Kenya's urban youth are treading a dangerous, increasingly alcohol-fuelled path that is leaving them vulnerable to HIV and other sexually transmitted diseases, according to anti-AIDS campaigners.

"The class of clubbing youth is expanding by the day as trendy and chic beer and music joints spring up in major towns," said Juma Kimani, a counsellor with Alcoholics Anonymous in the Kenyan capital, Nairobi. "Booze drives the mind and equips it with dangerous machismo; heavy drinkers become immune to the anti-HIV messages in their pursuit of pleasure."

A visit to any one of Nairobi's hip clubs proves Kimani's point: young people fill the darkened, smoky rooms, downing copious amounts of alcohol that give them the courage to make sexual advances they ordinarily would not try.

"I need a few beers or shots to get up the nerve to tune [flirt with] a girl," said Richard Muchiri*, a 25-year-old student partying at an upscale Nairobi club. "When I'm a little tipsy then I have the confidence to try to get her to go home with me - it helps if the girl is also drinking."

According to Muchiri, it takes at least five beers to become "a little tipsy".

Another reveller, Jenny Ogutu*, said the morning after a night of heavy drinking she often woke up with no recollection of her actions the previous night. "It's what I've done for years - after a long week of hard work my friends and I go out and get drunk to unwind," she said.

Both Muchiri and Ogutu said they knew how HIV was spread and both had previously been tested for HIV; however, they both confessed to having failed to use a condom occasionally after drinking heavily.

"Alcohol use is so widespread in Kenya that people don't think of it as a drug," said Dr Karusa Kiragu, a programme associate with Horizons, a research project under the United States Agency for International Development. "People familiarise themselves with it at a very early age and don't think of it as risky behaviour."
An additional headache, compounding the problem of booze drinking, was that youths, apparently bored with the usual stream of AIDS messages, have begun tuning out. The availability of cheap or free life-prolonging antiretroviral (ARV) drugs has, for some, also drawn the sting of AIDS.

Living dangerously

Graffiti on the walls of one of the public toilets at the University of Nairobi declares in Kiswahili, "Usiogope Ukimwi, ARV zipo", or "Don't fear AIDS, ARVs are available".

To anti-HIV campaigners, the message sums up the 'live fast' attitude of some young people. "It is a manifestation of open rebellion to safe sex," Kimani, himself a rehabilitated drug addict and alcoholic, said. "Some take consolation in the belief that the availability of ARVs would enable them to live longer if they contracted the virus."

Horizons' Kiragu noted that high-risk behaviour associated with the availability of ARVs was not unique to Kenya. "We saw this trend in the US, when ARVs were introduced and the resulting apathy led to a spike in prevalence among MSM [men who have sex with men]," she said.

But "treatment can fail; HIV is an ever-evolving condition and people cannot afford to relax," she added. "Behaviour change experts must find ways to keep the message fresh and keep it in the public's consciousness."

Kiragu also noted the hypocrisy that prevented unvarnished messages about HIV from being used by the media. "People complain about the sexual nature of the very direct HIV messages their children are exposed to, but these are the same children who spend all day watching overtly sexual music videos."

Spreading the word

She also has a robust line on the need to educate Kenyans about healthy drinking, and the responsibility of the alcohol industry.

"If we had a standard, a guide to what healthy drinking is, that would be a start," Kiragu said. "As it stands, people are never told whether two drinks or 10 is the upper limit for healthy drinking - they need to know what effect excessive drinking has on their bodies."

The government's National Campaign Against Drug Abuse in Kenya has acknowledged the need for a national alcohol policy to regulate the alcohol industry, but the agency is limited by funding, while breweries spend millions of dollars making booze look sexy.

In addition, the alcohol companies - among the country's biggest tax payers - have political clout, and efforts to regulate drinking have been met with resistance. For instance, in 2006, the government introduced a breathalyser test to deter drink-driving, but within months a court injunction saw the test banned.

"There is a need for corporate social responsibility among alcohol brewers and distributors, and this need is not being met," Kiragu said.

She suggested that incorporating an alcohol counselling component into voluntary counselling and testing would also help to inform the general public about the dangers posed by excessive drinking.

With the right information campaigns, Kiragu said, it was possible to reduce problem drinking.

"We have been able to learn new behaviours like condom use and reduction of sexual partners, so with the right messages and wide dissemination, we can also turn the tide with alcohol abuse," she said.