Randomized Trial of a Community-based Alcohol-related HIV Risk-reduction Intervention for Men and Women in Cape Town South Africa

Background  HIV is devastating southern Africa and alcohol use is closely related to HIV transmission risks. Purpose  The current study tested the efficacy of a brief single-session HIV–alcohol risk-reduction intervention for men and women who drink at informal alcohol serving establishments (i.e., shebeens) in South Africa. Methods  A randomized community field trial recruited men (N = 117) and women (N = 236) through outreach and chain referrals. Participants received either: (a) 3-h theory-based behavioral HIV–alcohol risk-reduction intervention that focused on skills training for sexual negotiation and condom use or (b) 1-h HIV–alcohol information/education control group. Participants were followed up for 3 and 6 months post-intervention with 89% retention. Results  The risk-reduction intervention demonstrated significantly less unprotected intercourse, alcohol use before sex, numbers of sex partners, partners met at drinking establishments and greater condom use relative to the control group. However, intervention effects were moderated by alcohol use; lighter drinkers demonstrated significantly more intervention gains than heavier drinkers in the risk-reduction condition. Intervention effects occurred at 3 months follow-up and dissipated by 6 months. Conclusions  A brief HIV risk-reduction intervention reduced sexual-risk behaviors among drinkers in South Africa. However, intervention effects were weakest for those who drink heaviest. Our results provide a basis for establishing HIV prevention in alcohol serving establishments in South Africa. Research is needed to identify multi-level intervention models that can reduce risks among heavier drinkers and sustain behavior changes over time. National Institute of Alcohol Abuse and Alcoholism Grants R21-AA014820 and R01AA017399 supported this research.