Structural Intervention for Adolescent Alcohol Use and HIV Risk in Tanzania

DESCRIPTION (provided by applicant): Reducing HIV transmission among adolescents in sub-Saharan Africa (SSA) remains of tremendous urgency. Almost a third of global annual new infections occur in young women aged 15-24 in SSA, and 81% of HIV infected adolescents worldwide live in SSA. There is growing evidence that increasing levels of adolescent alcohol use in SSA may be contributing to these high rates of infection, particularly heavy episodic drinking and early age of alcohol initiation. Both behaviors increase the risk for unsafe sex. Research is urgently needed to understand current patterns of adolescent alcohol use and related sexual risk-taking behaviors in SSA to reduce HIV risk. A potentially effective approach is to change the structures that enable adolescent alcohol use. Recent evidence suggests the potential effectiveness of structural approaches (e.g. underage drinking laws) for reducing adolescent alcohol consumption in high-income countries. A new National Alcohol Policy being developed in Tanzania offers the opportunity to study its efforts to reduce adolescent alcohol use and HIV risk, and to identify gaps in the policy. Tanzania has a population of over 48 million, with 65% under the age of 24, and ranks 12th in global HIV prevalence rates. A recent review of the regulatory status of alcohol identified a significant lack of coordination between agencies. In response, the Ministry of Health is drafting a new alcohol policy. Unlike in high-income countries, the majority of alcohol in Tanzania reportedly continues to be 'home brew' (high alcohol content and limited regulatory oversight). Our prior research suggests an increase in adolescent use of home brew and of commercial beers marketed to youth. The proposed research will examine the current social, community and environmental context of adolescent alcohol initiation and consumption in urban Tanzania, the gendered aspects of consumption, and subsequent experiences of risky sexual behavior. The proposed study is highly innovative because it engages adolescents in an exploration of the synergy between adolescent alcohol use and risky sexual behavior in the context of a new National Alcohol Policy. The findings will provide critical data to inform the development of evidence-based structural interventions aimed at reducing adolescent alcohol use and risky sexual behaviors in SSA. Specific aims: Specific Aim #1: To explore the current patterns of alcohol initiation and consumption by adolescent girls and boys (aged 14-18) in urban Tanzania, including a mapping of types and sources of alcohol availability. Specific Aim #2: To understand the social processes and contextual factors shaping the dynamic between adolescent alcohol consumption and risky sexual behaviors in urban Tanzania, and mapping contexts of high risk where adolescent alcohol use (or purchase/provision) and unsafe sex occur. Specific Aim #3: To inform the development of new, or the adaptation of existing, structural and environmental interventions for reducing the contribution of alcohol consumption to unsafe sexual practices among urban Tanzanian adolescents in the context of a new National Alcohol Policy and existing alcohol laws.