Skip to main content
Top
Published in: Journal of Prevention 4/2014

01-08-2014 | Original Paper

Exploring the Relationships Among Food Insecurity, Alcohol Use, and Sexual Risk Taking Among Men and Women Living in South African Townships

Authors: Lisa A. Eaton, Demetria N. Cain, Eileen V. Pitpitan, Kate B. Carey, Michael P. Carey, Vuyelwa Mehlomakulu, Leickness C. Simbayi, Kelvin Mwaba, Seth C. Kalichman

Published in: Journal of Prevention | Issue 4/2014

Login to get access

Abstract

South African townships have among the highest rates of HIV infection in the world. Considerable research on understanding the high rates of HIV transmission in this country has identified alcohol use as a critical factor in driving the HIV epidemic. Although the relationship between alcohol use and sexual risk-taking is well documented, less is known about how other factors, such as food insecurity, might be important in understanding alcohol’s role in sexual risk-taking. Furthermore, prior research has highlighted how patterns of alcohol use and sexual risk-taking tend to vary by gender. We examined how food insecurity is related to both alcohol use and sexual risk-taking. We administered anonymous community surveys to men (n = 1,137) and women (n = 458) residing within four contiguous Black African townships outside of Cape Town, South Africa. In multivariate linear regression, we found that food insecurity was related to having higher numbers of male sex partners and condom-protected sex acts among women only. These relationships, however, were fully mediated by women’s alcohol use. Among men, we found that food insecurity was negatively related to unprotected sex; that is, men with greater food security reported more unprotected sex acts. Unlike the results found among women, this relationship was not mediated by alcohol use. Food insecurity appears to be an important factor in understanding patterns of sexual risk-taking in regards to gender and alcohol use, and may serve as an important point of intervention for reducing HIV transmission rates.
Literature
go back to reference Altman, M., Hart, T., & Jacobs, P. (2009). Food security in South Africa. Pretoria: Human Sciences Research Council: Center for Poverty, Employment and Growth. Altman, M., Hart, T., & Jacobs, P. (2009). Food security in South Africa. Pretoria: Human Sciences Research Council: Center for Poverty, Employment and Growth.
go back to reference Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRef Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRef
go back to reference Bennett, G. A., Withers, J., Thomas, P. W., Higgins, D. S., Bailey, J., Parry, L., et al. (2005). A randomised trial of early warning signs relapse prevention training in the treatment of alcohol dependence. Addictive Behavior, 30(6), 1111–1124. doi:10.1016/j.addbeh.2004.10.008.CrossRef Bennett, G. A., Withers, J., Thomas, P. W., Higgins, D. S., Bailey, J., Parry, L., et al. (2005). A randomised trial of early warning signs relapse prevention training in the treatment of alcohol dependence. Addictive Behavior, 30(6), 1111–1124. doi:10.​1016/​j.​addbeh.​2004.​10.​008.CrossRef
go back to reference Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for measurement of food access: Indicator guide. Washington, DC: Food and Nutrition Technical Support, USAID. Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for measurement of food access: Indicator guide. Washington, DC: Food and Nutrition Technical Support, USAID.
go back to reference Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, P. S., Kay, W., & Pickering, R. (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence, 71(1), 7–16.PubMedCrossRef Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, P. S., Kay, W., & Pickering, R. (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence, 71(1), 7–16.PubMedCrossRef
go back to reference Gruenewald, P. J., Russell, M., Light, J., Lipton, R., Searles, J., Johnson, F., et al. (2002). One drink to a lifetime of drinking: Temporal structures of drinking patterns. Alcoholism, Clinical and Experimental Research, 26(6), 916–925.PubMedCrossRef Gruenewald, P. J., Russell, M., Light, J., Lipton, R., Searles, J., Johnson, F., et al. (2002). One drink to a lifetime of drinking: Temporal structures of drinking patterns. Alcoholism, Clinical and Experimental Research, 26(6), 916–925.PubMedCrossRef
go back to reference IBM Corp. (2012). IBM SPSS statistics for windows, version 21.0. Armonk, NY: IBM. IBM Corp. (2012). IBM SPSS statistics for windows, version 21.0. Armonk, NY: IBM.
go back to reference Jewkes, R., Abrahams, N., Mathews, S., Seedat, M., Van Niekerk, A., Suffla, S., et al. (2009). Preventing rape and violence in South Africa: Call for leadership in a new agenda for action. MRC Policy Brief. Jewkes, R., Abrahams, N., Mathews, S., Seedat, M., Van Niekerk, A., Suffla, S., et al. (2009). Preventing rape and violence in South Africa: Call for leadership in a new agenda for action. MRC Policy Brief.
go back to reference Jewkes, R., & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, 13, 6. doi:10.1186/1758-2652-13-6.PubMedCentralPubMed Jewkes, R., & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, 13, 6. doi:10.​1186/​1758-2652-13-6.PubMedCentralPubMed
go back to reference Kalichman, S. C., Simbayi, L. C., Jooste, S., & Cain, D. (2007). Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa. [Comparative Study Research Support, N.I.H., Extramural]. American Journal of Drug and Alcohol Abuse, 33(5), 687–698. doi:10.1080/00952990701522716.PubMedCrossRef Kalichman, S. C., Simbayi, L. C., Jooste, S., & Cain, D. (2007). Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa. [Comparative Study Research Support, N.I.H., Extramural]. American Journal of Drug and Alcohol Abuse, 33(5), 687–698. doi:10.​1080/​0095299070152271​6.PubMedCrossRef
go back to reference Kalichman, S. C., Simbayi, L., Jooste, S., Vermaak, R., & Cain, D. (2008a). Sensation seeking and alcohol use predict HIV transmission risks: Prospective study of sexually transmitted infection clinic patients, Cape Town, South Africa. Addictive Behaviors, 33(12), 1630–1633. doi:10.1016/j.addbeh.2008.07.020.PubMedCrossRef Kalichman, S. C., Simbayi, L., Jooste, S., Vermaak, R., & Cain, D. (2008a). Sensation seeking and alcohol use predict HIV transmission risks: Prospective study of sexually transmitted infection clinic patients, Cape Town, South Africa. Addictive Behaviors, 33(12), 1630–1633. doi:10.​1016/​j.​addbeh.​2008.​07.​020.PubMedCrossRef
go back to reference Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., Cherry, C., Jooste, S., et al. (2005). Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in Cape Town, South Africa. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. Journal of Sex Research, 42(4), 299–305. doi:10.1080/00224490509552285.PubMedCrossRef Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., Cherry, C., Jooste, S., et al. (2005). Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in Cape Town, South Africa. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. Journal of Sex Research, 42(4), 299–305. doi:10.​1080/​0022449050955228​5.PubMedCrossRef
go back to reference Kalichman, S. C., Simbayi, L. C., Vermaak, R., Jooste, S., & Cain, D. (2008b). HIV/AIDS risks among men and women who drink at informal alcohol serving establishments (Shebeens) in Cape Town, South Africa. Prevention Science, 9(1), 55–62. doi:10.1007/s11121-008-0085-x.PubMedCrossRef Kalichman, S. C., Simbayi, L. C., Vermaak, R., Jooste, S., & Cain, D. (2008b). HIV/AIDS risks among men and women who drink at informal alcohol serving establishments (Shebeens) in Cape Town, South Africa. Prevention Science, 9(1), 55–62. doi:10.​1007/​s11121-008-0085-x.PubMedCrossRef
go back to reference Kalichman, S. C., Watt, M., Sikkema, K., Skinner, D., & Pieterse, D. (2012). Food insufficiency, substance use, and sexual risks for HIV/AIDS in informal drinking establishments, Cape Town, South Africa. Journal of Urban Health. doi:10.1007/s11524-012-9686-6. Kalichman, S. C., Watt, M., Sikkema, K., Skinner, D., & Pieterse, D. (2012). Food insufficiency, substance use, and sexual risks for HIV/AIDS in informal drinking establishments, Cape Town, South Africa. Journal of Urban Health. doi:10.​1007/​s11524-012-9686-6.
go back to reference Korsten, M. (1989). Alcoholism and pancreatitis: Does nutrition play a role? Alcohol Health and Research World, 13(3), 232–237. Korsten, M. (1989). Alcoholism and pancreatitis: Does nutrition play a role? Alcohol Health and Research World, 13(3), 232–237.
go back to reference Le Marcis, F., & Ebrahim-Vally, R. (2005). People living with HIV and AIDS in everyday conditions of township life in South Africa: Between structural constraint and individual tactics. SAHARA Journal, 2(1), 217–235.PubMedCrossRef Le Marcis, F., & Ebrahim-Vally, R. (2005). People living with HIV and AIDS in everyday conditions of township life in South Africa: Between structural constraint and individual tactics. SAHARA Journal, 2(1), 217–235.PubMedCrossRef
go back to reference Morojele, N. K., Kachieng’a, M. A., Mokoko, E., Nkoko, M. A., Parry, C. D., Nkowane, A. M., et al. (2006). Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province. South Africa. Social Science Medicine, 62(1), 217–227. doi:10.1016/j.socscimed.2005.05.031.CrossRef Morojele, N. K., Kachieng’a, M. A., Mokoko, E., Nkoko, M. A., Parry, C. D., Nkowane, A. M., et al. (2006). Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province. South Africa. Social Science Medicine, 62(1), 217–227. doi:10.​1016/​j.​socscimed.​2005.​05.​031.CrossRef
go back to reference Parry, C. D. H., Pluddemann, A., Steyn, K., Bradshaw, D., Norman, R., & Laubscher, R. (2005). Alcohol use in South Africa: Findings from the first Demographic and Health Survey (1998). Journal of Studies on Alcohol, 66(1), 91–97.PubMed Parry, C. D. H., Pluddemann, A., Steyn, K., Bradshaw, D., Norman, R., & Laubscher, R. (2005). Alcohol use in South Africa: Findings from the first Demographic and Health Survey (1998). Journal of Studies on Alcohol, 66(1), 91–97.PubMed
go back to reference Pitpitan, E. V., Kalichman, S. C., Eaton, L. A., Cain, D., Sikkema, K. J., Watt, M. H., et al. (2012a). Co-occurring psychosocial problems and HIV risk among women attending drinking venues in a South African Township: A syndemic approach. Annals of Behavioral Medicine,. doi:10.1007/s12160-012-9420-3.PubMedCentralPubMed Pitpitan, E. V., Kalichman, S. C., Eaton, L. A., Cain, D., Sikkema, K. J., Watt, M. H., et al. (2012a). Co-occurring psychosocial problems and HIV risk among women attending drinking venues in a South African Township: A syndemic approach. Annals of Behavioral Medicine,. doi:10.​1007/​s12160-012-9420-3.PubMedCentralPubMed
go back to reference Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.PubMedCrossRef Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.PubMedCrossRef
go back to reference Rehm, J., Rehn, N., Room, R., Monteiro, M., Gmel, G., Jernigan, D., et al. (2003). The global distribution of average volume of alcohol consumption and patterns of drinking. European Addiction Research, 9(4), 147–156. doi:10.1159/00007222172221.PubMedCrossRef Rehm, J., Rehn, N., Room, R., Monteiro, M., Gmel, G., Jernigan, D., et al. (2003). The global distribution of average volume of alcohol consumption and patterns of drinking. European Addiction Research, 9(4), 147–156. doi:10.​1159/​00007222172221.PubMedCrossRef
go back to reference Romeo, J., Warnberg, J., Diaz, L. E., Gonzalez-Gross, M., & Marcos, A. (2007). Effects of moderate beer consumption on first-line immunity of healthy adults. [Comparative Study Research Support, Non-U.S. Gov’t]. Journal of Physiology and Biochemistry, 63(2), 153–159.PubMedCrossRef Romeo, J., Warnberg, J., Diaz, L. E., Gonzalez-Gross, M., & Marcos, A. (2007). Effects of moderate beer consumption on first-line immunity of healthy adults. [Comparative Study Research Support, Non-U.S. Gov’t]. Journal of Physiology and Biochemistry, 63(2), 153–159.PubMedCrossRef
go back to reference Schneider, M., Norman, R., Parry, C., Bradshaw, D., & Pluddemann, A. (2007). Estimating the burden of disease attributable to alcohol use in South Africa in 2000. South African Medical Journal, 97(8 Pt 2), 664–672.PubMed Schneider, M., Norman, R., Parry, C., Bradshaw, D., & Pluddemann, A. (2007). Estimating the burden of disease attributable to alcohol use in South Africa in 2000. South African Medical Journal, 97(8 Pt 2), 664–672.PubMed
go back to reference Scott-Sheldon, L. A., Carey, M. P., Carey, K. B., Cain, D., Harel, O., Mehlomakulu, V., et al. (2012). Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town. South Africa. Addictive Behavior, 37(4), 492–497. doi:10.1016/j.addbeh.2012.01.002.CrossRef Scott-Sheldon, L. A., Carey, M. P., Carey, K. B., Cain, D., Harel, O., Mehlomakulu, V., et al. (2012). Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town. South Africa. Addictive Behavior, 37(4), 492–497. doi:10.​1016/​j.​addbeh.​2012.​01.​002.CrossRef
go back to reference Shisana, O., Rehle, T., Simbayi, L., Parker, W., Bhana, A., Zuma, K., et al. (2005). South African national HIV prevalence, incidence, behaviour and communication survey 2005. Cape Town: Human Sciences Research Council Press. Shisana, O., Rehle, T., Simbayi, L., Parker, W., Bhana, A., Zuma, K., et al. (2005). South African national HIV prevalence, incidence, behaviour and communication survey 2005. Cape Town: Human Sciences Research Council Press.
go back to reference Shisana, O., Rice, K., Zungu, N., & Zuma, K. (2010). Gender and poverty in South Africa in the era of HIV/AIDS: A quantitative study [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.]. Journal of Women’s Health (Larchmt), 19(1), 39–46. doi:10.1089/jwh.2008.1200.CrossRef Shisana, O., Rice, K., Zungu, N., & Zuma, K. (2010). Gender and poverty in South Africa in the era of HIV/AIDS: A quantitative study [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.]. Journal of Women’s Health (Larchmt), 19(1), 39–46. doi:10.​1089/​jwh.​2008.​1200.CrossRef
go back to reference Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 2003(17), 423–441.CrossRef Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 2003(17), 423–441.CrossRef
go back to reference Suliman, S., Seedat, S., Williams, D. R., & Stein, D. J. (2010). Predictors of transitions across stages of alcohol use and alcohol-use disorders in South Africa. Journal of Studies on Alcohol and Drugs, 71(5), 695–703.PubMedCentralPubMed Suliman, S., Seedat, S., Williams, D. R., & Stein, D. J. (2010). Predictors of transitions across stages of alcohol use and alcohol-use disorders in South Africa. Journal of Studies on Alcohol and Drugs, 71(5), 695–703.PubMedCentralPubMed
go back to reference Watt, M. H., Aunon, F. M., Skinner, D., Sikkema, K. J., Kalichman, S. C., & Pieterse, D. (2012). “Because he has bought for her, he wants to sleep with her”: Alcohol as a currency for sexual exchange in South African drinking venues [Research Support, N.I.H., Extramural]. Social Science Medicine, 74(7), 1005–1012. doi:10.1016/j.socscimed.2011.12.022.PubMedCentralPubMedCrossRef Watt, M. H., Aunon, F. M., Skinner, D., Sikkema, K. J., Kalichman, S. C., & Pieterse, D. (2012). “Because he has bought for her, he wants to sleep with her”: Alcohol as a currency for sexual exchange in South African drinking venues [Research Support, N.I.H., Extramural]. Social Science Medicine, 74(7), 1005–1012. doi:10.​1016/​j.​socscimed.​2011.​12.​022.PubMedCentralPubMedCrossRef
go back to reference Watzl, B., & Watson, R. R. (1992). Role of alcohol abuse in nutritional immunosuppression [Research Support, U.S. Gov’t, P.H.S.Review]. Journal of Nutrition, 122(3 Suppl), 733–737.PubMed Watzl, B., & Watson, R. R. (1992). Role of alcohol abuse in nutritional immunosuppression [Research Support, U.S. Gov’t, P.H.S.Review]. Journal of Nutrition, 122(3 Suppl), 733–737.PubMed
go back to reference Weir, S. S., Morroni, C., Coetzee, N., Spencer, J., & Boerma, J. T. (2002). A pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town. South Africa. Sexually Transmitted Infections, 78(Suppl 1), i106–i113.CrossRef Weir, S. S., Morroni, C., Coetzee, N., Spencer, J., & Boerma, J. T. (2002). A pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town. South Africa. Sexually Transmitted Infections, 78(Suppl 1), i106–i113.CrossRef
go back to reference Weiser, S. D., Leiter, K., Bangsberg, D. R., Butler, L. M., Percy-de Korte, F., Hlanze, Z., et al. (2007). Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Medicine, 4(10), 1589–1597 (discussion 1598). doi:10.1371/journal.pmed.0040260. Weiser, S. D., Leiter, K., Bangsberg, D. R., Butler, L. M., Percy-de Korte, F., Hlanze, Z., et al. (2007). Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Medicine, 4(10), 1589–1597 (discussion 1598). doi:10.​1371/​journal.​pmed.​0040260.
go back to reference Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., et al. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. American Journal of Clinical Nutrition, 94(6), 1729S–1739S. doi:10.3945/ajcn.111.012070.PubMedCentralPubMedCrossRef Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., et al. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. American Journal of Clinical Nutrition, 94(6), 1729S–1739S. doi:10.​3945/​ajcn.​111.​012070.PubMedCentralPubMedCrossRef
go back to reference WHO. (2010). UNAIDS/World Health Organization (2010). AIDS epidemic update. Geneva: Word Health Organization. WHO. (2010). UNAIDS/World Health Organization (2010). AIDS epidemic update. Geneva: Word Health Organization.
go back to reference Wood, K., & Jewkes, R. (1997). Violence, rape, and sexual coercion: Everyday love in a South African township. Gender and Development, 5(2), 41–46.PubMedCrossRef Wood, K., & Jewkes, R. (1997). Violence, rape, and sexual coercion: Everyday love in a South African township. Gender and Development, 5(2), 41–46.PubMedCrossRef
Metadata
Title
Exploring the Relationships Among Food Insecurity, Alcohol Use, and Sexual Risk Taking Among Men and Women Living in South African Townships
Authors
Lisa A. Eaton
Demetria N. Cain
Eileen V. Pitpitan
Kate B. Carey
Michael P. Carey
Vuyelwa Mehlomakulu
Leickness C. Simbayi
Kelvin Mwaba
Seth C. Kalichman
Publication date
01-08-2014
Publisher
Springer US
Published in
Journal of Prevention / Issue 4/2014
Print ISSN: 2731-5533
Electronic ISSN: 2731-5541
DOI
https://doi.org/10.1007/s10935-014-0346-3

Other articles of this Issue 4/2014

Journal of Prevention 4/2014 Go to the issue