Inequitable gender norms are associated with male partner concurrency, unprotected sex, binge drinking and male perpetration of intimate partner violence (IPV). Binge drinking is strongly associated with transactional, casual and condomless sex and multiple and concurrent partnerships. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.īinge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. ConclusionsĪlthough binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0–2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8–7.2%) or by 7.3% (0.6–21.2%) if there was no waning of intervention impact. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0–68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. Binge drinking accounted for 6.8% of new HIV infections (0.0–32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Resultsīinge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000–2021 period 54% (95% CI: 34–74%) of new HIV infections occurred in binge drinkers. Binge drinking was defined as five or more drinks on a single day, in the last month. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions ( n = 9) and gender-transformative interventions ( n = 4) in sub-Saharan Africa. We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission. Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked.
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