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The PEPFAR National Alcohol Initiative and Implementation in Namibia. Puja Seth, PhD Centers for Disease Control and Prevention, USA for Mary Glenshaw, PhD Centers for Disease Control and Prevention, Botswana Katherine Fritz, PhD International Center for Research on Women (ICRW)

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The pepfar national alcohol initiative and implementation in namibia

The PEPFAR National Alcohol Initiative and Implementation in Namibia

Puja Seth, PhD

Centers for Disease Control and Prevention, USA


Mary Glenshaw, PhD

Centers for Disease Control and Prevention, Botswana

Katherine Fritz, PhD

International Center for Research on Women (ICRW)

July 22, 2012

Sexual risk and alcohol use
Sexual Risk and Alcohol Use Namibia

Alcohol use leads to sexual disinhibition

Lower condom use

Earlier sexual debut

Alcohol drinkers have higher risk sex partners

Multiple concurrent partners

Casual partners

More at-risk partners


85% new sex partners meet in bars

46 – 57% patrons have multiple partners

Informal alcohol venues double as sex locations

Sivaram et al., 2008 Fisher et al., 2008 Kalichman et al., 2007 WHO, 2005

Alcohol use hiv driver
Alcohol Use: HIV Driver Namibia

Higher HIV, STI prevalence among drinkers

Southern Africa: South Africa, Botswana, Zimbabwe, Zambia

East Africa: Uganda, Tanzania, Kenya

Higher odds of new HIV infection among drinkers

Any alcohol use, AOR 1.8*

Alcohol use before/during sex, AOR 1.9*

Binge drinking, AOR 2.2*

Converging epidemics in Africa

Highest global HIV prevalence (>15%)

Among highest global alcohol use (~43%)

Shuper et al., 2010

Kalichman et al., 2007 WHO, 2005


Pepfar alcohol initiative background
PEPFAR Alcohol Initiative Background Namibia

Started 2007

$2.5 million USD over 4 years

Most funds allocated to Namibia

Collaboration between several U.S. Government agencies: CDC, USAID, DOD, SAMHSA

GOAL: Prevention of sexual HIV transmission through reduction of alcohol-related risk behaviors

Strategic planning
Strategic Planning Namibia

  • Determine research and data needs

    • Existing tools, partners, resources

    • Standardization

  • Follow Socio Ecological framework

    • Policy, legislative, environmental

    • Health sector

    • Community

    • Interpersonal

    • Individual

Alcohol initiative components
Alcohol Initiative Components Namibia

Conduct assessments

Develop and evaluate interventions for at-risk populations

Promote health provider screening &alcohol abuse resource services

Support networks of community stakeholders

Support policy and structural interventions

Institutionalize universal prevention messages

Assessments Namibia

2009 audit study needs assessment
2009 AUDIT Study Needs Assessment Namibia

  • Purpose: To determine alcohol consumption levels in Katutura, an urban Namibian township

  • WHO Alcohol Use Disorders Identification Test

    • Reliable, sensitive

    • Used worldwide, including in southern Africa

  • Multi-Stage Stratified Sampling Strategy

    • 639 surveys completed

Audit study results n 639
AUDIT Study Results (n=639) Namibia

  • 35% adults made or sold alcohol from home

  • 73% adults were current drinkers

    • 76% consumed ≥ 3 drinks on typical day

    • 49% reported binge drinking in past year

      • 31% reported binge drinking at least monthly






Audit study results by sex
AUDIT Study Results by Sex Namibia


Develop evaluate interventions for at risk populations
Develop & Evaluate Interventions Namibiafor At-Risk Populations

Counseling intervention trial ongoing
Counseling Intervention Trial: Ongoing Namibia

  • Purpose

    • Determine the effectiveness of a new counseling program in reducing alcohol-related sexual risk behavior

    • Build upon emerging evidence

    • Key message: Drunk sex is unsafe sex

  • RCT of 550 men in HIV testing centre

    • Complete baseline, 3- and 6-month assessments

    • Outcomes

      • Drinking before sex

      • Condom use, multiple partners

      • Hazardous alcohol consumption

    • Baseline enrollment will end by Dec 2012; results in 2013

Promote health provider screening alcohol abuse resource services
Promote Health Provider Screening & NamibiaAlcohol Abuse Resource Services

Brief motivational interviewing bmi
Brief Motivational Interviewing (BMI) Namibia

  • Behavior change intervention designed to be implemented in a variety of healthcare settings.

  • Cost-effective

  • BMI pilot was conducted in Hardap region

    • Proved difficult for facilities to implement

      • Time

      • Perceived stigma (social desirability)

      • Complexity of assessing drinking levels

    • Training revised and re-pilot planned

      • Task shifting approach

      • I-Tech in collaboration with MOHSS and CDC will adapt the materials

      • Brief evaluation planned as part of the pilot

Alcohol resource center1
Alcohol Resource Center Namibia

  • Substance Abuse Resource Center opened in Katutura March 2012

    • Collaboration between MOHSS, NGOs, PEPFAR

  • Plans for “marketing” to health facilities and to the communities to increase the number of referrals received

  • Focus on support groups, individual counseling, youth activities as well as provision of pamphlets, materials

Support networks of stakeholder organizations
Support Networks of NamibiaStakeholder Organizations

Coalition on responsible drinking
Coalition on Responsible Drinking Namibia

Plans to change name to Coalition on Reduction of

Harmful Drinking

Multi-sectoral partners


Donors, Partners, NGOS

Private industry

Expansion to all 13 regions in Namibia

Regional, constituency committees

Guided by MoHSS social workers

Plans to develop national strategy to focus more on standardized, high impact activities

Plans to develop M & E tools

Pepfar southern eastern africa meeting on alcohol and hiv april 2011
PEPFAR Southern & Eastern Africa Meeting on Alcohol and HIV, April 2011

Exchange intervention ideas and best practices

Review WHO and PEPFAR strategies on alcohol

Review the evidence on alcohol and HIV

Assistance with strategic planning

80+ participants from 14 countries

Structural interventions
Structural Interventions April 2011

  • Legislation

    • Revision of national Alcohol Abuse Prevention and Treatment Bill

      Alcohol Industry Efforts

  • Self-Regulating Alcohol Industry Forum (SAIF), Namibia

    • Underage drinking campaign

    • Drunk driving campaign

  • Namib Breweries, Namibia

    • Assisted with testing alcohol content of home/traditional brews

Alcohol traders program
Alcohol Traders Program April 2011

  • Promote Traders’ rights & responsibilities, 1998 Liquor Act

    • Legal parameters of alcohol sales

    • Establish Code of Conduct

    • Safe server, better business guidance

    • Condom distribution

  • Community and Trader IEC materials created

  • Materials are being piloted by SFH (USAID contractor).

  • CDC Namibia/MOHSS also has developed a draft training manual (via contractor).

    • Pilot will be conducted and will include assessment and evaluation materials.

  • MOHSS will wait until both evaluations are completed prior to scaling up the program.

Institutionalize universal prevention messages
Institutionalize Universal April 2011Prevention Messages

Alcohol prevention materials toolkit
Alcohol Prevention Materials Toolkit April 2011

  • Broad range of IEC materials for partners, providers, clients

  • Materials in English, Afrikaans, Oshiwambo

  • Currently contains 13 tools

    • 5x Booklets

      • Basic Facts About Alcohol

      • Alcohol & HIV

      • Family Drinking

      • Youth Drinking

      • Stand Up! Campaign

  • 1x Regional Support Services brochure

  • 2x Liquor Act informational flyers

    • Community

    • Alcohol Trader rights & responsibilities

  • 2x posters

    • Underage drinking

    • Youth drinking

  • 3x Facilitation Guides

    • C-Change Picture Codes

    • Lifeline/Childline Male Engagement DVD

    • MoHSS Guideline on the Management of Substance Intoxification & Withdrawal

  • Universal prevention messages
    Universal Prevention Messages April 2011

    Mass media & community action campaign

    Promote unacceptability of drunkenness, binge drinking

    Mobilize communities to take action

    Focus on affected/concerned community members

    STAND UP! Against Alcohol Misuse

    NawaLife Trust





    Acknowledgments April 2011


    Tom Kresina


    Billy Pick

    Brad Corner

    Todd Koppenhaver

    Kristen Ruckstuhl

    Namibia MoHSS

    Rene Adams

    Verona du Preez

    Manny Kandjii


    Naomi Bock

    Nick DeLuca

    Dietrich Remmert

    Jan Moore

    Jen Sabatier

    Sasha Mital

    John Pitman

    Dawn Broussard

    Sue Gerber

    Jeff Hanson


    Anne Thomas

    Mike Grillo

    Helen Chun

    Cynthia Simon-Ardnt


    Kendall Bryant

    THANK YOU! April 2011Puja Seth, PhDDivision of Global HIV/AIDSCenters for Disease Control and PreventionEmail: [email protected]