Risky sex and alcohol abuse - making the connection

In a regularly flighted television advert in South Africa, a black screen appears with the words: Good Idea - get some rest. A young girl sleeping innocently then appears. The black screen emerges again with the message: Bad Idea - drinking before you do. Then the camera zooms out and reveals the young girl passed out on the pavement around the corner from a nightclub. The advert is part of a campaign by the Industry Association for Responsible Alcohol Use (ARA), which represents the country's major liquor companies, including SABMiller. Young South Africans have been inundated with campaigns on responsible drinking, but very few make the connection between substance abuse, particularly alcohol, and the associated risk of HIV infection. South Africa has been classified as one of the world's hardest drinking nations, with a high level of acceptance of alcohol abuse, especially among men. In Orange Farm, a township south of Johannesburg, uniformed school children walking home after classes with little to do, loiter along one of the township's few tarred roads, blocking the street to traffic. As one of the largest and poorest informal settlements in the country, all the ingredients that promote heavy drinking: unemployment, boredom and disempowerment, can be found here. The purple buildings of the LoveLife Y centre, a youth centre run by the anti-AIDS NGO, are in stark contrast to the dusty road and ramshackle buildings that surround it. Eighteen-year-old Lebogang Tsoametsi, who had just walked in from the local high school, was only too aware of the dangers of alcohol abuse. "When you're drunk or high, you only look at the here and now - you don't even think straight and think about condoms or how many people you have slept with. If anyone wants to give it up to you ... it's so easy," she commented. LoveLife peer educator Thebe Tlhapane agreed. "When you're young and you take drugs or booze, you feel like Superman because all your fears are gone. You can do anything, everywhere," he said. A study conducted by the Medical Research Council's (MRC) Alcohol and Drug Abuse Research Group revealed that although there have been a substantial number of surveys on HIV/AIDS and sexual risk behaviour, very few have factored alcohol into the equation. The MRC study found that adolescents, the group at the highest risk of HIV infection, were also associated with problems of alcohol abuse, particularly binge drinking. Tsoametsi noted, frankly, that alcohol was the only form of entertainment available. "Whenever we go to parties or outings, there's got be alcohol. Everyone will try by all means to get it, especially at house parties. It's all we know; it keeps us busy." "And the sad thing is that a lot of young people don't realise that there is a link between alcohol and the chance of getting AIDS," she noted. According to the MRC study participants, when it came to sex, finding a partner in a bar after a few drinks was a lot easier than when they were sober. Bars also offered an opportunity for on-site sex and the use of narcotics, which can further lower inhibitions. The director of the National Council on Alcoholism and Drug Dependence (SANCA), Shamim Garda, said SANCA's efforts to address the connection between substance abuse and HIV infection "have almost gone unheard". She called for more HIV/AIDS prevention efforts to integrate SANCA, the largest organisation dealing with substance abuse in the country, into their campaigns. Existing AIDS campaigns, such as LoveLife's, have begun to address the issue. "We have to look at HIV in relation to lifestyles, and alcohol is becoming a lifestyle issue for young people," LoveLife spokeswoman Angela-Stewart Buchanan told PlusNews. But ARA's Dr Chan Makan pointed out that "the worst thing ... interventions can do is create the forbidden fruit syndrome. Messages should not be saying, 'If you drink you will get AIDS' because this is simply not true," he said. Makan suggested explaining the connection in a "credible way, by giving them healthier alternatives they can understand". Back at the Y-centre a basketball match was in progress, with a handful of spectators sitting in the shade. Occasionally glancing at the match outside, Ludwe Mqati, a peer educator and basketball coach, was restless and had become tired of "making a connection". For him, talking and "going around in circles" about abusing alcohol would not solve anything. The main reason young people in Orange Farm drank, Mqati said, was boredom and a lack of recreational activities. "If you want to drink, all you have to do is go next door," he said pointing to the general dealer situated next to the Y-centre. Adjoining the general dealer there was a room filled with people drinking cartons of home-made beer, sold for only R1.50 (US $0.20), at half-past three in the afternoon.