An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa
| dc.contributor.author | Johnson, Leigh F. | |
| dc.contributor.author | Kubjane, Mmamapudi | |
| dc.contributor.author | de Voux, Alex | |
| dc.contributor.author | Ohrnberger, Julius | |
| dc.contributor.author | Tlali, Mpho | |
| dc.date.accessioned | 2023-08-08T13:57:20Z | |
| dc.date.available | 2023-08-08T13:57:20Z | |
| dc.date.issued | 2023-07-29 | |
| dc.date.updated | 2023-07-30T03:15:13Z | |
| dc.description.abstract | Abstract Background Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission. Methods We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month. Results Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000–2021 period 54% (95% CI: 34–74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0–32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0–68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0–2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8–7.2%) or by 7.3% (0.6–21.2%) if there was no waning of intervention impact. Conclusions Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed. | en_US |
| dc.identifier.apacitation | Johnson, Leigh F., Kubjane, M., de Voux, A., Ohrnberger, J., & Tlali, M. (2023). An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa. <i>BMC Infectious Diseases</i>, 23(1), 500. http://hdl.handle.net/11427/38217 | en_ZA |
| dc.identifier.chicagocitation | Johnson, Leigh F., Mmamapudi Kubjane, Alex de Voux, Julius Ohrnberger, and Mpho Tlali "An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa." <i>BMC Infectious Diseases</i> 23, 1. (2023): 500. http://hdl.handle.net/11427/38217 | en_ZA |
| dc.identifier.citation | Johnson, Leigh F., Kubjane, M., de Voux, A., Ohrnberger, J. & Tlali, M. 2023. An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa. <i>BMC Infectious Diseases.</i> 23(1):500. http://hdl.handle.net/11427/38217 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Johnson, Leigh F. AU - Kubjane, Mmamapudi AU - de Voux, Alex AU - Ohrnberger, Julius AU - Tlali, Mpho AB - Abstract Background Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission. Methods We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month. Results Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000–2021 period 54% (95% CI: 34–74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0–32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0–68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0–2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8–7.2%) or by 7.3% (0.6–21.2%) if there was no waning of intervention impact. Conclusions Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed. DA - 2023-07-29 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Infectious Diseases KW - HIV/AIDS KW - Structural intervention KW - Alcohol KW - Gender norms KW - Mathematical modelling KW - South Africa LK - https://open.uct.ac.za PY - 2023 T1 - An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa TI - An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa UR - http://hdl.handle.net/11427/38217 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12879-023-08470-y | |
| dc.identifier.uri | http://hdl.handle.net/11427/38217 | |
| dc.identifier.vancouvercitation | Johnson Leigh F, Kubjane M, de Voux A, Ohrnberger J, Tlali M. An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa. BMC Infectious Diseases. 2023;23(1):500. http://hdl.handle.net/11427/38217. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s) | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_US |
| dc.source | BMC Infectious Diseases | en_US |
| dc.source.journalissue | 1 | en_US |
| dc.source.journalvolume | 23 | en_US |
| dc.source.pagination | 500 | en_US |
| dc.source.uri | https://bmcinfectdis.biomedcentral.com/ | |
| dc.subject | HIV/AIDS | en_US |
| dc.subject | Structural intervention | en_US |
| dc.subject | Alcohol | en_US |
| dc.subject | Gender norms | en_US |
| dc.subject | Mathematical modelling | en_US |
| dc.subject | South Africa | en_US |
| dc.title | An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa | en_US |
| dc.type | Journal Article | en_US |