual behavior change to locating personal stories within the meta-narratives and social discourses that shape pregnant women's lives. [ABSTRACT FROM AUTHOR]

Foetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while pregnant. South Africa has the highest prevalence of FASD in the world. We review the social determinants underpinning FASD in South Africa and add critical insight from an intersectional feminist perspective. We undertook a scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. Drawing from EBSCOhost and PubMed, 95 articles were screened, with 21 selected for analysis. We used the intersectionality wheel to conceptualize how the social and structural determinants of FASD identified by the literature are interconnected and indicative of broader inequalities shaping the women and children affected. Key intersecting social determinants that facilitate drinking during pregnancy among marginalized populations in South Africa documented in the existing literature include social norms and knowledge around drinking and drinking during pregnancy, alcohol addiction and biological dependence, gender-based violence, inadequate access to contraception and abortion services, trauma and mental health, and moralization and stigma. Most of the studies found were quantitative. From an intersectional perspective, there was limited analysis of how the determinants identified intersect with one another in ways that exacerbate inequalities and how they relate to the broader structural and systemic factors undermining healthy pregnancies. There was also little representation of pregnant women's own perspectives or discussion about the power dynamics involved. While social determinants are noted in the literature on FASD in South Africa, much more is needed from an intersectionality lens to understand the perspectives of affected women, their social contexts and the nature of the power relations involved. A critical stance towards the victim/active agent dichotomy that often frames women who drink during pregnancy opens up space to understand the nuances needed to support the women involved while also illustrating the contextual barriers to drinking cessation that need to be addressed through holistic approaches. [ABSTRACT FROM AUTHOR]

This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence. [ABSTRACT FROM AUTHOR]

Background: Little is known about longitudinal patterns of adolescent health risk behavior initial engagement and persistence in low- and middle-income countries.Methods: Birth to Twenty Plus is a longitudinal birth cohort in Soweto-Johannesburg, South Africa. We used reports from Black African participants on cigarette smoking, alcohol, cannabis, illicit drug, and sexual activity initial engagement and adolescent pregnancy collected over 7 study visits between ages 11 and 18 y. We fit Kaplan-Meier curves to estimate behavior engagement or adolescent pregnancy, examined current behavior at age 18 y by age of first engagement, and performed a clustering analysis to identify patterns of initial engagement and their sociodemographic predictors.Results: By age 13 y, cumulative incidence of smoking and alcohol engagement were each > 21%, while the cumulative incidence of other behaviors and adolescent pregnancy were < 5%. By age 18 y (15 y for cannabis), smoking, alcohol, and sexual activity engagement estimates were each > 65%, cannabis and illicit drug engagement were each > 16%; adolescent pregnancy was 31%. Rates of engagement were higher among males. Current risk behavior activity at age 18 y was generally unrelated to age of initial engagement. We identified three clusters reflecting low, moderate, and high-risk patterns of initial risk behavior engagement. One-third of males and 17% of females were assigned to the high-risk cluster. Sociodemographic factors were not associated with cluster membership.Conclusions: Among urban dwelling Black South Africans, risk behavior engagement across adolescence was common and clustered into distinct patterns of initial engagement which were unrelated to the sociodemographic factors assessed. Patterns of initial risk behavior engagement may inform the timing of primary and secondary public health interventions and support integrated prevention efforts that consider multiple behaviors simultaneously. [ABSTRACT FROM AUTHOR]

Alcohol and drug misuse (ADM) pose a significant disease burden globally. Yet, there remains a gap in understanding risk factors associated with women's ADM, particularly those in marginalised settings. We investigated risk factors associated with ADM amongst young women in urban informal settlements in South Africa. Bivariate and multivariable logistic regression analyses were conducted on a sample of 680 young women assessing associations between sociodemographic factors, mental health, relationship factors and past year ADM. Alcohol misuse was assessed using the 10 item Alcohol Use Disorders Identification Test (AUDIT) scale, with scores ≥8 defining misuse, a single item assessed past year illegal drug use. Alcohol and drug misuse were reported by 23.1% and 31.8% of the women respectively. In multivariable regression, alcohol misuse was associated with experiencing past year non-partner sexual violence, transactional sex with a main partner, past year drug use, and past week depressive symptoms, while drug misuse was associated with alcohol misuse, transactional sex with a casual partner, past year experience of physical and/or sexual IPV and having a functional limitation (disability). Results indicate ADM in informal settlements are shaped by violence and poor mental health. Interventions geared towards strengthening women's economic position and mental healthcare are recommended. [ABSTRACT FROM AUTHOR]

Background: South Africa is considered to have the highest prevalence of fetal alcohol spectrum disorder (FASD) globally. Nevertheless, the extent to which the South African government has responded to the high FASD prevalence at the policy level is unclear. Herein, we aimed to identify targeted and generic clauses that could be attributed to the prevention and management of FASD in relevant South African policy documents.Methods: We conducted a search of two search engines (PubMed and Google) and the websites of South African national and provincial departments from January to April 2018. A total of 33 policy documents were included in this review. Using content analysis, we sought documents that mention the terms 'fetal alcohol syndrome' and 'fetal alcohol spectrum disorder'. The Framework method was also used to thematically identify specific and generic clauses attributed to the prevention and management of FASD in South Africa.Results: The content analysis indicated that 12 policy documents contained the searched terms. Findings from the thematic analysis showed that targeted and generic clauses for FASD exist in various policy documents. Some of the generic clauses focused on the regulation of liquor outlets, enforcement of liquor laws, and the general management of persons with mental and educational challenges. Specific clauses focused on creating platforms to improve the awareness, screening, identification and support for individuals with FASD.Conclusions: There is a noticeable increase in the number of policy documents that considered elements of FASD enacted in the last decade. Although this study revealed the existence of targeted and generic clauses that could be attributed to the prevention and management of FASD, the sustained high prevalence of FASD in South Africa, as reported in the literature, calls for more holistic and comprehensive approaches to tackle the FASD problem in South Africa. [ABSTRACT FROM AUTHOR]

Scholarship on the geographies of beer is concentrated mainly in the global North. Sub-Saharan Africa is the most undeveloped region in terms of international beer focused research. This neglect must be set against the growing attention on the region by the world's leading brewing enterprises. Within beer research geographies, one distinctive facet of Africa's beer economy is the manufacture of a variety of traditional or indigenous beers which are quite unlike the barley based clear beers and multiplying varieties of craft beers as consumed in the Global North. Indigenous beers formed an important part of the rural African social fabric and undertaken by mainly women brewers. The objective here is to address the limited extant knowledge about fermentation geographies of Africa. The focus is on South Africa's sorghum beer industry and the commodification of traditional beer, interrogating the changing organization and associated spaces of production of this sector. Using archival sources and the industry press two historical phases are unpacked in the chequered development of the sorghum beer industry in South Africa. The study demonstrates the shrinking spaces of production of the formal economy of sorghum beer as the industry moved from serving narrow localized markets to concentrated production for wider regional and national markets. Arguably, recent struggles surrounding the ownership and control of South Africa's sorghum beer industry represent an integral facet of the increasingly competitive economic landscape of beer across contemporary sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Many drinkers globally are at risk of developing an alcohol use disorder (AUD). The study aimed to identify the extent of AUDs and associated individual and societal-level risk factors or vulnerabilities among adult drinkers in a country with high levels of heavy episodic drinking. A household survey was conducted in the Tshwane Metro, South Africa, using multistage stratified cluster random sampling. Complete data were available on 949 adult drinkers. Half (49%) reported symptoms of alcohol problems, as a proxy for AUDs, as measured using the RAPS4. Gender and age were not associated with symptoms of alcohol problems. White persons had 74% lower odds of symptoms of alcohol problems compared to Black Africans, and persons who reported stressful life events in the past 6 months were four times more likely to report symptoms of alcohol problems. Persons whose primary drinking location was a pub/bar/tavern and "other club" were more than twice as likely to have symptoms of alcohol problems than persons who drank at home, and persons whose primary beverage was wine were 74% less likely to have symptoms of alcohol problems compared to beer drinkers. The findings raise important implications regarding particular vulnerabilities experienced by Black Africans; the sale of alcoholic beverages, and especially beer, in locations such as pubs/bars/taverns; and the need for more comprehensive epidemiological research to assess the nature and extent of AUDs in South Africa together with focused contextual research on particular groups at risk. [ABSTRACT FROM AUTHOR]

Excessive alcohol consumption has been shown to increase HIV risk for men who have sex with men (MSM) and compromise HIV prevention behaviors. However, there is limited contextual understanding of alcohol use for MSM in rural sub-Saharan African settings, which can inform and direct HIV interventions. Applying an adaptation of PhotoVoice, we worked with 35 HIV-positive MSM who created photo-essays about alcohol and HIV in Mpumalanga. A semi-structured protocol was used in focus group discussions that were audio-recorded, translated and transcribed. Transcript data and visual data of 24 photo-essays were analyzed using a constant comparison approach. We found that participants used alcohol to build and sustain social networks, meet sexual partners, and enhance sexual experience. Excessive alcohol use was common, which was associated with increased HIV risk behaviors within a community of MSM who maintained multiple partnerships. Our study suggests that HIV interventions need to address excessive alcohol use to mitigate the associated HIV risk at both the individual and community levels. [ABSTRACT FROM AUTHOR]

Background: Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town.Methods: Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted.Results: Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital.Discussion: The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers.Conclusions: Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access. [ABSTRACT FROM AUTHOR]

Alcohol and other drug use is prevalent among peri-urban, South African adolescents. We identified correlates of alcohol and other drug use by gender among adolescents (age = 16–18 years; N = 822) in peri-urban Johannesburg. Interviewer-administered surveys assessed sexual activity, alcohol and other drug use, and relevant psychosocial factors. In separate logistic regression models of alcohol and other drug use stratified by gender, violence exposure and sexual activity were associated with alcohol use for both males and females. For females only, depressive symptoms were associated with drug use. For males only, being older and sexually active were associated with drug use. Substance use interventions for South African adolescents should consider psychological health, sexual health, and tailoring by gender. [ABSTRACT FROM AUTHOR]

HIV-infected pregnant women in sub-Saharan Africa are at risk for depression and alcohol abuse. Young women may be more vulnerable, but little is known about the psychosocial functioning of this population. We compared younger (18-24 years old) and older (≥25 years old) HIV-infected pregnant women initiating antiretroviral therapy (ART) in Cape Town, South Africa. Women were assessed on a range of psychosocial measures, including the Alcohol Use Disorders Identification Test and the Edinburgh Postnatal Depression Scale (EPDS). Among 625 women initiating ART, 16 % reported risky alcohol use and 21 % alcohol-related harm; these percentages were similar across age groups. When younger women were stratified by age, 37 % of 18-21 years old versus 20 % of 22-24 years old reported alcohol-related harm ( p = 0.02). Overall, 11 % of women had EPDS scores suggesting probable depression, and 6 % reported self-harming thoughts. Younger women reported more depressive symptoms. Report of self-harming thoughts was 11 % in younger and 4 % in older women ( p = 0.002). In multivariable analysis, age remained significantly associated with depressive symptoms and report of self-harming thoughts. Level of HIV-related stigma and report of intimate partner violence modified the association between age and depressive symptoms. Young HIV-infected pregnant women in South Africa were more likely to report depressive symptoms and self-harming thoughts compared to older women, and the youngest women reported the highest levels of alcohol-related harm. HIV-related stigma and intimate partner violence may be moderating factors. These findings have implications for maternal and infant health, underscoring the urgent need for effective targeted interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]

Although hazardous/harmful alcohol use impacts response to HIV treatment, there have been few attempts to deliver alcohol-reduction interventions within South African HIV treatment services. As a first step towards implementing alcohol-focused interventions in these settings, we explored patients’ views of the acceptability of a brief motivational interviewing and problem-solving intervention. In-depth interviews were conducted with 11 patients recruited from three HIV treatment sites in Tshwane, South Africa, who had completed the intervention. Participants noted that the intervention was acceptable and appropriate. As a result of the intervention, participants reported less use of alcohol as a coping mechanism. They described greater use of problem-focused and emotional coping strategies for dealing with mutable and immutable problems, respectively. Their only recommendation for improving the intervention was the addition of booster sessions. Findings suggest that this intervention is acceptable to patients receiving HIV treatment and is perceived to be helpful for reducing their use of alcohol. [ABSTRACT FROM AUTHOR]

Alcohol-serving venues in South Africa are sites for high-risk behaviours that may lead to HIV transmission. Prevention and treatment interventions are sorely needed in these settings, but HIV-related stigma may limit their effectiveness. This study explored expressions of stigma among alcohol-serving venue patrons in Cape Town and examined the potential impact of stigma on HIV disclosure, testing and treatment-seeking behaviours. A total of 92 in-depth interviews with male and female, black and coloured patrons were conducted. Transcripts were analysed via memo-writing and diagramming techniques. Many participants mentioned knowing other patrons living with HIV/AIDS (PLWH), and this visibility of HIV impacted expressions of HIV-related stigma. Participants discussed four forms of HIV-related stigma in the venues: fearing PLWH, fearing HIV acquisition, blaming others for spreading HIV and isolating PLWH. HIV visibility and expressions of HIV-related stigma, particularly fear of isolation, influenced participants' willingness to disclose their status. HIV-related stigma in the venues also appeared to indirectly influence testing and treatment-seeking behaviour outside the venue. Results suggest that efforts to change norms and reduce expressions of HIV-related stigma in alcohol-serving venues are necessary to successfully deliver tailored HIV prevention interventions and increase uptake of HIV testing and care in this important social setting. [ABSTRACT FROM PUBLISHER]

Alcohol use is associated with compromised antiretroviral therapy (ART) adherence. We aimed to identify patterns and predictors of ART use among alcohol drinkers. Using purposive sampling, we recruited 304 male and female patients from two ART clinics in Tshwane, South Africa. Interviews were conducted using a structured questionnaire comprising measures of demographic factors, psychosocial factors (i.e., ART adherence, self-efficacy beliefs, alcohol and ART interactions beliefs, ART-alcohol outcome expectancy, attitude towards drinking alcohol and taking ART and HIV stigma) and alcohol use (AUDIT). Data were analysed using descriptive statistics and three multivariate linear regressions. Forty percent of the sample reported drinking alcohol. Half of the drinkers endorsed one of three unique patterns of ART use: (1) dosing ART earlier than required (2) taking ART while drinking alcohol and (3) skipping ART doses. The other half endorsed combinations of ART use on drinking days, for example, earlier ART dosing and taking ART while drinking alcohol was the most common combination. High adherence perseverance (a self-efficacy subscale) and a non-favourable attitude towards drinking alcohol and taking ART predicted the unique pattern of taking ART early when planning to drink alcohol. The unique pattern of taking ART despite drinking alcohol was predicted by higher levels of education (marginal significance) and experiencing low HIV stigma. A high score on the AUDIT and experience of high stigma predicted the unique pattern of skipping ART doses when drinking alcohol. Patterns of ART taking in alcohol drinkers in this sample are varied, and not always mutually exclusive. This apparent complexity of medication taking patterns among alcohol drinkers warrants further exploration. Furthermore, the finding that different psychosocial factors predict different ART-taking patterns suggests a need for programmes to improve alcohol-related non-adherence to ART to be multifaceted. [ABSTRACT FROM PUBLISHER]

South Africa's HIV prevalence among young people remains among the highest in the world. A cross-sectional study was carried out in 2012 to estimate prevalences of sexual risk behavior and hazardous alcohol use (HAU) (via the Alcohol Use Disorder Identification Test) as well as to investigate potential associations between these outcomes and social media use. In all, 4485 students (mean age 15.66 years, SD 1.39) at 46 secondary schools in informal settlements in Cape Town and Port Elizabeth completed mobile-phone-assisted, self-administered baseline questionnaires within a cluster-randomized trial. In all, 312 females (12.5 %) and 468 males (23.5 %) screened positive for HAU (AOR = 1.98, 95 % CI 1.69-2.34). 730 males (39.9 %) and 268 females (11.8 %) reported having had two or more partners in the last year (AOR = 3.46, 95 % CI 2.87-4.16). Among females, having a Facebook account was associated with reported multiple partnerships in the last year (AOR = 1.81, 95 % CI 1.19-2.74), age-disparate sex in the last year (AOR = 1.96, 95 % CI 1.16-3.32) and HAU (AOR = 1.97, 95 % CI 1.41-2.74). Using Mxit-a popular mobile instant messaging application-was associated with higher odds of reported multiple partnerships in the last year among both males (AOR = 1.70, 95 % CI 1.35-2.14) and females (AOR = 1.45, 95 % CI 1.07-1.96) and with HAU among both males (AOR = 1.47, 95 % CI 1.14-1.90) and females (AOR = 1.50, 95 % CI 1.18-1.90). Further longitudinal and qualitative research should explore in more depth the observed links between social media and risk behavior. [ABSTRACT FROM AUTHOR]

The article discusses a study on the role of the society in the financial status and use of tobacco, alcohol and drugs among patients with tuberculosis (TB) in South Africa. It describes how the study was carried out among black Africans who were enrolled in TB clinics in Tshwane Metropolitan Municipality from September 2011 to April 2013. It also mentions the use of structural equation modeling method in the analysis.

The regulation of space is understood to extend beyond the state to include decentralized, diffuse non-state actors. In South Africa, the regulation of shebeens has long been considered a means for state regulation of behaviour, controlling crime and disorder and generating state income. The post-apartheid state has sought to distance itself from old patterns, but struggles to respond to the problems associated with alcohol consumption. Non-state actors have sought to intervene in this gap. We examine how diverse actors contribute to the regulation of drinking and drinking spaces within informal settlements in Cape Town. Through applying a plural perspective on regulation, we identify and discuss strategies through which residents, shebeen owners and community leaders regulate the flow of alcohol and shebeen practices. We find some synergies between different actors' ideas regarding how shebeen practices should be regulated; however, we also see that while the current police regulation focuses on confiscation and arrest, actors within the settlements prefer softer regulation that takes into account the actual situation at hand. By displaying conflicts and intersections between formal and informal regulations of shebeens, we hope to inspire more research on plural, decentralized, and everyday regulations of alcohol and in the complex spaces of informality in the urban South. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We examined whether alcohol use is associated with antiretroviral therapy (ART) adherence independently of structural and psychosocial factors among 304 male and female ART recipients in ART sites in Tshwane, South Africa. ART adherence was assessed by the CASE Adherence Index. Independent variables were demographic, structural, psycho-social, and alcohol use (AUDIT score) factors. In hierarchical multiple regression, demographic variables (Step 1) explained 4 % of variance in ART adherence ( p ≤ 0.01). Variance explained increased to 16 % ( p ≤ 0.001) after entering structural variables (Step 2); 19 % ( p ≤ 0.001) after entering psychosocial variables (Step 3); and 24 % ( p ≤ 0.001) after entering AUDIT score (Step 4). Alcohol use is independently associated with ART adherence. [ABSTRACT FROM AUTHOR]

Background: Alcohol abuse remains one of the most serious substance abuse disorders in South African society, resulting in inordinately large social, economic and health problems at all levels of society. Alcohol consumers in South Africa are estimated to drink 16.6 l per annum, with a per capita consumption of 7.1 l. South Africa has one of the highest rates of deaths attributable to crime, violence, traffic accidents and HIV/AIDS in the world. These rates relate directly to the high prevalence of alcohol abuse and risky drinking patterns. A food-based dietary guideline that appears to encourage alcohol consumption is not in the nation’s best interest. Method: A search was conducted of websites supported by the World Health Organization to find published literature on substance abuse in South Africa. The website of the Medical Research Council of South Africa for studies on the social impact of alcohol abuse on humans was also reviewed. The search terms “alcohol guidelines”, “alcohol abuse”, “noncommunicable diseases”, “health benefits of alcohol”, “moderate drinking”, “alcohol” and “intake patterns” were used. Studies published between 2002 and the present were reviewed. Results: Based on evidence of the past two decades, messages that convey the positive health benefits of moderate alcohol consumption (e.g. increased levels of high-density cholesterol) should be promoted and even encouraged in moderate drinkers (i.e. one alcoholic drink per day for women and a maximum of two drinks per day for men). Moderate drinking is not encouraged in those who do not consume alcohol at all. Nutrition educators should emphasise the negative consequences of alcohol abuse. Conclusion: The current food-based dietary guideline “If you drink alcohol, drink sensibly”, issued by the South African Department of Health, should not remain as is. [ABSTRACT FROM AUTHOR]

Aim To test the effectiveness of motivational interviewing ( MI) to reduce the risk of an alcohol exposed pregnancy ( AEP) in a high-risk population. Design Randomized controlled trial. Setting Rural population in the Western Cape, South Africa. Participants A total of 165 women aged 18-44 years at risk of AEP. Intervention Five-session MI intervention. Measurements Structured questionnaires were administered pre-intervention and at 3 and 12 months follow-up. The primary outcome measure was AEP at 12 months. Secondary outcomes were AEP at 3 months, and alcohol use and effective contraception at 3 and 12 months. Findings There was a significant difference in the decline in the proportion of women at risk for an AEP in the MI group at 3 months (50 versus 24.59%; P = 0.004), maintained at 12 months (50.82 versus 28.12%; P = 0.009). In an intention-to-treat analysis these differences were also significant (32.93 versus 18.07%; P = 0.029; and 37.80 versus 21.69%; P = 0.024, respectively). The odds ratio for no longer being at risk of an AEP ( MI versus control) at 12 months was 2.64 [95% confidence interval ( CI): 1.18-5.94]. In the intention-to-treat analysis this ratio was 2.19 (95% CI: 1.05-4.65). Conclusions A five-session motivational interviewing intervention was found to be effective with women at risk of an alcohol-exposed pregnancy, and could be implemented as part of routine primary care clinic services in similar populations. The message of 'no alcohol in pregnancy' should be adapted to include better family planning and early recognition of pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Aims This study aims to estimate the prevalence of drug use by pregnant women living in Ibiza, using structured interviews and biomarkers in maternal hair. In addition, the potentially detrimental effects of maternal drug abuse on their newborns were investigated. Ibiza has a large international night-life resort associated with clubs, music and use of recreational drugs. Design, setting and participants Hair samples were collected prospectively from January to March 2010 from a cohort of consecutive mothers after giving birth in the Hospital Can Misses in Ibiza. Measurements Opiates, cocaine, cannabis, methadone, amphetamines, 3,4-methylenedioxymethamphetamine (MDMA) and their metabolites were detected in a 3-cm-long proximal segment of maternal hair corresponding to the last trimester of pregnancy by gas chromatography coupled to mass spectrometry ( n = 107). Data on socio-demographic characteristics and on tobacco, alcohol, drugs of prescription and drugs of abuse consumption during pregnancy were collected using a structured questionnaire. Findings Hair analysis showed an overall 16% positivity for drugs of abuse in the third trimester of pregnancy, with a specific prevalence of cannabis, cocaine, MDMA and opiates use of 10.3, 6.4, 0.9 and 0%, respectively. In the questionnaires, only 1.9% of mothers declared using drugs of abuse during pregnancy. Gestational drug of abuse consumption was associated with active tobacco smoking, a higher number of smoked cigarettes and the mother being Spanish. Conclusions Illicit drug use is substantially under-reported among pregnant women living in Ibiza, particularly among Spanish nationals. Voluntary, routine objective biological toxicology screening should be considered as part of routine examinations in antenatal clinics on this Mediterranean island. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim While drinking in the event is an important factor in injury occurrence, the pattern of usual drinking may also be important in risk of injury. Explored here is the relationship of an alcohol-related injury with an individual usual drinking pattern. Design Alcohol-related injury is examined using hierarchical linear models, taking into account individual usual volume of consumption over the past 12 months, as well as aggregate-level detrimental drinking pattern (DDP) and alcohol policy measures. Setting Data analyzed are from emergency departments (EDs) in 19 countries, comprising three collaborative studies on alcohol and injury, all of which used a similar methodology. Participants The sample comprised 14 132 injured drinkers across 46 emergency room (ER) studies. Measurements Alcohol-related injury was measured, separately, by any self-reported drinking prior to injury, a blood alcohol concentration (BAC) ≥ 0.08 and self-reported causal attribution of injury to drinking. Findings While individual usual volume strongly predicted an alcohol-related injury for all three measures, usual drinking pattern also predicted an alcohol-related injury (controlling for volume), with episodic heavy and frequent heavy drinking both more predictive of alcohol-related injury than other drinking patterns. When individual usual volume and drinking pattern were controlled, DDP was no longer a significant predictor of alcohol-related injury. Alcohol policy measures were predictive of both BAC and causal attribution (the stronger the policy the lower the rates of alcohol-related injury). Conclusions Volume of alcohol typically consumed and occurrence of heavy drinking episodes are associated independently with incidence of alcohol-related injury. The stronger the anti-alcohol policies in a country, the lower the rates of alcohol-related injury. [ABSTRACT FROM AUTHOR]

This article addresses the struggle between the temperance and wine interests in South Africa during three phases: 1890–1920, 1920–48 and 1948–65. It argues that divergent outcomes were rooted in a combination of differential levels of internal cohesion and the configuration of the political arena within which the protagonists manoeuvred for advantage. Conflicting interests within the wine industry hindered collective action, whereas the temperance movement derived strength from its decentralized modes of operation and international connections. The latter pioneered mass action alongside the art of lobbying. After 1948, the wine industry turned the tables by cementing a special relationship with the National Party, while tapping into popular nationalism, youth culture, and emergent consumerism. [ABSTRACT FROM PUBLISHER]

Charles Van Onselen's Masked Raiders is reviewed comparatively to suggest that Irish identities are always contested; that during early capitalist competition, like that in the Old Transvaal before Union, amateur 'primitive rebels' or 'outlaw heroes' cannot match harder professional accumulators, like Cecil John Rhodes; that murder is not heroic; that subaltern history is inevitably about subalterns, who cannot rationally be promoted to 'lead the parade'; and that Rhodes and his ilk made a major contribution to the long run project, begun in the 17th century, which culminated in English's dominating the world by the 21st century; whereas the primitive bandits in question, whether hanged, shot dead, jailed or escaped, were largely irrelevant to history, despite the fascination with which humans approach the murderous criminal mind. [ABSTRACT FROM AUTHOR]

Background Implementation of effective policies to reduce harmful alcohol consumption requires both a good understanding of the policy development process and which strategies are likely to work. Aims To contribute to this understanding by reviewing four specific policy development initiatives that have taken place in South Africa between 1994 and 2009: restrictions on alcohol advertising and counter-advertising, regulation of retail sales of alcohol, alcohol taxation and controls on alcohol packaging. Methods Material was drawn from a record of meetings and conferences held between 1994 and 2009 and a database of reports, newspaper clippings and policy documentation. Findings When the policy process resulted in a concrete outcome there was always a clear recognition of the problem and policy alternatives, but success was more likely if there was an alignment of ‘political’ forces and/or when there was a determined bureaucracy. The impact of the other factors such as the media, community mobilization, non-governmental organizations (NGOs), the liquor industry and research are also discussed. Future avenues for policy research are identified, including the need for more systematic studies that give greater consideration to economic factors. Conclusions Alcohol policy development in South Africa takes place in a piecemeal fashion and is the product of various competing influences. Having a comprehensive national alcohol strategy cutting across different sectors may be a better way for other developing countries to proceed. [ABSTRACT FROM AUTHOR]

South Africa has a massive burden of HIV and alcohol disease, and these pandemics are inextricably linked. Much evidence indicates that alcohol independently influences decisions around sex, and undermines skills for condom negotiation and correct use. Thus, not surprisingly, people with problem drinking in Africa have twofold higher risk for HIV than non-drinkers. Also, sexual violence incidents often coincide with heavy alcohol use, both among perpetrators and victims. Reducing alcohol harms necessitates both population- and individual-level interventions, especially raised taxation, regulation of alcohol advertising and provision of Brief Interventions. Alcohol counselling interventions must include discussion of linkages between alcohol and sex, and consequences thereof. Within positive-prevention services, alcohol reduction interventions could diminish HIV transmission. A trial is needed to definitively demonstrate that reduced drinking lowers HIV incidence. However, given available evidence, implementation of effective interventions could alleviate much alcohol-attributable disease, including unsafe sex, sexual violence, unintended pregnancy and, likely, HIV transmission. [ABSTRACT FROM AUTHOR]

Despite its importance in raising awareness of HIV risk behaviour and in linking HIV-positive individuals to care and treatment, research findings indicate that the HIV antibody testing rate in the general South African population remains relatively low, although knowledge of HIV testing services is high. The identification of important correlates of testing behaviour can be used to improve HIV testing campaigns by refining messages that target individuals at highest risk for infection. This study uses data from an ongoing prevention intervention study in Pretoria, South Africa to identify factors that may have a greater influence on facilitating or hindering HIV testing among South African women who face a high risk for infection. The data for this study (n=425) are derived from the baseline interviews and HIV test results collected between June 2004 and January 2007. HIV testing for this study was significantly associated with education level, alcohol and cannabis use, sex trading, number of STI symptoms, physical abuse and number of visits to a clinic for medical treatment. Results suggest that more focused efforts need to be made to provide HIV testing to women who report substance use behaviour, experience violence and report high-risk sexual behaviour. Interventions also need to address denial of HIV infection and fear to test for HIV. [ABSTRACT FROM AUTHOR]

We aimed to assess prevalence and correlates of hazardous use of tobacco, alcohol and other drugs in a primary care population in Cape Town, South Africa. Stratified random sampling was used to select 14 of the 49 clinics in the public health sector in Cape Town, and every “nth” patient, with those ages 18-25 oversampled (N = 2,618). Data were collected from December 2003 through 2004, using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test. Hazardous use of tobacco was most common, followed by alcohol and then other drugs. Hazardous tobacco use was associated with the 18-25 years age group, no religious involvement, high school completion, and higher stress. Hazardous alcohol use was associated with male gender, younger men, no religious involvement, employment, some high school education, and higher stress. Hazardous use of other drugs was associated with Colored (mixed) race (particularly among men), no religious involvement, employment, and stress. For all substances, women, particularly Black women, had the lowest rates of hazardous use. Although the study is cross-sectional, it does identify groups that may be at high risk of substance misuse and for whom intervention is urgent. Because prevalence of substance use is high in this population, routine screening should be introduced in primary care clinics. [ABSTRACT FROM AUTHOR]