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

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

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-NatalBoth within the province of KwaZulu-Natal Study Participants: DoE List –random selection-12 public high schoolsDoE List –random selection-12 public high schools One grade 9 class randomly selected in each schoolOne grade 9 class randomly selected in each school All students in the class included in the studyAll 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)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 behaviourQuestions 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)Likert Scale= Strongly disagree (1) to strongly agree (5) Administered by fieldworkers in absence of teachers (Anonymous)Administered by fieldworkers in absence of teachers (Anonymous)Analysis SPSS program – Univariates, Bivariate, and Covariates analysesSPSS program – Univariates, Bivariate, and Covariates analyses

7. Ethics Approval Ethical Approval, Informed consent UKZN-Biomedical Research Ethics Committee, Department of Education and School PrincipalsUKZN-Biomedical Research Ethics Committee, Department of Education and School Principals Written informed consent from Parents and LearnersWritten 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.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 alcoholAlcohol Drinker: Those who have ever had alcohol Non-drinker: Those who have never had an alcoholic drinkNon-drinker: Those who have never had an alcoholic drink Underage drinking- individuals below the age of 18 years who drink alcohol.Underage drinking- individuals below the age of 18 years who drink alcohol.

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

10. Prevalence of Underage Drinking by Gender, (n=657) 36.2% 63.8% 40.9% 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 Predisposing Factors of Under Age Drinking for KZN High School Learners Variable Non- drinkers DrinkersP-value Live with Mom and Dad 69.9% 37.1% 37.1%<0.005 Mom’s education** 71.1%28.9%0.05 Read mags. & n/papers 62.1%37.9%0.04 ** Mothers who have grade 10 –grade 12 / tertiary education

13. Intrapersonal Determinants Influencing Underage Alcohol Use Amongst High School Learners (n=657) VariableNon-drinkers (n) (n)Drinkers(n)P-value Age (years) 15.4015.81.007 Drink for fun* 1.732.50<.005 Drinking – problems* 1.832.25<.005 Drink- confident* 1.842.54<.005 *Likert Scale: Strongly disagree (1) – Strongly agree (5)

14. Interpersonal Determinants Influencing Underage Alcohol Use Amongst High School Learners (n=657) Variable Non- drinkers Drinkers DrinkersP-value Close friends drink * 3.42 (313) 3.05 (187).005 Friends approve use* 2.51 (329) 2.90 (193).002 Difficult to refuse a drink * 2.63 (287) 3.03 (183).004 *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 observedAfter 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)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)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 femalesStudy confirms that males use alcohol more than females This study has confirmed the prevalence of underage alcohol drinking and it association with unsafe sexThis study has confirmed the prevalence of underage alcohol drinking and it association with unsafe sex Learners perceived that alcohol benefits their social livesLearners perceived that alcohol benefits their social lives Learners’ knowledge about HIV did not influence their sexual behaviourLearners’ 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 learnersIn 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 educationFactors that protect are mothers’ higher education

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

21. Acknowledgements World AIDS FoundationWorld AIDS Foundation Department of EducationDepartment of Education PrincipalsPrincipals ParentsParents LearnersLearners ColleaguesColleagues