What Works for Women and Girls

11. Incorporating discussions of alcohol use into VCT and HIV counseling may increaseprotective behaviors such as condom use, partner reduction and reduction of alcohol use.A 2006 study in Kenya with intervention and comparison sites and follow up datawas conducted at 15 static and 10 mobile VCT sites with 1,073 VCT clients found thatclients from interventions sites displayed more concrete intentions to change behavior,stating that they would reduce or stop their alcohol intake. The intervention consistedof alcohol counseling, which increased the VCT component time by seven minutes.Providers did not find this burdensome. Over 90% of clients reported being receptiveto discussions about alcohol use while attending a VCT center. Alcohol use is associatedwith high-risk sexual behavior and reduced inhibitions (Woolf and Maisto, 2008;Kilonzo et al., 2008b; Zablotska et al., 2009; Ghebremichael et al., 2009; Kalichmanet al., 2007; Fisher et al., 2007). Alcohol users are more likely to perpetrate intimatepartner violence. [See also Chapter 11B. Strengthening the Enabling Environment: AddressingViolence Against Women]. Clients were screened with AUDIT and CAGE consisting ofquestions concerning alcohol use, such as feeling the need to cut down on drinking;feeling guilty about drinking; seeking help for drinking, etc. (Mackenzie et al., 2008).(Gray III) (sex behavior, violence, HIV testing, alcohol, Kenya)A study from 2004 to 2007 with 425 women in South Africa at high risk of alcoholabuse found that HIV education resulted in uptake of HIV testing, with 276 or 65%agreeing to HIV testing. HIV education addressed fear of stigma and testing for HIV,along with access to prevention, treatment and care services. Of the 425 women, 200 or74% reported drinking five or more drinks containing alcohol on a typical day (Lusenoand Wechsberg, 2009). (Gray III) (education, alcohol, HIV testing, South Africa)A randomized community field trial in South Africa found that a brief HIV and alcoholrisk reduction workshop reduced HIV-related risks among drinkers. 117 men and 238women were randomly assigned either a three-hour skills training on HIV-alcohol riskreduction or a one-hour HIV-alcohol information session. The three-hour programresulted in significant declines in unprotected intercourse and sexual partners, alcoholuse prior to sex and increased condom use compared to the one-hour session, evaluatedsix month post intervention. However, effects were weakest for the heaviest drinkers(Kalichman et al., 2008). (Gray III) (alcohol, sex behavior, sexual partners, South Africa)A pilot study with 80 women in South Africa who reported recent substance use andsex trading were randomly assigned to a standard HIV prevention intervention or awoman-focused HIV prevention intervention. Those who participated in the womanfocusedintervention reported greater decrease in unprotected sex with paying clients orwith baseline than those in the standard prevention intervention. Those in the womanfocusedgroup showed a large increase from 3% to 48% in any female condom use withboyfriends, while the standard group showed a smaller increase from 20% to 40%.Focus group discussions noted that drugs and alcohol were used prior to sex workto give the women courage to approach clients. In the woman-focused intervention164 CHAPTER 6 HIV TESTING AND COUNSELING FOR WOMEN