First International Conference on Alcohol and HIV in Mumbai, India, August 3 – 4, 2009.– Highlights and Presentations from the first conference.
The First International Conference on Alcohol and HIV in India was held on August 3 and 4, 2009 at the Taj President Hotel, Colaba, Mumbai. The two day conference which attracted over 200 social science, and epidemiology researchers, NGO and policy representatives, was cosponsored by the Institute for Community Research, the International Institute for Population Sciences, Mumbai and the National Institute on Alcohol Abuse and Addiction, NIH, Washington, D.C. A training program geared for approximately 20 researchers from across India, who were interested in shifting their research program to include alcohol and/or sexuality concerns was held at IIPS immediately prior to the conference on August 1 – 2. The conference was funded as a cooperative agreement with NIAAA.
Some conference highlights included:
- NIAAA Alcohol and AIDS Program Coordinator’s discussion of new directions in alcohol and HIV research. Dr. Bryant noted the importance of new technology measuring in-the-moment use of alcohol in association with other behaviors, more research on the effects of alcohol on HIV disease progression, discovery of critical intervention points in alcohol consumption trajectories, and the challenge and promise of multilevel culturally relevant prevention interventions.
- Dr. Prabha Chandra, NIMHANS, Bangalore, referring to her research on psychiatric patients, reminded the audience of the critical importance of mental illness, mood disorders and sensation seeking in explaining the alcohol and HIV connection.
- The definitive statement by Dr. Niranjan Saggurti of Population Council-Delhi of the direct association between alcohol consumption and STIs in a Mumbai low income population.
- Papers by Drs. Gupta, IIPS and Saggurti which showed that alcohol and HIV risk are concentrated in mobile but not migrant workers. Mobile workers are those who travel shorter or longer distances from their homes to work. Migrant workers are those who migrate from rural to urban areas to establish urban residence and financial stability for themselves and their families.
- Ellen Cromley’s paper showing the spatial distribution of social activities and sexual risk using the ICR-IIPS ASHRA study data base.
- Papers by Madhabika Nayak, ARG, CA. and Marlene Berg, ICR, describing the ways in which men’s use of alcohol and violence intersect to affect the quality of life of married women.
- Papers by Drs. Stephen Schensul and Pertti Pelto discussing approaches to ethnographic research on sexual risk and HIV appropriate for the India context.
- Dr. Tom Greenfield’s description of ways ARG working with Sangath-Goa met the challenge of obtaining accurate measures of alcohol consumption by working with local key informants, locally used types of alcohol, and local measures.
- Dr. Jean Schensul’s paper on multiple pathways to sexual risk among married and unmarried men in Mumbai, using methodology that allowed for differentiation of risk pathways with and without the presence of alcohol as a causal contributor. The paper simultaneously challenges the gateway hypothesis (initial drinking leads to addiction), and the correlational studies that show one predominant pattern linking alcohol and sexual risk behavior.
Conference Themes and Challenges
Presenters and audience members raised many issues about alcohol use and hiv risk. A final conference panel summarized the main themes and issues that emerged and the challenges for future research and intervention.
One of the most salient issues raised in the presentations was the importance of mental health variables including history of mental health problems, and sensation seeking in understanding drinking and sexuality. The links between mental health problems and substance use are not sufficiently explored as yet in India and this area calls for further research. A second important gap was information on the actual effects of drinking on sexual function, and the points at which specific amounts of drinking have an effect on arousal and performance.
Another important issue is the need for a gendered perspective in future research examining alcohol use and unprotected sex. In particular, differences between men’s and women’s views about the utility or detrimental aspects of alcohol in sexual contexts need to be explored more fully in the India context.
A critical issue related to women’s vulnerability with respect to the negative consequences of spouses’ alcohol use. For example, women hired to sell alcohol in bars and dance bars generally drink with their clients. And some female sex workers are required to drink with clients. They are fully cognizant of the fact that alcohol impairs their ability to negotiate condoms with the clients. Yet they do not always have control over whether they drink and how much they drink with their clients. Papers showed that interventions could be effective when women are supported to organize around the use of condoms, provide condoms to partners, and include the cost of condoms in the price of a sexual encounter. Other women experience various forms of abuse including sexual violence because of their husband’s drinking. The effects of alcohol use in joint or extended families on adult women, and children including girls has not yet bee explored.
Some papers argued for the importance of understanding the laws and regulations governing the production, marketing, purchase and consumption of alcohol in different states. Dr. Ram of IIPS called for a review of policies related to these factors nationally and across states, as well as a look at where prohibition policies did or did not make a difference. Some states see the advantage of increasing legal alcohol sales to reap tax revenues. There is widespread understanding that prohibition does not result in decreased alcohol consumption. In fact, it sends alcohol production and consumption underground.
Proper measurement of alcohol consumption was deemed an important problem. Most measures of alcohol use in India are relatively limited, depending on “ever used” or, at best, “thirty day use” of any alcohol. But in various parts of the country many different types of alcohol are used, fermented, or distilled. Alcohol is composed of substances ranging from rice to coconut and cadjew and manufactured and licensed, or made at home, or illegally (home brews of various sorts). Dr. Greenfield and other researchers noted that identifying which substances are used in a local area, how much is drunk at a sitting, in what vessels, and how often, and how much pure alcohol is included in each type of drink are critical indicators that can be used to arrive at a more accurate measure of alcohol consumption. With better indicators, it may be easier to determine whether more quantity of pure alcohol or consumption patterns and contexts or both lead to unprotected sex.
Alcohol consumption among women needs closer examination. Although many women do not use alcohol in large amounts or at all in India, there are groups identified by caste, tribal affiliation and geographic zone for which alcohol consumption by women is acceptable. Dr. Schensul suggested that a closer examination of regular alcohol use among women, especially those of reproductive age, is warranted, to detect possible effects of alcohol on pregnancies, pregnancy outcomes, and stis as well as other indicators of reproductive health. Formative research to create nonstigmatizing services for women drinkers is another priority.
Finally, many papers pointed to the notion that reducing alcohol consumption cannot take place through individualized behavioral interventions. The berg, Schensul and Bryant papers in particular noted that interventions at individual, family, community and policy levels were required to change social norms and practices around alcohol consumption and its consequences. Berg argued that multilevel intervention was necessary to protect women against the effects of alcohol consumption of their spouses. She suggested that these could include shelters in police stations, protective behaviors of families and elected officials, organizations of men and women allied together to stop violence against women, and strong implementation of existing gender-discrimination policies at the national and state level. More such multilevel interventions are required to reduce alcohol marketing, sales, consumption and the consequences of overconsumption of alcohol that affect men, women and families. Alcohol, Gender and the development, measurement, and dissemination of interventions and policy at multiple levels is the focus of the Second International Conference on Alcohol and HIV in India, to be held in Delhi, September 28th through 30th, 2010.
The conference closing panel included Drs. F. Ram, Demographer and Director of IIPS, Ravi Verma, psychologist, and Director, ICRW, Kendall Bryant, Alcohol and AIDS Program Coordinator, NIAAA and Jean Schensul, Senior Scientist and Founding Director, ICR
The Conference Pretraining Program was held in the Administration Building and Computer Laboratory on the IIPS Campus. Trainees came from Goa, Lucknow, Delhi, Mumbai, Chennai, and other areas of India. Speakers included Drs. Bryant, Stephen Schensul and Greenfield, addressing international alcohol and HIV research, sexuality research and alcohol measurement in India. Dr. Pertti Pelto introduced ethnographic field methods to the audience composed primarily of statisticians and administrators. The ICR-IIPS ASHRA study was presented by Dr. S.K. Singh, India PI, as a case example of mixed methods approach to community based alcohol and HIV related research. On the second day, Marlene Berg conducted a three hour training session on cultural modeling and domain analysis using ANTHROPAC software and Jean Schensul conducted a second three hour training session defining text data, and on approaches to coding and analysis of text data using ATLAS-Ti software. All conference and pretraining presentations will be available on ICR and Conference websites (put conference website here).
A second International Conference on Alcohol, Gender and HIV will be held in Delhi, 2010, cosponsored by ICR, International Center for Research on Women and NIAAA, date to be determined. This conference will highlight successful multilevel interventions addressing alcohol and HIV prevention approaches utilized and evaluated in India, and in other international settings with relevance to the India context.
Presentations
Inaugural session
First session
Second session
Third session