Support for Addiction and Prevention in Africa
Converging Epidemics in Sub-Saharan Africa
HIV/AIDS, TB and Alcohol and Drug Abuse in sub-Saharan Africa
Important information about converging epidemics
Physiological and behavioral research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use2. Consumption of alcohol and multiple partners were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence3 .
Alcohol use, especially heavy drinking and alcohol use disorders, increases the risk of contracting TB and pneumonia, as well as the progression of TB and HIV4. Alcohol use was estimated to have been responsible for 939 000 disability-adjusted life-years lost in South Africa for tuberculosis and HIV/AIDS alone in 2004 (253 000 for women, 687 000 for men). This figure corresponds to 4•6% of the overall disease burden in South Africa (2•5% for women, 6•6% for men). These numbers show the potential for reducing alcohol-attributable infectious disease burden in South Africa, since cost-effective measures for reducing alcohol-attributable harm in developing societies exist and could be applied5. Among the government of Kenya's health sector targets to be achieved in the next five years include reducing cases of TB from 888 to 444 per 100,000 persons; and reducing the HIV prevalence rate to less than 2%6
Alcohol users may be at increased risk for acquiring or developing TB, but given the many other potential risk factors that commonly occur among such persons, alcohol use has been difficult to identify as a separate risk factor for TB7. Alcohol use has been causally linked to tuberculosis incidence. Two pathways are involved: one biological via weakening of the immune system, and one social via social exclusion and drift, resulting in about a threefold increased risk of tuberculosis8.
Controlling the transmission of HIV will require access to care and treatment of individuals who abuse illicit drugs and alcohol. Improving health outcomes (e.g. access to and adherence to antiretroviral therapy) among HIV-infected substance users will also require access to evidenced-based pharmacological therapies for the treatment of drug abuse and dependence9.
1Bryant, K. (2006). Converging epidemics: Alcohol and HIV/AIDS. Substance use and misuse, 41: 1465-1507. National Institute of Alcohol Abuse and Alcoholism, NIAA.
2Chersich, M.F., Rees, H.V., Scorgie, F., et. al. (2009, November). Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa. Globalization and Health, 2009, 5:16.
3Karamagi, C. A. S., Tumwine, J.K. & Tylleskar, T., et. al (2006, November). Intimate partner violence against women in eastern Uganda: implications for HIV prevention. BMC Public Health, 6:284.
4Rehm, J., Anderson, P. & Kanteres, F. (2004). Alcohol, social development and infectious disease. Toronto: University of Toronto.
5Rehm, J., Parry, C.D. (2009, December 19-26). Alcohol consumption and infectious diseases in South Africa. The Lancet Series, 374.
6GoK (2008). Vision 2030 First Medium Term Plan 2008-2012. Nairobi: Ministry of State for Planning, National Development and Vision 2030.
7Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (2000, June).
8Rehm, J., Parry, C.D. (2009, December 19-26). Alcohol consumption and infectious diseases in South Africa. The Lancet Series, 374.
9Bruce, R.D., Kresina, T.F. & McCanze-Katz, E.F. (2010, February). Medication-assisted treatment and HIV/AIDS: Aspects in treating HIV-infected drug users. AIDS, 24 (3): 331-340. Lippincott Williams & Wilkins