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Heterosexual HIV transmission among alcohol using serodiscordant couples may drive the epidemic in Cape Town townships: The Promise of Less Incidence
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 preventionClinical 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 couples’ intervention relative to two other conditions and how it can be protective against incidence.
Keyword(s): Alcohol Use, HIV Interventions
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.