CHAPTER ONE
INTRODUCTION
1.0      BACKGROUND TO THE STUDY
Available statistics suggest that the global burden of disease with regard to both alcohol and unsafe sex is considerable. For example, in 1990 alcohol accounted for 3.5 percent of the total Disability-Adjusted Life Years (DALYs) lost globally, and for 2.1 percent of the total years of life lost; unsafe sex accounted for 3.0 percent of the total years of life lost globally (Room et al., 2002: Murray & Lopez, 1996). The respective contributions of alcohol and unsafe sex to the global burden of disease are, furthermore, amplified through the linkages that have been shown to exist between alcohol, risky sexual behaviour (unintended or unprotected sexual contact) and the spread of sexually transmitted infections (STIs), including HIV infection.
Sexual risk behaviour accounts for a large number of opportunities for acquiring HIV infection, and alcohol use has been shown to increase high-risk sexual behaviour. Moreover, the social dynamics that surround alcohol use, sexual risk behaviour and HIV infection and interactions between these issues warrant a search for alternative ways of dealing with the problem in diverse socio-cultural settings, if intervention is to be effective. Only by unraveling the social dynamics of alcohol use-related sexual risk behaviour within particular cultural settings can this be achieved. It can be anticipated that the body of knowledge acquired through proven scientifically sound instruments will not only highlight the relevant preventive measures to be adopted but will bring out relevant clinical and experimental research questions to be considered by all disciplines interested in curbing the problem of alcohol use-related sexual risk behaviour with regard to HIV infection.
People with alcohol use disorders are more likely than the general population to contract HIV. Similarly, people with HIV are more likely to abuse alcohol at some time during their lives. (Petry, 1999) Krupitsky et al. Found a rate of 9 percent for alcohol abuse/dependence in hospitalized patients with HIV/AIDS (Krupitsky et al, 2005). Alcohol use is associated with high-risk sexual behaviors and IV drug use which are two major modes of HIV transmission. Alcohol-related problems are a major public health issue. A submission of the studies on alcohol use in Nigeria shows that there has been a rapid increase in alcohol availability and consumption in recent times with young adults in universities and colleges being those mainly concerned. (Abiodun, 1991) Most alcohol-related problems appear in non-alcoholic dependent individuals who fall into the categories of hazardous or harmful drinkers according to the WHO (2000) terminology.
In Nigeria studies have focused on lifetime and current prevalence rates of alcohol use without exploring alcohol-related problems. (Odejide et al, 1997; Adelekan et al, 1999) Adewuya in a sample of University young people found Alcohol related problems in 13.2 percent of subjects of which 9.4 percent had Hazardous drinking, 3.1 percent had Alcohol abuse and 0.74 percent had Alcohol dependence (Adewuya, 2005). There is an urgent need to encourage extensive epidemiological and longitudinal studies of alcohol-related problems in Nigeria in order to accurately determine the populations at risk. Early detection of people with hazardous alcohol intake and time bound interventions aimed at decreasing alcohol consumption and thus the likelihood of harm and dependence is warranted. People who abuse alcohol are more likely to engage in behaviors that place them at risk for contracting or transmitting HIV. A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (e.g., injection drug users, prostitutes), and the exchange of sex for money or drugs. (Windle, 1999; Avins et al, 1999; Boscarino et ai, 2000; Malow et al, 2001) There may be many reasons for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish risk perception. (MacDonald et al, 2000; Fromme et al, 2000; Cooper, 2002) Decreasing alcohol uses among HIV patients not only reduces the medical and psychiatric consequences associated with alcohol consumption but also decreases other drug use and risky sexual behavior and hence reduce HIV transmission (Lucas et al, 2002). Thus, alcohol and other drug abuse treatment can be considered primary HIV prevention as well (Metzger et ai, 1999).