BOTSWANA: A risky combination of alcohol and sex
SELEBI-PHIKWE, 5 November 2009 (PlusNews) - On a recent Wednesday evening, Gillian Otsile, a volunteer at a local NGO, Men Sex and AIDS, approached a group of young men drinking cartons of traditional sorghum beer at a tavern in Selebi-Phikwe, a mining town in northeastern Botswana.
In a country where nearly one in four adults is infected with HIV, Otsile's focus is talking to the patrons of local drinking establishments about the risks of combining alcohol with sex.
Most of the group in the bar in Selebi-Phikwe are unemployed and rely on occasional piece-work to buy beers for themselves and any girls they meet. Tato, who is slightly older than the others and works as an electrician, confirmed that after buying a girl beers all night, he expected to go home with her.
Using a condom depended on how drunk he was. "If you're drunk, you lose half the sensation, so the only way you can do it is flesh-to-flesh. You forget about HIV."
Tato's comments echo the findings of several studies: heavy drinking is associated with an increased likelihood of engaging in sexual behaviours that put individuals at risk of HIV infection.
A 2006 study in Botswana found that both male and female heavy drinkers were above three times more likely to have unprotected sex than non-drinkers; their odds of having multiple partners and paying for or selling sex were also much higher.
Alcohol use as a driver of HIV infections is evident throughout southern Africa, the region worst hit by the global HIV/AIDS pandemic, but few governments have implemented policies to address the problem.
However, in 2008 Botswana President Ian Khama's government acknowledged the link by legislating shortened hours for bars and slapping a 30 percent levy on alcohol. It is too soon to say whether these measures have changed drinking habits enough to have an impact on HIV infection rates.
 If you're drunk...you forget about HIV |
Some commentators say people have simply switched to drinking traditional beer called Chibuku, which still sells for less than US$1 for a one-litre carton that can be shared between friends.
The tavern adjacent to the office of District AIDS Coordinator Lamech Myengwa is still doing brisk business, especially at month-end. "In Botswana, drinking has become a pastime," he told IRIN/PlusNews. As few small towns have a cinema or much else by way of recreational facilities, people mostly do their socialising at bars to socialise, he added.
Sex for booze
Government figures from 2008 show that HIV infections in Selebi-Phikwe, as in most of Botswana and across southern Africa, are highest among young women and older men, demographics that tend to be replicated in the bars.
"The women are young girls, from 16 [years old]," said Dikgang Keabetswe, a project leader at Men Sex and AIDS, one of several community-based organizations receiving funding from Population Services International (PSI), a global health organization, to raise awareness about alcohol and HIV in local bars.
"Some [young women] go [to the bars] without a cent; they look for males to buy them something to drink, and even for transport money. Men mostly expect sex in return. The BCL guys [workers at the local copper and nickel mine] - those who have more money - are mostly over 25."
Employment opportunities for women in Selebi-Phikwe have shrunk since several textile factories closed in the late 1990s, and some have turned to commercial sex work, while others occasionally exchange sex for drinks or small amounts of cash.
On her way home from buying a bag of maize, Elizabeth, 27, has stopped at the tavern where Tato and his friends are drinking. "I want a drink but I don't have money, so I'm hoping someone will buy me one," she said, admitting that some men expected sexual favours in return.
"If I want, I go with him. Sometimes I use a condom, but if he says, 'I don't have a condom', and I see he has a lot of money, I'll agree ... In life, we need money."
She recently tested negative for HIV, but believes it is only a matter of time before she contracts the virus.
Tato and his friends have similarly fatalistic attitudes and a reluctance to change risky sexual behaviours; several said they slept with sex workers whenever they had money.
"I'm not afraid of HIV because there are ARVs [antiretrovirals] for free," said one, referring to the government ARV programme which reaches nearly 100 percent of those in need of the medication. "I'm afraid of it ... when I'm sober," laughed Tato.
Changing behaviours no easy task
Persuading people to reduce their alcohol consumption will have little effect on Botswana's HIV infection rates unless it is accompanied by fundamental changes in attitudes and behaviours.
The young volunteers doing the PSI-funded interventions at bars are trained to strike up conversations with people not only about drinking responsibly, but also about the common practice of having multiple concurrent partners (MCPs) - perhaps the biggest and most neglected driver of HIV infections in southern Africa, according to recent research.
PSI is providing technical assistance to Botswana's National AIDS Coordinating Agency (NACA) in an initiative launched earlier this year to raise awareness and eventually change behaviour.
The first phase is a mass media campaign featuring the slogan "o icheke" (check yourself), to get people to recognize the risks of having MCPs. Starting in December, a second phase will target demographic groups most likely to have MCPs with tailored messages, said Richard Matlhare, head of behaviour change at NACA.
"We looked at alcohol as one of the predisposing factors, and that's why the President has taken a stance on responsible drinking," Matlhare said. "We know people can't make informed judgements when they're drunk."
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