Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa.
BMC Infect Dis. 2023 Jul 29;23(1):500. doi: 10.1186/s12879-023-08470-y.
Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission.
We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month.
Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000-2021 period 54% (95% CI: 34-74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0-32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0-68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0-2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8-7.2%) or by 7.3% (0.6-21.2%) if there was no waning of intervention impact.
Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.
狂饮、不平等的性别规范和性风险行为密切相关。本研究旨在通过建模来评估酒精咨询干预（针对男性和女性）和性别转换干预（针对男性）作为减少 HIV 传播的策略的潜在效果。
我们开发了一种 HIV 和其他性传播感染的基于代理的模型，该模型考虑了狂饮对性风险行为的影响，以及不平等性别规范（针对男性）对性风险行为和狂饮的影响。该模型应用于南非，并使用来自撒哈拉以南非洲地区的酒精咨询干预（n=9）和性别转换干预（n=4）的随机对照试验数据进行了校准。该模型还根据南非的酒精消费和不平等性别规范接受度数据进行了校准。狂饮被定义为在一个月内的某一天内喝了五杯或更多的酒。
据估计，南非的狂饮行为非常普遍（2021 年男性为 54%，女性为 35%），在 2000-2021 年期间，54%（95%CI：34-74%）的新 HIV 感染发生在狂饮者中。在同一时期，狂饮行为导致 6.8%（0.0-32.1%）的新 HIV 感染，这主要是通过女性狂饮对随意性行为的影响来介导的。不平等的性别规范导致了 17.5%（0.0-68.3%）的新 HIV 感染，这主要是通过不平等的性别规范对男性伴侣同时存在的影响来介导的。一项针对所有狂饮者的多次酒精咨询干预措施，将在 5 年内使 HIV 发病率降低 1.2%（0.0-2.5%），而一项基于社区的性别转换干预措施，如果干预效果没有减弱，将使发病率降低 3.2%（0.8-7.2%）或 7.3%（0.6-21.2%）。
尽管狂饮和不平等的性别规范在南非对 HIV 传播有很大贡献，但最近试验的酒精咨询和性别转换干预措施对 HIV 发病率的影响可能很小。需要进一步创新开发针对狂饮和不平等性别规范的本地相关干预措施。
