Chapter 2: ls there a causal relationship between alcohol and HIV? Implications for policy, practice and future research by Charles A. H. Parry, Jurgen Rehm & Neo K. Morojeie



Sub—Saharan Africa (SSA) remains the region most heavily affected by HIV and AIDS. In 2008 it accounted for 67% of HIV infections worldwide, accounting for 70% of new infections and 70% of AIDS—related deaths (UNAIDS and WHO, 2009). South Africa is one country in SSA that has been substantially affected, with an adult (15-49 years) HIV prevalence rate of 18.1% in 2007 and approximately 350,000 AIDS deaths reported in that year (WHO, UNAIDS & UNICEF, 2008). SSA has a high proportion of the population that abstains from drinking, reported to be 55% of males and 69% of females, while annual per capita consumption of alcohol per drinker is very high in this region, at an estimated 19.5 litres (Roerecke, Obot, Patra, & Flehm, 2008). Average drinking pattern scores in SSA are also high, 2.9 out of 4 in Afro Region D and 3.1 out of 4 in Afro Region E, reflecting detrimental drinking patterns such as heavy episodic drinking and drinking outside of meals (Hoerecke et al., 2008). A recent review of drinking practices in 20 African countries reported that 23% of South Africans had drunk alcohol in the previous week, but of these 29% could be categorized as high consumers (that is, drinking 15 or more units of alcohol during the previous week and 48% could be categorized as heavy drinkers (that is, drinking five or more units on one or more occasions during this time period). Of the 20 countries, South Africa was ranked fourth highest in terms of the proportion of heavy drinkers as a percentage of current drinkers (Clausen, Rossow, Naidoo, & Kowal, 2009}- In this country rates of heavy drinking are four to five times higher on weekends than on weekdays (Parry, Pltiddemann, Steyn, Bradshaw, Norman, & Laubscher, 2005).
In this article We will review international research on the linkages between alcohol and HIV before presenting the results of analyses reported by Rehm, Kehoe, Fiehm, and Patra l2009b) on the burden of alcohol in terms of death and disability in South Africa. in particular we will present data quantifying the contribution of alcohol to the progression of HIV disease. The implications of this burden and also the strong association between alcohol and the acquisition of HIV will be discussed in terms of new policies and practices needed and what research is required to fill in some of the gaps in our understanding of causality and how best to intervene.