Alcohol Use Trends in South Africa

The purpose of this review is to synthesize the prevalence data from five national surveys and local surveys on alcohol use in South Africa over the past 12 years. Systematic review. Results indicate that life time, current (past month) use and binge drinking remained similar over the years for both adolescents and adults. Binge drinking was between 7-11% and risky drinking also remained stable over the years (6%) with larger sex, geographic and racial differences. Risky drinking in pregnant women was 2.5% nationally but particularly high among urban dwellers (4.1%), Coloureds (11.6%) and in the Northern Cape province (24.9%). Local surveys among adolescents, university students, clinic populations and mine employees seem to all generally indicate higher levels of risky drinking than in the national surveys. The burden of alcohol was found to be high: Hazardous or harmful drinking and binge drinking were associated with multiple/indiscriminate (irregular) sex partners among persons living with HIV; alcohol related death in transport and homicide of 50% and fetal alcohol syndrome from 10-74 per 1000 in local surveys. Alcohol production/per capita remained stable with 8 litres but there is relatively high alcohol consumption considering an additional 3-4 litres unrecorded production/consumption, and that high amounts are consumed by a small population since most abstain from drinking in South Africa.Although no significant increase of alcohol use over the past 12 years was found, a high burden of alcohol abuse was found. country levels (WHO 2002). Since about 1980, the developed world, mainly consisting of Western Europe and North America, has shown stable or decreasing alcohol consumption levels. In the post-war period, the differences in average consumption levels among developed countries have narrowed and there has been some convergence in drink preferences (WHO 2002). In contrast, in Asia (with the exception of Japan), Latin America and Africa, recorded per capita consumption grew from 1961 to the middle 1970s, but then kept increasing in Asia, but decreased somewhat in Latin America, and decreased somewhat more in Africa up to 1997. The general rule seems to be that alcoholic beverage consumption rises with improving economic circumstances. This suggests that as economic development occurs, alcohol consumption and resulting problems are likely to rise with increasing incomes (Obot 2006). The levels of alcohol-related problems in a given society tend to rise and fall, all else being equal, with changes in the level of per-capita alcohol consumption in the society. Prevention measures which affect the level of alcohol consumption are thus among the most effective ways of preventing alcohol-related problems (WHO 2002). Industrially produced beverages, particularly lager beer, are gradually gaining ground against indigenous beverages, on the basis of prestige, promotion and other Address correspondence to: Prof. Karl Peltzer Social Aspects of HIV/AIDS and Health (SAHA) Human Sciences Research Council (HSRC) Private Bag X41, PRETORIA 0001, South Africa E-mail: [email protected] 2 KARL PELTZER AND SHANDIR RAMLAGAN advantages, although they are typically more costly. Most pervasive is the replacement of traditionally and locally prepared beverages by industrial beverages, and particularly by lager beer (Obot 2006). Population surveys provide evidence of drinking patterns at the individual level. Abstention is the first crucial variable to examine. If abstention is common, which is the case among men and women in many developing countries, then per capita consumption estimates will understate the average consumption per drinker. The available evidence indicates, however, that in many societies, particularly in Africa, including South Africa, many of those who drink at all usually drink large amounts when they drink, especially at weekends (Parry et al. 2005]. As the age distribution in most developing societies is skewed towards younger populations, many of the primary effects of alcohol misuse arise from episodes of acute alcohol intoxication (Parry and Bennets 1998). Acute alcohol intoxication is associated with increased mortality and morbidity in South Africa due to accidents, violence, unsafe sexual practices, misuse during pregnancy, etc. (Parry et al. 2002). The purpose of this study is to review and to synthesize the prevalence data from five national surveys and local surveys on alcohol use in South Africa over the past 12 years. The review will also examine structural factors such as gender, age, socio-economic status (SES), ethnicity and urban versus rural location that may increase the risk for, or protect against alcohol use among South Africans. For the assessment of alcohol use on a national level the following national surveys have been used (see Table 1). Life time and Current (past month) Alcohol Use Comparing adolescents from the population based survey in 1998 to a school-based national survey in 2002, life time and current alcohol use more than doubled among adolescents within the four year period, while the 2005 South African national HIV prevalence, Behaviour and Communication Survey (SABSSM II)survey shows a decline in life time and current alcohol use among adolescents. Regarding life time and current alcohol use among adults, this seemed to have remained stable for the adult population (see Table 2). Current (past month) alcohol use has been about 30% (40% among men and 16% among women), which is lower than those reported for other developing countries, e.g. Namibia (men 61%, women 47%), Mexico (men 77%, women 44%), and Thailand (men 77%, women 46%) (Room et al. 2002).