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Alcohol Epidemiology and Pilot Intervention to Reduce Alcohol, IPV and HIV in Women in Uganda
Uganda has one of the highest global rates of alcohol use and Ugandan women’s per capita intake is 2 times higher than the worldwide average (8.9 liters) for females. Alcohol consumption (particularly in sexual situations) is correlated with high-risk sex behaviors, spousal quarrelling, aggression and intimate partner violence (IPV) against women. Alcohol use is also a barrier to HIV testing among Ugandan women and associated with HIV prevalence 2 times as high (10% v. 5%) as in non-drinkers. In Rakai, the proposed study setting, women 15-24 years are the most frequent alcohol drinkers and its use is associated with physical and sexual IPV and increased HIV incidence. The study pilot test a screening and brief intervention (SBI) to reduce harmful alcohol use in abused women seeking HIV counseling and testing (HCT) from Rakai Health Sciences Program (RHSP), an HIV program in rural Uganda. Women who consume alcohol are at increased risk for intimate partner violence (IPV) and high-risk sexual behaviors, both of which are risk factors for HIV infection. The study aims to assess the feasibility of implementing an alcohol and IPV SBI in an extremely vulnerable population of women seeking HCT in a high HIV and alcohol prevalence fishing community of Rakai, Uganda (pop. 484,400) which has a generalized HIV epidemic, disproportionately affecting women and residents of fishing communities and alcohol use is high among Rakai fisherfolk. As in other regions of SSA, IPV is common in Rakai and associated with alcohol and incident HIV. The design of the SBI to be pilot tested will be informed by findings from qualitative research and secondary data from the Rakai Community Cohort Study (RCCS), one of the oldest community-based HIV and STI cohorts in the world.