June 2006

Studies in Brief
Alcohol and HIV services: Study finds Kenyan counselors need support to handle alcohol use among clients

Alcohol use among clients can be a challenge for VCT and ART providers in Kenya. Photo credit: Curt Carnemark/World Bank

Voluntary counseling and testing (VCT) services play a vital role in HIV prevention and care. By determining and discussing an individual’s serostatus, VCT can promote the adoption of HIV prevention behaviors and facilitate early initiation of antiretroviral therapy (ART). However, an important challenge facing VCT service providers surrounds the use of alcohol among their clients.

Alcohol use has been associated with high-risk sexual behavior; it reduces inhibitions and self-control, which makes it easier for individuals to engage in risky behavior, such as multiple sex partners and unprotected sex.

A study among clients of rural public clinics in Kenya found that more than half reported “hazardous” drinking behavior, suggesting that alcohol use is a serious problem (Shaffer et al. 2004).

Horizons, in partnership with Liverpool VCT and Care Inc and The Steadman Group, conducted a study in December 2005 to explore the need for integrating alcohol counseling and referral into VCT services, and the preparedness of service providers to address alcohol use among clients accessing Kenyan facilities. The study also queried providers who counsel patients about ART because alcohol use can have a major impact on people living with HIV; drinking alcohol is associated with poor adherence to ART (Samet et al. 2004).

Findings from the study include that alcohol is indeed an issue among VCT and ART clients, and that providers are not prepared to address it in a uniform and systematic way.

The study consisted of focus groups and in-depth interviews with VCT and ART providers, patients on ART, bar patrons, and others. Conducted in Nairobi and Mombasa, the study, although not representative, provides important insights into the issues surrounding alcohol use in the context of VCT and ART services.

VCT counselors reported that it is not uncommon for alcohol users to seek HIV testing while intoxicated to help them cope with learning their HIV status. According to one VCT provider:

Most of them say they drink to get courage…to gain confidence to talk to someone for 45 minutes [during counseling].

In general, people who are intoxicated are not likely to get tested. According to the study informants, these individuals are often turned away by the receptionist and told to come back another day, or only counseled about the test by the provider and then asked to return for testing. However, the decision to test or not depends on the providers’ discretion, rather than formal guidelines, and there is no formal referral mechanism. As a counselor recounted about a client who came in for testing while drunk,

…I didn’t test him, he had no concentration. I told him to go and come back again. He has never come back.

Another challenge for counselors is how to help female clients who are concerned about their partner’s drinking and the fact that it impedes communication about preventing HIV.

…They come and say that the husband takes a lot of alcohol but they don’t know how to explain to the husband that they have to use protection during sex….

Study findings suggest that most VCT counselors and ART providers have limited training and skills in alcohol counseling. The current practice of ART providers is to tell their patients to stop drinking. Many are unable to answer questions such as how much alcohol is too much, what types of alcohol are safer to consume, and the relationship between eating well and drinking.

Patients on ART stated a desire for more information on why they should stop drinking, and a discussion of feasible options. As one patient on ART expressed,

Doctors say do not take alcohol…. But you see you are not told why you should not take alcohol…as a human being when you start feeling better, you will be like ‘why not?’…. Drinking in our society is a way of relaxing and entertainment.

VCT and ART providers themselves expressed a need for training in alcohol counseling, citing the need for knowledge to be better equipped to confront different situations.

Next Steps

Study findings document the need to equip VCT and ART providers to offer alcohol counseling and referral as part of service delivery. This will require adequate training of providers to be able to use screening tools to identify clients at risk, to counsel them about alcohol abuse, and to counsel clients about how to deal with partners who abuse alcohol.

Horizons is developing a follow-on intervention study that will offer such training, as well as standardized guidelines for dealing with intoxicated clients. This will allow providers to offer these clients minimal counseling and educational materials and not to lose an opportunity to foster serostatus awareness and HIV risk reduction.

For more information about this study, please contact Caroline Mackenzie (cmackenzie@pcnairobi.org).

—Hena Khan

References

Shaffer, S.N. et al. 2004. “Alcohol abuse among patients with and without HIV infection attending public clinics in Western Kenya,” East African Medical Journal 81:594–598.

Samet, J.H. et al. 2004. “Alcohol consumption and antiretroviral therapy adherence among HIV infected persons with alcohol problems,” Alcoholism: Clinical and Experimental Research 28: 572–577.

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• Population Council – Treatment, Care and Support

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This page updated 21 July 2006

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