Qualitative Research in Uganda on Knowledge, Attitudes and Practices Concerning Alcohol

This report, conducted for Young Empowered and Healthy (YEAH) - an organisation involved in behaviour change communication aimed at reducing the prevalence of HIV and AIDS in Uganda - presents the findings of a qualitative study about alcohol which involved 30 focus groups of adolescents (15-17), young people (18-24 years of age), and adults (25-35) in 5 districts in Uganda, namely, Lira, Nakasongola, Hoima, Soroti, and Kampala. The study aimed to: understand the knowledge, attitudes, and practices of participants in relation to alcohol use and abuse; identify drivers of alcohol use and abuse; explore the linkages between gender norms and alcohol use; determine the linkages between alcohol abuse and risky sexual behaviour; assess the roles of existing social support structures and institutions that influence behaviour in relation to alcohol abuse; and explore perceptions about norms surrounding alcohol consumption.

Study participants demonstrated some awareness of the short-term and long-term problems associated with excessive alcohol use. They were fully aware that alcohol use - and particularly, excessive use - could have a detrimental impact on an individual's health and quality of life. Participants were able to identify general health problems associated with excessive alcohol consumption. Social effects of alcohol abuse included domestic violence, strained family relations, perpetuation of alcohol abuse in the family, and financial strain.

Alcohol use was associated with risky sexual behaviour including unprotected sex, casual sex, multiple partners, and sexual violence (rape) among both women and men (adolescents and adults). Alcohol use lowers inhibitions and gives people the boldness to do what they would not ordinarily do. In fact, young men sometimes use alcohol to bolster their courage to approach women, and sometimes it is used to soften a girl's resolve. Both men and women were seen as likely to sleep with someone they would not have slept with if they had not consumed alcohol. Participants also indicated that people are less likely to use condoms while under the influence of alcohol. They recognised that this was a potential driver for HIV infection.

Alcohol was also seen to increase the risk of sexual assault. Among the perpetrators, who were usually reported to be male, drinking reduces inhibitions against socially unacceptable behaviour and allows them to attribute responsibility for their behaviour to alcohol. On the victims' part (usually women), alcohol impairs judgment about high-risk companions or situations.

The research showed that there are various influences that lead people to drink alcohol. These include inadequate parental controls, the environment in which children are raised, social events, peer pressure, and the need to prove masculinity. Alcohol was cited as a coping strategy for stress, a way to escape problems, and a means to overcome idleness and boredom. Alcohol was also used because it is cheap and easily accessible. The home environment in which the child is raised was identified as having an influence on his or her alcohol use behaviour later in life. Children who grow up in homes where alcohol is brewed and sold will most likely use it when they are grown. Parents were also seen to have a major role in influencing alcohol use among their children. Children whose parents used and abused alcohol were also likely to copy this behaviour when they grew up. The media were also seen as major influences on alcohol use among young people. Social events and celebrations such as weddings and funerals where alcohol is likely to be served also provide young people with an opportunity to access alcohol.

With regard to the linkage between gender norms and alcohol use, the study found that the existing gender norms largely influence the drinking habits of men and women. In fact, most social norms to regulate the use of alcohol tend to be gendered. It is generally agreeable for men to consume strong drinks and to have their drink anywhere. Women, on the other hand, are expected not to have strong drinks or drink away from their homes. Boys generally begin to drink at an earlier age than girls. While use of alcohol among young boys was linked to masculinity, among girls it was associated with lack of respect. While it is acceptable for older women to drink, they are expected to do so only in the evening, after completing their domestic chores.

The research showed that there is generally limited knowledge about the laws on alcohol use. There is knowledge that young people below the age of 18 are not supposed to drink alcohol and that there are laws around drunk driving and opening hours for bars.

The study found that the family almost single-handedly presented the only formidable social infrastructure to influence behaviour in relation to alcohol abuse. The family plays a role in counselling and advising young people about alcohol use and is seen as playing a role in keeping young people busy. Parents also encourage their children to participate in church and other community activities, where they think children will be protected. This notwithstanding, the findings also show that family was sometimes responsible for alcohol use and abuse among young people by introducing it to them and not imposing restrictions to limit their access.

The study found that, although there are social norms to regulate alcohol, these are openly violated. There are no visible sanctions to deter the population from violating social norms. This could be an indication of a growing trend of permissiveness among the community in relation to alcohol use. The study observed that there were no services in place to support communities around alcohol issues. Services in education and support services for individuals with alcohol-related problems were non-existent in all the study areas.