NN Nyawo, SB Dlamini, M Taylor, CC Jinabhai, G Friedland

1. Investigation of Alcohol use prevalence and Sexual Behaviour amongst school going learners in KwaZulu-Natal. NN Nyawo, SB Dlamini, M Taylor, CC Jinabhai, G Friedland Nelson R Mandela School of Medicine Department of Public Health Medicine

2. Background • Alcohol- fifth largest risk factor contributing to the global burden of disease, (WHO 2001) South Africa: • Underage alcohol consumption- 49% of learners have used alcohol, (DoH 2002) KZN: • 38.8% of learners use alcohol, (DoH 2002) • Acute alcohol intoxication is associated with unsafe sexual practices, (MRC, 2003) • Estimated 40.7% ANC woman were HIV positive, (DOH, 2004). • Alcohol misuse, combined with poor nutritional status, increases susceptibility to opportunistic diseases by compromising the immune system.

3. Aim • To investigate the prevalence, determinants and associations of alcohol use with risky sexual behaviour amongst rural and urban learners in KwaZulu-Natal.

4. Predisposing Factors MotivationFactors Ability Factors Behavioral factors Plans Psychological factors Attitude: Pros & Cons Rational & Emotional Performance Skills Biological factors Social Cultural factors Social Influences: Norms Modelling Pressure Intention State Behavior State Awareness Factors Precontemplation Trial Efficacy: Routine Social Situational Stress Knowledge Contemplation Cues to Action Maintenance Preparation Risk Perception Information Factors Message Barriers The I-CHANGE Model De Vries et al., 2004; 2005 Channel Source Theoretical Framework

5. Methods Study design: Cross-sectional study Study Area : -Rural -Ugu District– with estimated population- 900 000: -Urban -Umlazi township -300.000 • Both within the province of KwaZulu-Natal Study Participants: • DoE List –random selection-12 public high schools • One grade 9 class randomly selected in each school • All students in the class included in the study

6. Instruments Data collecting tool • Self-reported questionnaire based on I-Change Model (de Vries et al, 2003) • Questions on demographic data & home environment, knowledge, attitudes- social influences, self-efficacy, alcohol use and sexual behaviour • Likert Scale= Strongly disagree (1) to strongly agree (5) • Administered by fieldworkers in absence of teachers (Anonymous) Analysis • SPSS program – Univariates, Bivariate, and Covariates analyses

7. Ethics Approval Ethical Approval, Informed consent • UKZN-Biomedical Research Ethics Committee, Department of Education and School Principals • Written informed consent from Parents and Learners

8. Definitions • Risky drinking: Drinking 5 or more standard bottles/ glasses drinks one time in a row for males and three or more drinks for females. • Alcohol Drinker: Those who have ever had alcohol • Non-drinker: Those who have never had an alcoholic drink • Underage drinking- individuals below the age of 18 years who drink alcohol.

9. Results:Description of Learners • n=657 respondents • Mean age-15.6 years (SD 1.68) • Males- (49.5%), Females- (50.5%) • Prevalence Underage Drinking -38.1% • (No significant differences in religious beliefs or watching of television)

10. Prevalence of Underage Drinking by Gender, (n=657) 36.2% 40.9% 63.8% 59.1%

11. Prevalence (%) of Underage Drinking by School Location (n=657) (%) P<.005

12. Predisposing Factors of Under Age Drinking for KZN High School Learners ** Mothers who have grade 10 –grade 12 / tertiary education

13. Intrapersonal Determinants Influencing Underage Alcohol Use Amongst High School Learners (n=657) *Likert Scale: Strongly disagree (1) – Strongly agree (5)

14. Interpersonal Determinants Influencing Underage Alcohol Use Amongst High School Learners (n=657) *Likert Scale: Strongly disagree (1) – Strongly agree (5)

15. Learners’ Knowledge and Attitudes about HIV/AIDS (n=623) (%) P<.005

16. Underage alcohol use and Sexual History of Learners in KZN (%) P<.005

17. Underage Alcohol use and Risky Sexual behaviour of Learners in KZN (%) P=.001

18. Significant Factors Associated with Underage Alcohol Use • After adjusting for sex, age and school location – non significance observed • Drink to run way from problems • Close friends drink • Friends will approve if I drink • But “drink to be confident” and “drink to have fun” were still highly significant (P<.005) • I find it difficult to refuse alcohol in a party- was highly significant (P=.019)

19. Summary • Study confirms that males use alcohol more than females • This study has confirmed the prevalence of underage alcohol drinking and it association with unsafe sex • Learners perceived that alcohol benefits their social lives • Learners’ knowledge about HIV did not influence their sexual behaviour • In the context where HIV/AIDS epidemic is so prevalent, alcohol is a significant risk factor and this has been shared with schools and learners • Factors that protect are mothers’ higher education

20. Conclusion • Study has identified key areas for behaviour change • The I-Change model assists in developing focused interventions • Implementation of interventions need to be targeted at a primary level • Strengthen alcohol age restriction policy implementation on the grass-root level

21. Acknowledgements • World AIDS Foundation • Department of Education • Principals • Parents • Learners • Colleagues