Cited by 142HIV, Drug Use, Sexual RiskHIV/AIDS Research and InterventionsSubstance Abuse Treatment and Outcomes

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

Kalichman, Seth C., Simbayi, Leickness C., Vermaak, Redwaan, Cain, Demetria, Smith, Gino, Mthebu, Jacqueline, Jooste, Sean·2008·Annals of Behavioral Medicine

DOI 10.1007/s12160-008-9067-2

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Abstract

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.

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Background
“If She is Drunk, I Don’t Want Her to Take it”: Partner Beliefs and Influence on Use of Alcohol and Antiretroviral Therapy in South African Couples
Conroy, A. A., McKenna, S. A., Leddy, A. M., Johnson, M. O., Ngubane, T., Darbes, L. A., & van Rooyen, H. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1697-6 · Cited by 31
“the US and in other developed countries, a few studies from South Africa have shown brief interventions to be effective at reducing alcohol consumption and HIV risk behavior [37, 38].”
Single-Session Behavioral Interventions for Sexual Risk Reduction: A Meta-Analysis
Sagherian, M. J., Huedo-Medina, T. B., Pellowski, J. A., Eaton, L. A., & Johnson, B. T. (2016) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9818-4 · Cited by 29
The Roles of Behavioral and Social Science Research in the Fight Against HIV/AIDS: A Functional Framework
Gaist, P., & Stirratt, M. J. (2017) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001399 · Cited by 28
A Systematic Review of the Effects of Behavioral Counseling on Sexual Risk Behaviors and HIV/STI Prevalence in Low- and Middle-Income Countries
Zajac, K., Kennedy, C. E., Fonner, V. A., Armstrong, K., O’Reilly, K., & Sweat, M. D. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0893-x · Cited by 26
“[15] Yes Yes Yes Yes No Yes Yes Yes Kalichman et al.”
Influential
Rarity and limited geographical coverage of individual level alcohol interventions in sub Saharan Africa: findings from a scoping review
Francis, J. M., Cook, S., Morojele, N. K., & Swahn, M. H. (2020) · Journal of Substance Use · doi:10.1080/14659891.2019.1664662 · Cited by 26
Health promotion interventions and policies addressing excessive alcohol use: a systematic review of national and global evidence as a guide to health‐care reform in C hina
Li, Q., Babor, T. F., Zeigler, D. W., Xuan, Z., Morisky, D. E., Hovell, M. F., Nelson, T. F., Shen, W., & Li, B. (2014) · Addiction · doi:10.1111/add.12784 · Cited by 26
Reducing Numbers of Sex Partners: Do We Really Need Special Interventions for Sexual Concurrency?
Kalichman, S. C., & Grebler, T. (2010) · AIDS and Behavior · doi:10.1007/s10461-010-9737-5 · Cited by 26
Self-citation
Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research.
Parry, C., Rehm, J. T., & Morojele, N. K. (2011) · African Journal of Drug and Alcohol Studies · doi:10.4314/ajdas.v9i2.64141 · Cited by 26
Feasibility and acceptability of a bar-based sexual risk reduction intervention for bar patrons in Tshwane, South Africa
Morojele, N. K., Kitleli, N., Ngako, K., Kekwaletswe, C. T., Nkosi, S., Fritz, K., & Parry, C. D. H. (2014) · SAHARA-J: Journal of Social Aspects of HIV/AIDS · doi:10.1080/17290376.2014.890123 · Cited by 24
A prospective study of alcohol consumption and HIV acquisition among injection drug users
Howe, C. J., Cole, S. R., Ostrow, D. G., Mehta, S. H., & Kirk, G. D. (2010) · AIDS · doi:10.1097/qad.0b013e328340fee2 · Cited by 24
“Finally, randomized evidence is not feasible due to ethical concerns, or lack of compliance in the case of risk reduction trials [35,36].”
Background
Food Insufficiency, Substance Use, and Sexual Risks for HIV/AIDS in Informal Drinking Establishments, Cape Town, South Africa
Kalichman, S. C., Watt, M., Sikkema, K., Skinner, D., & Pieterse, D. (2012) · Journal of Urban Health · doi:10.1007/s11524-012-9686-6 · Cited by 23
Self-citation
Task-shifting alcohol interventions for HIV+ persons in Kenya: a cost-benefit analysis
Galárraga, O., Gao, B., Gakinya, B. N., Klein, D. A., Wamai, R. G., Sidle, J. E., & Papas, R. K. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2169-4 · Cited by 24
Efficacy of a Brief HIV Prevention Counseling Intervention Among STI Clinic Patients in Russia: A Randomized Controlled Trial
Abdala, N., Zhan, W., Шаболтас, А. В., Skochilov, R. V., Kozlov, A. P., & Krasnoselskikh, Т. V. (2012) · AIDS and Behavior · doi:10.1007/s10461-012-0311-1 · Cited by 23
“similar brief interventions [23] and suggest that for a sustained effect, longer intervention or booster sessions may be required.”
Ethical Issues in a Stage 1 Cognitive-Behavioral Therapy Feasibility Study and Trial to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya
Papas, R. K., Gakinya, B. N., Baliddawa, J. B., Martino, S., BRYANT, K. J., Meslin, E. M., & Sidle, J. E. (2012) · Journal of Empirical Research on Human Research Ethics · doi:10.1525/jer.2012.7.3.29 · Cited by 22
“…Africa focused on reducing these public health crises, including interventions The ethical conduct of behavioral therapy trials in resource-limited settings has been largely ignored, in part because these trials have only recently been initiated (Wechsberg et al., 2010; Kalichman et al., 2008).”
Background
Food Insecurity and Alcohol Use Among Pregnant Women at Alcohol-Serving Establishments in South Africa
Eaton, L. A., Pitpitan, E. V., Kalichman, S. C., Sikkema, K. J., Skinner, D. G., Watt, M. H., Pieterse, D., & Cain, D. N. (2013) · Prevention Science · doi:10.1007/s11121-013-0386-6 · Cited by 22
Self-citation
Risk Factors of Alcohol Problem Drinking Among Female Bar/Hotel Workers in Moshi, Tanzania: A Multi-level Analysis
Ao, T. T.-H., Sam, N., Kiwelu, I., Mahal, A. S., Subramanian, S. V., Wyshak, G., & Kapiga, S. (2010) · AIDS and Behavior · doi:10.1007/s10461-010-9849-y · Cited by 21
“One facility-based intervention, which was recently conducted by Kalichman et al. [ 41 ] involves theory-based behavioral HIV-alcohol risk reduction session involving alcohol negotiation skills and condom use.”
Method
Toward Development of Enhanced Preventive Interventions for HIV Sexual Risk among Alcohol-Using Populations: Confronting the ‘Mere Pause from Thinking’
Freeman, R. C. (2015) · AIDS and Behavior · doi:10.1007/s10461-015-1179-7 · Cited by 20
A modified Delphi study towards developing a guideline to inform policy on fetal alcohol spectrum disorders in South Africa: a study protocol
Adebiyi, B. O., Mukumbang, F. C., Okop, K., & Beytell, A.-M. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019907 · Cited by 20
“[23] Urban M, Chersich MF, Fourie L-A, et al.”
Background
Joint Modeling of Longitudinal Data in Multiple Behavioral Change
Charnigo, R. J., Kryscio, R. J., Bardo, M. T., Lynam, D. R., & Zimmerman, R. S. (2010) · Evaluation & the Health Professions · doi:10.1177/0163278710392982 · Cited by 19
“Two other interventions combined elements of an alcohol-focused program with an HIV risk reduction program for populations in South Africa, one targeting secondary school students (Cupp et al., 2008) and the other targeting adults who drink in shebeens (similar to taverns, Kalichman et al., 2008).”
Background
The Role of Alcohol Expectancies in Sexual Risk Behaviors Among Adolescents and Young Adults in the Democratic Republic of the Congo
Hurley, E. A., Brahmbhatt, H., Kayembe, P. K., Busangu, M.-A. F., Mabiala, M.-U., & Kerrigan, D. L. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2016.08.023 · Cited by 19
The post‐2015 landscape: vested interests, corporate social responsibility and public health advocacy
Herrick, C. (2016) · Sociology of Health & Illness · doi:10.1111/1467-9566.12424 · Cited by 19
Hazardous alcohol use and HIV indicators in six African countries: results from the Population‐based HIV Impact Assessments, 2015–2017
Chang, G., West, C., Kim, A. A., Low, A., Lancaster, K. E., Behel, S. K., Hong, S. Y., Miller, L. A., Silver, R., Mgomella, G. S., et al. (2022) · Journal of the International AIDS Society · doi:10.1002/jia2.26029 · Cited by 17
“To reach HIV epidemic control, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set its ambitious 95-95-95 “Fast-Track” targets, which entails getting 95% of all PLHIV to know their HIV status, 95% of people who know their status to receive HIV treatment and 95% of people on HIV treatment to have viral load…”
BackgroundInfluential
Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions
Parry, C. D. H., Carney, T., & Williams, P. P. (2017) · SAHARA-J Journal of Social Aspects of HIV/AIDS · doi:10.1080/17290376.2017.1381640 · Cited by 18
“The only significant change was that there was a decrease in the number of sexual partners reported at the follow-up period, which again is likely to lead to a reduction in harms at both an individual and population level (Kalichman et al., 2008; Mah & Halperin, 2010).”
Background
HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention
Velloza, J., Watt, M. H., Abler, L., Skinner, D. G., Kalichman, S. C., Dennis, A. C., & Sikkema, K. J. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1853-z · Cited by 18
“These interventions have already demonstrated some success in South Africa, although structurallevel interventions with community stakeholders and venue owners may be necessary for individuals with severe alcohol dependence, who may have difficulty changing their behaviors without a more integrated approach [44, 45].”
BackgroundSelf-citation
Changing trends and the impact of alcohol on the HIV/AIDS epidemic in South Africa: Review
Setshedi, M., & de la Monte, S. M. (2011) · SAHARA-J Journal of Social Aspects of HIV/AIDS · doi:10.1080/17290376.2011.9724990 · Cited by 15
“Kalichman et al., 2008 showed that among participants recruited from 4 shebeens in a racially integrated township, 28% met their sexual partners at the shebeens versus other locations, and that meeting sex partners at shebeens is correlated with significantly increased rates of HIV transmission…”
Background
Beliefs about fetal alcohol spectrum disorder among men and women at alcohol serving establishments in South Africa
Eaton, L. A., Pitpitan, E. V., Kalichman, S. C., Sikkema, K. J., Skinner, D. G., Watt, M. H., Pieterse, D., & Cain, D. N. (2014) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2013.830621 · Cited by 15
Self-citation
Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients
Trillo, A. D., Merchant, R. C., Baird, J. R., Ladd, G. T., Liu, T., & Nirenberg, T. D. (2013) · BMC Emergency Medicine · doi:10.1186/1471-227x-13-9 · Cited by 14
“, 313 participants were randomly assigned to a three-hour HIV-alcohol risk-reduction skills intervention or a single one-hour HIV-alcohol education control group [93].”
Examining the relationship between alcohol use and high-risk sex practices in a population of women with high HIV incidence despite high levels of HIV-related knowledge
Zetola, N. M., Modongo, C., Olabiyi, B., Ramogola‐Masire, D., Collman, R. G., & Chao, L. (2014) · Sexually Transmitted Infections · doi:10.1136/sextrans-2013-051244 · Cited by 14
Common Elements Treatment Approach (CETA) for unhealthy alcohol use among persons with HIV in Zambia: Study protocol of the ZCAP randomized controlled trial
Kane, J. C., Sharma, A., Murray, L. K., Chander, G., Kanguya, T., Lasater, M. E., Skavenski, S. V. W., Paul, R., Mayeya, J., Danielson, C. K., et al. (2020) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2020.100278 · Cited by 13
Taxonomy of Caribbean tourism alcohol venues: Implications for HIV transmission
Guilamo‐Ramos, V., Jaccard, J. J., McCarthy, K. J., Tavárez, Z. Q., Lushin, V., Skinner-Day, M., Padilla, M., & Meisterlin, L. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.02.010 · Cited by 13
“Extant research reports likelihood of HIV risk behaviors in alcohol settings (Fritz et al., 2002; Go et al., 2007; Kalichman et al., 2008), and in some instances has documented an increased prevalence of HIV among venue patrons compared with the general population (Lewis et al.”
BackgroundInfluential
HIV/AIDS-related stigma in South African alcohol-serving venues and its potential impact on HIV disclosure, testing and treatment-seeking behaviours
Velloza, J., Watt, M. H., Choi, K. W., Abler, L., Kalichman, S. C., Skinner, D. G., Pieterse, D., & Sikkema, K. J. (2015) · Global Public Health · doi:10.1080/17441692.2014.1001767 · Cited by 12
“…a short-term increase in condom use among patrons, but the effects waned approximately six months after the intervention potentially due to contextual factors, which could include HIV-related stigma, that prevented maintenance of risk reduction behaviours (Kalichman et al., 2007, 2008).”
Self-citation
How Inexpensive Does an Alcohol Intervention in Kenya Need to be in Order to Deliver Favorable Value by Reducing HIV-Related Morbidity and Mortality?
Braithwaite, R. S., Nucifora, K. A., Kessler, J., Toohey, C., Li, L., Mentor, S. M., Uhler, L. M., Roberts, M. S., Galvani, A. P., & BRYANT, K. J. (2014) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000140 · Cited by 12
“Randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT)-based interventions addressing unhealthy alcohol consumption in Kenya show promising results, increasing abstinence by 45%,(12,13) and decreasing risky sex.(14,15) However, alcohol remains conspicuously absent from programming in HIV and substan…”
Background
What works to prevent violence against women and girls evidence reviews
Fulu, E., Kerr-Wilson, A., Gibbs, A., Jacobson, J., Jewkes, R. K., Lang, J., Mazars, C., Schauerhammer, V., & Watts, C. H. (2015) · Cited by 12
HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride
Shuper, P. A., MacLachlan, D., Joharchi, N., Guimond, T. H., Maxwell, J., & Adam, B. D. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2117-2 · Cited by 12
Transactional Sex, Alcohol Use and Intimate Partner Violence Against Women in the Rakai Region of Uganda
Miller, A. P., Pitpitan, E. V., Nabukalu, D., Nalugoda, F. K., Nakigozi, G. F., Kigozi, G., Grabowski, M. K., Kennedy, C. E., & Wagman, J. A. (2020) · AIDS and Behavior · doi:10.1007/s10461-020-03069-9 · Cited by 12
“Working around alcohol also exposes women to its availability, increasing likelihood of consumption and many studies in Africa have linked drinking with lowered inhibitions and heightened sexual risk behavior and HIV and other sexually transmitted infections [19, 20].”
Background
Brief Intervention of Alcohol Problems in Sub-Saharan Africa: A Review
Peltzer, K. (2009) · Journal of Psychology in Africa · doi:10.1080/14330237.2009.10820310 · Cited by 11
“…alcohol use Daily cocaine use (1 ms follow-up) Reduction from 15% to 5% in daily alcohol use in woman-focused group and from 18% to 10% in standard group Kalichman et al. (2008) 117 men and 236 women who drink at informal alcohol serving establishments (i.e., shebeens) recruited from community.”
Background
Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries
Greene, M. C., Kane, J., Alto, M., Giusto, A., Lovero, K., Stockton, M., McClendon, J., Nicholson, T., Wainberg, M. L., Johnson, R. M., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013350.pub2 · Cited by 11
Alcohol and Sexual Risk Reduction Interventions Among People Living in Russia: A Systematic Review and Meta-analysis
Lan, C., Scott‐Sheldon, L. A. J., Carey, K. B., Johnson, B. T., & Carey, M. P. (2013) · AIDS and Behavior · doi:10.1007/s10461-013-0615-9 · Cited by 11
Factors Associated with HIV Discussion and Condom Use with Sexual Partners in an Underserved Community in South Africa
Conserve, D. F., Middelkoop, K., King, G., & Bekker, L. (2016) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2016.0015 · Cited by 11
Complex solutions for a complex problem: A meta-analysis of the efficacy of multiple-behavior interventions on change in outcomes related to HIV.
Sunderrajan, A., White, B., Durantini, M. R., Sánchez, F., Glasman, L. R., & Albarracín, D. (2021) · Health Psychology · doi:10.1037/hea0001088 · Cited by 11
Cultural Adaptation of an Intervention to Reduce Sexual Risk Behaviors among Patients Attending a STI Clinic in St. Petersburg, Russia
Grau, L. E., Krasnoselskikh, Т. V., Шаболтас, А. В., Skochilov, R. V., Kozlov, A. P., & Abdala, N. (2013) · Prevention Science · doi:10.1007/s11121-012-0301-6 · Cited by 11
“and demonstrated to be effective in promoting HIV risk reduction behavior change including those associated with alcohol consumption (Kalichman et al. 2007; Kalichman et al. 2008), has been successfully adapted for use in South Africa (Mathiti et al.”
A scoping review of substance use brief interventions in Africa
Jaguga, F., Kiburi, S. K., Temet, E., Aalsma, M. C., Ott, M. A., Maina, R. W., Wachira, J., Mostert, C., Kosgei, G., Tenge, A., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003340 · Cited by 10
Social and structural determinants of youth alcohol use in Tanzania: The role of gender, social vulnerability and stigma
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“List of Abbreviations HIV Human Immunodeficiency Virus AIDS Acquired Immunodeficiency Syndrome TasP Treatment-as-Prevention PEP Post-Exposure Prophylaxis PrEP Pre-Exposure Prophylaxis References Beckham SW, Shembilu CR, Brahmbhatt H, Winch PJ, Beyrer C, Kerrigan DL, Services C, Beckham SW, Shembilu CR, & Brahmbhatt H…”
BackgroundInfluential
Gender inequality dynamics in the prevention of a heterosexual HIV epidemic in sub-Saharan Africa
Wathuta, J. (2016) · African Journal of AIDS Research · doi:10.2989/16085906.2016.1150310 · Cited by 9

Authors: Kalichman, S. C., Simbayi, L. C., Vermaak, R., Cain, D., Smith, G., Mthebu, J., & Jooste, S.
Affiliations: University of Connecticut (US)
Human Sciences Research Council (ZA)
Corresponding author: Kalichman, Seth C.
ORCID: Kalichman, Seth C.
Simbayi, Leickness C.
Vermaak, Redwaan
Cain, Demetria
Jooste, Sean
Venue: Annals of Behavioral Medicine
Publisher: Oxford University Press (OUP)
Published: 2008-10-04
Volume: 36
Issue: 3
Pages: 270-279
ISSN: 0742-5554 (ISSN-L)
0883-6612
1532-4796
DOI: 10.1007/s12160-008-9067-2
OpenAlex: W2104218863
Cited by: 142
References: 41
Citations by year: 2026: 2 · 2024: 1 · 2023: 2 · 2022: 7 · 2021: 3 · 2020: 5 · 2019: 10 · 2018: 7 · 2017: 12 · 2016: 7 · 2015: 13 · 2014: 12 · 2013: 9 · 2012: 11
FWCI: 10.14
Type: journal article
Language: en
Open access: closed
Locations: Annals of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Alcohol Abuse and Alcoholism (R21AA014820, R01AA017399)
Topics: Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: HIV risk reduction, alcohol consumption, sexual risk behavior, condom use, sexual negotiation, shebeens, brief intervention, community-based intervention, heavy drinking, intervention moderators, HIV prevention, Cape Town
MeSH terms: Adult, Alcohol Drinking, Community-Institutional Relations, Female, Health Education, Humans, Male, Sexual Behavior, South Africa, HIV Infections, Condoms, Risk Reduction Behavior

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

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