1. How can integration of the alcohol perspective strengthen existing HIV/AIDS strategies? Dag Endal FORUT Norwegian Campaign for Development and Solidarity ADD Project Coordinator (Alcohol, Drugs and Development)

2. A shift in approach: Alcohol problems as only a backdrop when designing HIV/AIDS interventions

3. A shift in approach: Alcohol problems as only a backdrop when designing HIV/AIDS interventions To see alcohol consumption as an integral part of the HIV/AIDS problem – and then address also this factor in intervetions

4. Three categories of possible links between alcohol and HIV/AIDS: >Alcohol use increasing the risk for HIV infection >Alcohol boosting the development of the disease, once you are infected >Alcohol reducing the effects of (medical) treatment

5. Basic 1: The level of alcohol consumption and the drinking habits in a population are not constant. They change over time and between nations and groups

6. Basic 2: The level of alcohol problems can be regulated through interventions by governments and by society as a whole

7. Assumption: Reduction of alcohol consumption and change of drinking patterns can contribute to * reduction in HIV incidence rates * slower development from HIV to AIDS for the infected * increased effectivity of ARV treatment

8. Alcohol policy advocacy as part of HIV/AIDS prevention strategies?

9. Recorded consumption 2003 1,44 litres pure alcohol per person aged 15+ WHO Global Status Report on Alcohol 2004

11. Distribution of consumption: Beer 78,0% Wine 0,5% Spirits 21,5%

12. Carlsberg samlebånd Recorded alcohol

13. Unrecorded alcohol

14. Total alcohol consumption WHO Region Africa E: (litres per person aged 15+) Recorded3,8 (54%) Unrecorded3,3 (46%)

17. Risk group

18. Risk places

19. EMERGING MARKETS!

20. Challenges in AIDS prevention: * Keep general alcohol consumption low; * Maintain Malawian women as a group of non-drinkers; * Stimulate male non-drinkers to maintain their position; * Target men who have risky drinking patterns; * Target drinking places

21. Add the alcohol perspective to existing HIV/AIDS strategies, not replace these strategies

22. Gender dimensions and drinking habits More men drink than women Men drink more often than women Men drink larger quantities than women It is more accepted that men drink than women Men create more problems when drunk A universal picture …with a few exceptions and local variations

23. The story of Chimwemwe: Chimwemwe says that her husband is a very jealous man, and he drinks alcohol every day. When he drinks he almost always beats her; 'A week cannot pass without beating me'. He spends much of the family's income on alcohol, money Chimwemwe feels could be used on much more useful things. Every night Moses comes home drunk, and he urinates and vomits in the bed, and when she tells him to go outside he beats her. She does not like to sleep with her husband when he is drunk, because he stinks, he behaves badly, and she is afraid that he has been cheating on her with other women who may be HIV positive. If she refuses to have sex with him, he forces her.

24. THE KEY to understanding the problem and taking efficient action 1.Construction of masculinity 2.The symbolic, social meaning of drinking 3.Privileges attached to drinking

25. Construction of masculinity Drinking and drunken behaviour = masculinity ”Being able to hold one’s drink and to drink heavily is a sign of masculinity”

26. Address privileges attached to drinking: Permission to break rules and social conventions; Excuse for rude and violent behaviour; Acceptance by other people to behave badly; Explanation or excuse for bad performance.

27. Myth-busting: A critical loook at existing conventional wisdom on the effects of alcohol (strength, attractiveness, virility, intelligence etc) Communicate basic facts on the real effects of alcohol

28. Gender transformative programs for HIV/AIDS prevention: Address also drinking habits as an integral part of the masculine identity

29. This problem has to be adressed * by men; * by working with men; * by working for men.