Reducing alcohol-related HIV risk in katutura, Namibia: Results from a multilevel intervention with bar owners, servers, patrons, and community members

In sub-Saharan Africa, evidence-based approaches are urgently needed to address the community- and bar-level dynamics that enable heavy drinking and sexual risk behavior. We contributed to this evidence-base by designing, implementing, and evaluating a 3-year demonstration project in a low-income community near Windhoek, Namibia—a country with high HIV prevalence and heavy alcohol use. The main project components included bar-based prevention activities, changes to the bar environments, and widespread community outreach.

Results from two waves of cross sectional survey data (conducted before and after the intervention) indicate that more intense program exposure was significantly associated with positive behaviors such as discussing condom use, obtaining condoms, and refusing to have sex without a condom, however we found little evidence linking program exposure to safer sexual practices. In addition, female patrons with the highest exposure to the intervention reported lower rates of heavy episodic drinking as compared to their peers with less exposure, even after controlling for any unobserved bar-level effects. No statistical associations were found between program exposure and rates of alcohol consumption among male patrons; however overall trends suggest that rates of binge drinking have decreased among men and women over the study period. Findings from this small-scale and short-term program demonstrate that a multi-level intervention with bar owners and community members is feasible to implement. Moreover, we find promising indications that community mobilization and delivery of prevention advice within the bar setting may motivate some patrons to alter their attitudes and behaviors related to using condoms and alcohol consumption.