Dash of booze counselling needed to stem HIV

The social and biomedical links between excessive alcohol consumption and HIV, coupled with the pervasiveness of hazardous drinking in Kenya, highlight a need to include an alcohol component in voluntary counselling and testing (VCT), according to researchers.

"There is scientific evidence of a link between alcohol and HIV," said Dr Karusa Kiragu, a programme associate with Horizons, a research project of the United States Agency for International Development.

"We know, for instance, that alcohol interferes with the body's ability to metabolise ARVs [life-prolonging antiretroviral drugs], increasing the likelihood of drug resistance," she added, "so it would be useful for counsellors to pass this information on to their clients."

The Kenyan government has acknowledged the seriousness of the alcohol problem, saying in a recent press release that "abuse and misuse of alcohol and other drugs in Kenya has now reached magnitudes that may lead to a national disaster if timely measures are not put in place".

A recently released Horizons research paper reported that alcohol has several effects that increase people's vulnerability to HIV. In addition to blunting one's self-monitoring behaviour, thus increasing the likelihood of having multiple partners and unprotected sex, the paper noted that "evidence suggests a direct biomedical link between alcohol consumption and HIV infection and disease".

"Heavy and sustained alcohol use depress the immune system and cause alcohol-induced malnutrition, which can cause vulnerability to HIV infection," it said. "Emerging laboratory evidence suggests that alcohol may morphologically alter cellular structure to increase both HIV infectivity and vulnerability of cells."

Kiragu, who co-authored the study, said both men and women were more likely to become violent and to have multiple sexual partners while under the influence of alcohol, which put even partners who didn't drink in danger of contracting the HI virus.

Alcohol counselling at the VCT level

In its study, Horizons found that there was an unmet need for alcohol counselling among VCT clients in Kenya.

"During pre-test counselling, clients are given information on modes of HIV transmission and triggers of risky behaviour," it added. "Thus, the VCT centre offers an optimal venue for discussing alcohol as a factor in HIV transmission and for helping clients formulate a risk-reduction plan."

The research found that 76 percent of males and 25 percent of females who were current drinkers reported hazardous drinking behaviour based on the United Nations World Health Organisation's AUDIT - Alcohol Use Disorders Identification Test.

Based on a survey of 1,073 men and women attending VCT centres around Kenya, it found that two-thirds of respondents who did not receive alcohol counselling during visits would have liked to advice on the topic.

Partners of drinkers were equally concerned about the issue, the study found, with half of the respondents concerned that their partners "drink too much".

"They [the women] come and say that the husband takes a lot of alcohol but they don't know how they can avoid him or explain to the husband that they have to use protection during sex," one VCT counsellor in the coastal city of Mombasa was quoted as saying.

The study recommended training of VCT counsellors on the role of alcohol as a trigger for HIV and AIDS, the development of tools to screen VCT clients for alcohol use, and the creation of strong referral systems to existing services such as rehab centres and domestic violence support groups.

Kiragu said Horizons had moved onto the next phase of the research, which involved testing the success of alcohol counselling at the VCT level, but said regardless of the results, there remained a need to address the link between HIV and alcohol abuse.

"At the minimum, providers need to have this information so they are in a position to advise their clients of the effects of alcohol on the body and the links between alcohol and HIV," she said.

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