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Conference
Themes and Challenges
Presenters and audience members raised many issues about alcohol use and HIV risk. A final conference panel* summarized the main themes and issues that emerged and the challenges for future research and intervention.
One of the most salient issues raised in the presentations was the importance of mental health variables including history of mental health problems, and sensation seeking in understanding drinking and sexuality. Unfortunately, the links between mental health problems and substance use are not sufficiently explored as yet in India and this area calls for further research. A second important gap was information on the actual effects of drinking on sexual function, and the points at which specific amounts of drinking have an effect on arousal and performance.
Another important issue is the need for gendered perspective in future research examining alcohol use and unprotected sex. In particular, differences between men’s and women’s views about the utility or detrimental aspects of alcohol in sexual contexts need to be explored more fully in the India context.
A critical issue relates to women’s vulnerability to the negative consequences of alcohol use by spouses. For example, women hired to sell alcohol in bars and dance bars generally drink with their clients. And some female sex workers are required to drink with clients. They are fully cognizant of the fact that alcohol impairs their ability to negotiate condom use with clients. Yet they do not always have control over whether they drink and how much they drink with their clients. Thus interventions that help women to promote condom use with clients would be beneficial. A number of papers, including that of Schensul, Devyani et. al, illustrate how effective interventions can be when women are supported to organize around the use of condoms, provide condoms to partners, and include the cost of condoms in the price of a sexual encounter.
Some papers argued for the importance of understanding the laws and regulations governing the production, marketing, purchase and consumption of alcohol in different states. Dr. Ram of IIPS called for a review of policies related to these factors nationally and across states, as well as a look at where prohibition policies did or did not make a difference. Some states see the advantage of increasing legal alcohol sales to reap tax revenues. There is widespread understanding that prohibition does not result in decreased alcohol consumption. In fact, it sends alcohol production and consumption underground.
Proper measurement of alcohol consumption was deemed an important issue. Most measures of alcohol use in India are relatively limited, depending on “ever used” or, at best, “thirty day use” of any alcohol. But in various parts of the country many different types of alcohol are used, fermented or distilled. Alcohol is made of substances ranging from rice to coconut and cadjew and manufactured and licensed, or made at home, or illegally (home brews of various sorts). Dr. Greenfield and other researchers noted that identifying which substances are used in a local area, how much is drunk at a sitting, in what vessels, and how often, and how much pure alcohol is included in each type of drink are critical indicators that can be used to arrive at a more accurate measure of alcohol consumption. With better indicators, it may be easier to determine whether higher quantity of pure alcohol or consumption patterns and contexts or both lead to unprotected sex. Dr. Ellen Cromley and other researchers explored an additional dimension of alcohol use by investigating patterns in where alcohol was consumed. Individuals who live in the same communities drink in different settings including places outside of the communities where they live.
Alcohol consumption among women needs closer examination. Although many women do not use alcohol in large amounts or at all in India, there are groups identified by caste, tribal affiliation and geographic zone for which alcohol consumption by women is acceptable. Dr. Schensul suggested that a closer examination of regular alcohol use among women, especially those of reproductive age, is warranted to detect possible effects of alcohol on pregnancies, pregnancy outcomes, and STIs as well as other indicators of reproductive health. Formative research to create non stigmatizing services for women drinkers is another priority.
Finally, many papers pointed to the notion that reducing alcohol consumption could not happen through individualized behavioral interventions. The Berg, Schensul and Bryant papers in particular, noted that interventions at individual, family, community and policy levels were required to change social norms and practices around alcohol consumption and its consequences. Berg argued that multilevel interventions were necessary to protect women against the effects of alcohol consumption of their spouses. She suggested that these could include shelters and counseling support in police stations, protective behaviors of families and elected officials, organizations of men and women allied together to stop violence against women, and strong implementation of existing gender-discrimination policies at the national and state level. More such multilevel interventions are required to reduce alcohol marketing, sales, consumption and the consequences of over consumption of alcohol that affect men, women and families. Developing, measuring and disseminating interventions at multiple levels is the focus of the Second International Conference on Alcohol and HIV in India, to be held in Delhi, September 28th through 30th, 2010.
Conference Highlights & Selected Presentations
*The conference closing panel included Drs. F. Ram, Demographer and director of IIPS; Ravi Verma, Psychologist, and Director, ICRW; Kendall Bryant, Alcohol and AIDS Program Coordinator, NIAAA; and Jean Schensul, Senior Scientist and Founding Director, ICR.
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