An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa.
Alcohol
Gender norms
HIV/AIDS
Mathematical modelling
South Africa
Structural intervention
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
29 Jul 2023
29 Jul 2023
Historique:
received:
20
01
2023
accepted:
18
07
2023
medline:
31
7
2023
pubmed:
30
7
2023
entrez:
29
7
2023
Statut:
epublish
Résumé
Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. 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. 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. 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. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month. Binge 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 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. 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. 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. Although 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. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.
Sections du résumé
BACKGROUND
BACKGROUND
Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. 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.
METHODS
METHODS
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. 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. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month.
RESULTS
RESULTS
Binge 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 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. 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. 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.
CONCLUSIONS
CONCLUSIONS
Although 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. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.
Identifiants
pubmed: 37516819
doi: 10.1186/s12879-023-08470-y
pii: 10.1186/s12879-023-08470-y
pmc: PMC10385913
doi:
Substances chimiques
Ethanol
3K9958V90M
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
500Subventions
Organisme : Bill and Melinda Gates Foundation
ID : 007145
Informations de copyright
© 2023. The Author(s).
Références
Lancet. 2019 Jun 15;393(10189):2455-2468
pubmed: 31155273
JAMA. 2018 Nov 13;320(18):1910-1928
pubmed: 30422198
BMJ Glob Health. 2016 Dec 30;1(4):e000125
pubmed: 28588979
Curr HIV/AIDS Rep. 2011 Sep;8(3):172-80
pubmed: 21713433
Int J Public Health. 2010 Jun;55(3):159-66
pubmed: 19949966
PLoS Med. 2022 Apr 12;19(4):e1003961
pubmed: 35413054
J Int AIDS Soc. 2014 Sep 08;17:19052
pubmed: 25204872
S Afr Med J. 2014 Mar;104(3 Suppl 1):249-51
pubmed: 24893502
J Acquir Immune Defic Syndr. 2022 Jun 1;90(2):115-123
pubmed: 35125471
Prev Sci. 2014 Jun;15(3):296-308
pubmed: 23494405
Epidemiol Perspect Innov. 2012 Feb 01;9(1):1
pubmed: 22296660
Soc Sci Med. 2012 Apr;74(7):1005-12
pubmed: 22326304
J Int AIDS Soc. 2018 Jul;21(7):e25134
pubmed: 29972287
Alcohol Res. 2015;37(2):159-70
pubmed: 26695755
AIDS. 1997 Apr;11(5):641-8
pubmed: 9108946
AIDS Behav. 2018 Apr;22(4):1253-1264
pubmed: 29273945
Drug Alcohol Depend. 2015 Jun 1;151:110-4
pubmed: 25823906
Infect Dis Model. 2017 Feb 16;2(1):71-89
pubmed: 29928730
PLoS One. 2012;7(1):e28739
pubmed: 22247761
Addiction. 2017 Apr;112(4):705-710
pubmed: 27859902
PLoS One. 2021 Aug 5;16(8):e0255843
pubmed: 34352005
Alcohol Clin Exp Res. 2002 Jan;26(1):36-43
pubmed: 11821652
Psychol Bull. 2018 Oct;144(10):1081-1110
pubmed: 29878796
AIDS Care. 2010 Dec;22(12):1544-54
pubmed: 20824551
Soc Work Public Health. 2013;28(3-4):313-32
pubmed: 23731422
J Acquir Immune Defic Syndr. 2013 Jan 1;62(1):119-26
pubmed: 23075920
AIDS. 2019 Dec 15;33 Suppl 3:S203-S211
pubmed: 31343430
AIDS Behav. 2020 Sep;24(9):2616-2623
pubmed: 32124109
J Pers. 1992 Jun;60(2):175-215
pubmed: 1635039
J Consult Clin Psychol. 2011 Jun;79(3):296-306
pubmed: 21500886
J Adolesc Health. 2019 Dec;65(6):730-737
pubmed: 31543406
Afr J Psychiatry (Johannesbg). 2011 Mar;14(1):30-7
pubmed: 21509408
Addiction. 2002 Jun;97(6):665-75
pubmed: 12084136
AIDS Behav. 2013 Nov;17(9):2845-63
pubmed: 23934267
Soc Sci Med. 2007 Sep;65(6):1235-48
pubmed: 17560702
J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):230-7
pubmed: 21372724
J Acquir Immune Defic Syndr. 2019 Jun 1;81(2):193-201
pubmed: 30893127
AIDS. 2003 Apr 11;17(6):895-903
pubmed: 12660537
BMJ Glob Health. 2020 Oct;5(10):
pubmed: 33051283
AIDS Behav. 2011 May;15(4):687-92
pubmed: 20890654
PLoS Med. 2020 Apr 17;17(4):e1003056
pubmed: 32302308
J Acquir Immune Defic Syndr. 2015 Jun 1;69 Suppl 2:S118-27
pubmed: 25978478
Violence Vict. 2006 Apr;21(2):247-64
pubmed: 16642742
PLoS One. 2015 Dec 18;10(12):e0145326
pubmed: 26683812
S Afr Med J. 2017 Dec 13;108(1):33-39
pubmed: 29262976
BMC Public Health. 2017 Jul 4;17(Suppl 3):548
pubmed: 28832283
J Int AIDS Soc. 2020 Jun;23 Suppl 2:e25518
pubmed: 32589340
AIDS Care. 2018 Oct;30(10):1231-1238
pubmed: 29947246
Afr Health Sci. 2020 Sep;20(3):1397-1406
pubmed: 33402988
PLoS One. 2017 Feb 16;12(2):e0171200
pubmed: 28207844
Math Biosci. 1996 Apr 15;133(2):165-95
pubmed: 8718707
Alcohol Clin Exp Res. 2014 Apr;38(4):1059-67
pubmed: 24428236
J Acquir Immune Defic Syndr. 2014 Dec 1;67(4):446-53
pubmed: 25197826
AIDS Behav. 2017 Nov;21(Suppl 2):126-143
pubmed: 28831609
Arch Sex Behav. 2020 Apr;49(3):999-1015
pubmed: 31552573
AIDS Behav. 2018 Jun;22(6):1858-1869
pubmed: 28161801
Addict Sci Clin Pract. 2021 Jun 29;16(1):41
pubmed: 34187582
Prev Sci. 2007 Jun;8(2):141-51
pubmed: 17265194
Soc Sci Med. 2004 Oct;59(8):1581-92
pubmed: 15279917
AIDS Behav. 2021 Nov;25(Suppl 2):215-224
pubmed: 34478016
Alcohol Alcohol. 2010 Mar-Apr;45(2):159-66
pubmed: 20061510
AIDS Behav. 2014 Nov;18(11):2230-9
pubmed: 24699714
AIDS Behav. 2021 Sep;25(9):2863-2874
pubmed: 33566214
AIDS Behav. 2016 Jun;20(6):1244-55
pubmed: 26271813
Sex Transm Dis. 2016 Mar;43(3):139-46
pubmed: 26859800
BMJ Open. 2021 Aug 9;11(8):e052879
pubmed: 34373316
Sex Transm Dis. 2007 Nov;34(11):856-63
pubmed: 18049422
Soc Sci Med. 2022 Feb;295:112637
pubmed: 31708236
PLoS One. 2015 Apr 08;10(4):e0122671
pubmed: 25853870
AIDS Behav. 2018 Dec;22(12):3962-3970
pubmed: 30003507
Lancet Glob Health. 2020 Feb;8(2):e225-e236
pubmed: 31879212