The Intersection of Substance Use and HIV in a Namibian Mining Town

Background: HIV is a critical issue in southern Africa, and the southern African country, Namibia, has one of the highest HIV rates at 19.6% (UNAIDS, 2006). An important HIV risk factor receiving attention in southern Africa is the role of alcohol use in the transmission of HIV. The link between alcohol and HIV has been receiving growing attention from researchers and health and social service professionals in southern Africa, and a number of studies have found alcohol consumption to be a risk factor for HIV (Hargreaves 2002; Morrison, Sunkutu, Musaba, and Glover, 1997; Zuma, Gouws, Willaims, & Lurie 2003). However, most research findings linking HIV and alcohol in Africa were not specifically designed to focus on the relationship between alcohol and HIV, and thus are both imprecise and unable to examine this specific relationship in depth (Kalichman, 2007). As alcohol use is exceptionally high among migratory mineworkers in Africa, this study looks at the intersection of alcohol and HIV among people living in a remote Namibian mining town. The specific research questions were: 1) What is the knowledge regarding the link between HIV and alcohol use among people living in a remote mining town?, and 2) What are the mechanisms affecting how alcohol leads to risky sexual behavior among people living in a remote mining town?

Methods: This study used a qualitative approach to gather in-depth knowledge regarding the link between risky sexual behaviors and alcohol among mineworkers, family members of mineworkers and professionals who lived in a remote Namibian mining town. This study purposively sampled participants to ensure a range of mineworker classifications, age, ethnic groups, and years lived in town, and a local social worker assisted with recruitment. Researchers collected data through 16 key informant interviews and six focus group discussions with a total of 62 participants. The lead interviewers were all multilingual native Namibians. Data were analyzed by three researchers separately coding data based on a start list of codes, and then together reconciling, collapsing and organizing codes into key themes, which were then linked into a conceptual model.

Results: The study found that although knowledge regarding HIV and alcohol was high among participants, the structure of the remote mining town which is isolated and gender imbalanced, led to loneliness and boredom. This in turn, led to both heavy alcohol use and risky sexual behaviors, including multiple concurrent partnerships. The heavy alcohol use within this mining town acted as an accelerant to these risky sexual behaviors in two key was – 1) as a source of courage for those with intentions of engaging in sexual partnerships, and 2) as a basis for engaging in risky sexual behaviors for people who intended to avoid risky sexual behaviors.

Implications: HIV prevention efforts must take into account the relationship between alcohol and HIV, particularly in southern Africa where alcohol consumption is high, and in mining communities where both alcohol use is high and the structural nature of the towns creates an environment ripe for multiple concurrent partnerships.