Community perspectives of second-generation alcohol misuse and HIV risk in rural Kenya: A gendered syndemic lens.

Sub-Saharan Africa is at the intersection of the HIV epidemic and the highest burden of alcohol-related disease and injury. Alcohol consumption is associated with an increased likelihood of HIV infection, high rates of intimate partner violence and is considered both a cause and a contributor of economic stress and poverty. Our study integrates the syndemic and socio-ecological system theoretical frameworks to qualitatively explore the effect of second-generation alcohol consumption on sexual risk behaviours, alcohol misuse, violence and economic stress (SAVE) factors and HIV infection risk. We recruited 80 people from rural Kenya to participate in 12 focus groups. Consistent with the literature, we found evidence of syndemic associations of second-generation alcohol consumption with SAVE factors, including HIV infection risk. Structural-level factors including availability of cheap second-generation alcohol and widespread unemployment are the biggest risk factors for alcohol misuse. Because of the psychological effect of women's increasing economic independence on men, gendered syndemic programming - that includes both men and women - and addresses the complex web of risk factors for second-generation alcohol misuse can interrupt the vicious cycle of poverty, violence, sexual risk behaviours and mitigate HIV infection risk in rural Kenya.