Intersection of Alcohol Disinhibition & HIV Exposure: Effects on Girls Vulnerability in Botswana, Malawi, and Mozambique

Background: Alcohol consumption is an indirect contributor to HIV transmission in sub-Saharan African countries. Alcohol use is associated with unprotected sex, sexual debut, multiple sex partners, and sexual violence, all of which lead to increased HIV risk exposure. Girls are particularly vulnerable in this equation because of their unregulated alcohol access and economic dependency on men in regards to transactional sex. Methods: A 2008 qualitative study relied on 12 focus group discussions (FGDs) in Botswana, 12 in Malawi, and 11 in Mozambique, divided between urban and rural sites and grouped as follows: adolescent girls (ages 10-14; 15-19), adolescent boys (14-19), adult women (20-49), adult men (20-49), and community leaders. In addition, a FGD (2009) from the Malawi BRIDGE project (girls ages 15-24) was included.

Results: Places considered ‘unsafe' by young girls were ubiquitous at the community level. Venues where alcohol is sold were identified as the most high-risk places for adolescent girls in all communities. Community regulations surrounding such sites appear non-existent. Alcohol disinhibition was a factor in girls' attenuated decision-making capacity when they consumed alcohol and in increasing their risk of sexual assault by inebriated men. Although participants were aware of the disinhibiting effect of alcohol, they showed little efficacy to reduce the effects of consumption.

Conclusions: The findings suggest intervening at a structural level to implement policies and enforce legal laws relating to alcohol production and consumption. As many families are dependent upon alcohol production, programs should seek to reduce girls' vulnerability by providing alternative viable economic opportunities.