142nd APHA Annual Meeting and Exposition

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310116
Heterosexual HIV transmission among alcohol using serodiscordant couples may drive the epidemic in Cape Town townships: The Promise of Less Incidence

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 1:30 PM - 1:50 PM

Wendee M. Wechsberg, MS, PhD , Substance Abuse Treatment Evaluations and Intervention Research Program, RTI International, Research Triangle Park, NC
Irene Doherty, MPH, PhD , Substance Abuse Treatment Evaluations & Interventions, RTI International, Research Triangle Park, NC
William A. Zule, DrPH , Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC
Alexandra Minnis, MPH, PhD , Women's Global Health Imperative, RTI International, San Francisco, CA
Jackie Ndirangu, MSC-GH , Substance Abuse Treatment Evaluations & Intervention Research Program, RTI International, Pretoria, South Africa
Nabila El-Bassel, DSW , School of Social Work, Columbia University, New York, NY
Bronwyn Myers, PhD , Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
Tara Carney, MA , Alcohol & Drug Abuse Research Unit, Medical Research Council, Tygerberg (Cape Town), 7505, South Africa
Charles Parry, PhD , Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
Background:  HIV transmission among heterosexuals drives the epidemic in Sub-Saharan Africa.

Methods:  This NIAAA trial tested an intervention (n=290 couples) to reduce alcohol and drug use, violence and increase safer sex in Cape Town, South Africa. Thirty neighborhood clusters were randomized to either: couple’s intervention; separate women’s and men’s group interventions; and women’s intervention only. Couples were recruited from neighborhood drinking venues and followed for 6 months.

Results: In a typical drinking day, men drank on average 12 drinks (95%CI[11.5-13.2]) and women drank 6 drinks (95%CI[4.7-6.4]). Men drank heavily on 6 (95%CI[5.5-7.0]) of the past 30 days compared to 2 days for women (95%CI [1.5-2.8]).  Among men, as compared the control group and controlling for baseline values, the interventions reduced the number of days of heavy drinking by 1.84 (95%CI [-0.12, 3.81]) and 2.20 (95%CI [-0.12, 3.89]) days for the men-only and couples interventions respectively.  

At baseline, 26% of women and 13% of men were HIV-infected.  At followup, 5 men and 16 women seroconverted, corresponding to an HIV seroincidence of 4.2/100 and 16.2/100 person-years among men and women respectively.  Compared to control condition, the couples intervention was borderline protective (IRR=0.31, 95%CI[0.08, 1.17], p=0., 083).   Relative the condition involving separate interventions, the couples intervention was efficacious (IRR=0.27 95%CI [0.08, 1.00]),p=0.049).

Conclusions:  Women bore the burden of HIV seroconversions, yet the couples’ intervention seemed to be protective.  Addressing alcohol abuse in combination with other safer sex interventions among couples holds more promise for ameliorating HIV transmission in South Africa.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify the significant gender differences in HIV prevalence between couples and their drinking patterns. Discuss what risk behaviors were reduced after a couplesí intervention relative to two other conditions and how it can be protective against incidence.

Keyword(s): Alcohol Use, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator and have conducted the study. This is one of a series of studies that I have been responsible over the last 13 years in South Africa. I have mentored most of the collaborators and have a fruitful relationship.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.