The relationship between HIV and alcohol in India

Alcohol use has become more widespread in India, whilst HIV infection also continues to grow rapidly. Indian researchers have examined the relationship between alcohol and HIV in India. Research has found that alcohol is a contributing factor to HIV. This can be seen among Nepalese migrants, where high levels of alcohol were found to contribute to HIV infection.

Indian researchers have found that men who pay for sex with women outside of brothels are much more likely to avoid condom use. This suggests that we should focus interventions on reducing risks associated with paid sex and informal sexual transactions that take place outside the brothel environment. They found that daily drinking is associated with extramarital sex, leading to gonorrhoea, chlamydia infection and an exposure to syphilis. They have concluded that perhaps, it is “not men in general who should be targeted for specific alcohol reduction intervention but those involved in chronic daily drinking.

There is also a gender difference. Alcohol use, like risky sexual behaviour, is deeply embedded in male identity, masculinity norms and gender relations. Ongoing research on masculinity suggests that men are socialized into believing that male identity and masculinity are connected with alcohol consumption. Alcohol use, along with sexual intercourse, is seen as a ‘coming of age’ for young men.

Violence associated with alcohol use has been shown to have an effect on HIV and STI risk exposure, primarily through forced, ‘‘rough’’ or painful sex between men and vulnerable or unwilling women including spouses. Evidence suggests that alcohol “disinhibits men, and focuses them on meeting their perceived sexual and other needs in marriage through the use of violence or abuse.” Overall however, research on the links among serious mental illness, alcohol use, and sexual risk needs more attention in India.

Evidently, alcohol plays a direct and an indirect role in promoting situations and decisions leading to unprotected sex with multiple partners and in vulnerable populations including mobile workers, and female sex workers, and those infected with HIV. Venues where alcohol is sold and consumed including wine shops, bars and restaurants clearly influence, endorse and promote risky sexual behaviour. We should address alcohol use in particular, in AIDS prevention programs.

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