Academic journal article Alcohol Research

Social and Structural HIV Prevention in Alcohol-Serving Establishments: Review of International Interventions across Populations

Academic journal article Alcohol Research

Social and Structural HIV Prevention in Alcohol-Serving Establishments: Review of International Interventions across Populations

Article excerpt

Alcohol use is among the most reliable predictors of sexual risk behavior across populations at high risk for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Associations between alcohol use and sexual risks are observed regardless of whether alcohol use is measured in terms of global patterns of drinking, or within situations where drinking occurs, or at the level of sexual events (Weinhardt and Carey 2001). Alcohol elevates sexual risks through multiple channels, including the psychological effects of intoxication on decisionmaking, inhibition of protective actions, interactions between drinking and risk taking personality characteristics, and perceived expectations regarding the effects of alcohol use on risk-taking and sexual experiences (Cook and Clark 2005). The association between drinking and sexual risk behaviors has led to interventions that seek to reduce both alcohol use and sexually risky behaviors (Palepu et al. 2005). For example, an HIV risk reduction intervention for inner-city African-American men reduced alcohol use in sexual contexts by 85 percent from baseline (Kalichman et al. 1999). In a similar study of one-on-one risk reduction counseling in South Africa, researchers reported a 59 percent reduction in alcohol use in sexual contexts 3 months following the intervention (Kalichman et al. 2007). However, the intervention effects on sex-related alcohol use decreased within 6 months to a 43 percent reduction from baseline. This short-lived effect is likely the result of individuals returning to unchanged high-risk environments that support risk-related alcohol use (Kincaid 2004), suggesting the need for interventions to alter risk factors within alcohol-serving environments.

This article examines the alcohol-serving venues that intersect with HIV transmission risks and offer potential environments for HIV prevention. Venues of greatest interest are those that sell alcohol for onsite consumption and serve as a point of social interaction. Multiple types of drinking establishments fit these criteria across cultures, including neighborhood bars, dance clubs, karaoke bars, taverns, wine shops, and informal lounges. In addition to describing the intersection of drinking places with HIV/AIDS risks, this article reviews the literature on HIV prevention interventions based in alcohol venues. Venue-based interventions are defined as strategies designed to alter the social and/or physical environment to promote protective action and reduce risk. Therefore, this article does not include interventions that target drinkers or those that are delivered outside of drinking places. The outcomes from completed venue-based intervention trials point to gaps in the existing literature and suggest future directions for HIV prevention efforts based in alcohol-serving venues.

ALCOHOL-SERVING ESTABLISHMENTS AND HIV TRANSMISSION RISKS

The contextual factors within which alcohol and sexual behaviors intersect are critical to our understanding of how alcohol influences HIV risks. The environments of drinking establishments are multifaceted and serve multiple functions, including being a place for recreation, fostering socially sanctioned drinking, facilitating social relationships, and providing opportunities to meet sex partners. The subsequent sections review selected studies that describe sexual risks for HIV incurred within drinking places. These studies are summarized in Table 1.

Studies of Gay Men

Early studies of HIV risks in alcohol serving establishments were focused on gay bars, primarily in the United States and Europe. Across studies, approximately one in three men who have sex with men sampled from gay bars and clubs reported engaging in unprotected anal intercourse, the highest risk behavior for HIV transmission. Nardone and colleagues (2001), for example, found that one-third of men who go to gay bars in London and Edinburgh engaged in unprotected anal sex, and only half of the men had been tested for HIV A study in California showed that one in three men who visit gay clubs and bars reported five or more sex partners in the past year (Xia et al. …

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