Is alcohol marketing telling slum teens to live dangerously?

A large billboard advertising beer sits in the middle of an Islamic primary school’s yard in Kamwokya. As a self-regulated industry, alcohol marketers can decide where to place ads, according to the Ministry of Trade. PHOTO by JULIA BURPEE.

What you need to know:

Alcohol marketing and HIV transmission are linked in slum youths, researchers say

“When I get drunk, I don’t always use condoms,” admits a 19-year-old, HIV-positive woman in Kamwokya, a slum area of Kampala.

Despite engaging in riskier sexual behaviour, feeling bad or falling sick as a result of drinking, the young woman, who started drinking at 14, says alcohol advertisements entice her to drink year after year. “I see new brands and I want to try them,” she explains.

The individual, whose identity has been protected, lives in an area where as many as 60 outdoor advertisements for alcohol, billboards and posters primarily, can be found within a 500-metre radius, according to research conducted by Uganda Youth Development Link (UYDEL) and an American epidemiologist, Monica Swahn, earlier this year.

In Kamwokya, like in the six other Kampala slums studied, where alcohol marketing is also rampant, 10.5 per cent of youths aged 12 to 18 are HIV-positive, significantly higher than the national average of 3.7 per cent of youths aged 15 to 24, says the researchers report based on a study of 1,134 young Ugandans.

The prevalence of HIV among disadvantaged youths and the high exposure to alcohol marketing in slums prompts the question increasingly asked by researchers around the world: is there a link between alcohol exposure and the transmission of infectious diseases?

“Alcohol use impairs your judgment and when alcohol is mixed with a high propensity for risky behaviour [the nature of young people], add the possibility of sex and HIV transmission and it can be even more dangerous,” says David Jernigan, director of the Center on Alcohol Marketing and Youth in the US. “There is a major vulnerability in young adult brains because the part that exercises judgment develops after the one that gives rewards” so any impairment can result in greater risk-taking.

Other youths in Kampala’s slums say they have taken more risks when drinking, including fighting, accepting drunken boda boda rides or not using condoms during sex. Each individual interviewed also acknowledged that alcohol advertisements, ranging from billboards and posters to loudspeaker vans promoting brands of alcohol and offering free samples to ads on radio and television, influence them to drink.

These experiences are echoed in a 2011 study of more than 450 youth, aged 14 to 24, in Kampala’s slums, that found that 62 per cent of them had been exposed to alcohol marketing, 26 per cent had received an item with an alcohol brand logo and 27 per cent had been “offered a free drink of alcohol by an alcohol company representative,” according to research by Swahn, the WHO’s consultant on alcohol marketing in sub-Saharan Africa.

“Alcohol marketing creates an environment around alcohol that is overwhelmingly positive; ads are designed to make alcohol use look sophisticated and like drinking will make you popular,” says Jernigan, who wrote WHO’s Global Status Report: Young People and Alcohol in 2011.

“The more young people are exposed to alcohol advertisements, the more likely they are to drink from an earlier age and to drink heavily, according to at least 15 long-term studies that have followed youth, their drinking and decision-making,” says Jernigan.

Margaret Nabasumba is a social worker at UYDEL’s drop-in centre in Kamwokya, where local youths are offered counselling and vocational training. Despite the centre providing free condoms, she says she hears the aftermath of alcohol consumption among minors. “They don’t know what goes on [during sex]. They just find out the next day that that person didn’t use protection - because she was drunk, she didn’t think of it.”

Both partners drinking alcohol at the time of sex was associated with 65 per cent of the HIV-positive youth, according to Swahn’s 2011 research in Kampala’s slums. This is alarming as “those who drink heavily are more likely to engage in unprotected sex.”

Swahn and UYDEL’s research from April also details that 37 per cent of youths in slums didn’t use condoms with their partner in the previous three months and nearly half had had sex with three or more partners.

Other factors, apart from alcohol advertisements, play a role in youth drinking and the resultant risky behaviour, says Nabasumba, who studied social work at Kyambogo University. These include: peer pressure, fragmented families, parents drinking, unemployment, poverty and easy access to alcohol for minors.

Possible solutions
Still, WHO has identified restricting alcohol marketing as one of the three best ways to reduce harmful alcohol consumption around the world, says Jernigan, a leading expert on alcohol marketing. With 23.7 litres of pure alcohol consumed per capita annually in Uganda, the country has the highest drinking rate in East Africa and one of the highest in the world, according to the WHO, but no comprehensive alcohol policy. The Enguli Act, which handles the licensing and manufacturing of alcohol, hasn’t been updated since 1964. However, the national trade and industrialisation policies do supplement some framework to regulate alcohol and other products, says Denis Ainebyona, senior industrial officer at the Ministry of Trade, Industry and Cooperatives.

“We try to put it as a requirement that when you’re labelling alcohol and spirits, they’re marked that they shouldn’t be sold to people under 18,” he says. “We ask marketers to take the lead on sensitisation about not selling to minors.” The ministry helped form the Uganda Alcohol Industry Association (UAIA) in 2011 so the industry could be ‘self-regulated,’ as done with textile and sugar producers,” he explains.

An effective step towards sensitising the public about the dangers of alcohol would be restricting the industry’s marketing, says Ministry of Health official, Dr Ndyanabangi. “When a person is on the road they see adverts or they hear good music from promoters so little children will come [too],” she says. All this normalises alcohol use in Uganda.

“Some of the promotions around alcohol are even attracting four-year-olds and giving them access,” she alleges.
“There should be regulations on [alcohol] advertising; ads are put everywhere” agrees Patricia Ejalu, deputy executive director of technical operations at UNBS. “It just can’t be allowed to make young people think it’s a cool thing to drink.”

Ejalu argues that the new national alcohol policy should also address issues of accessibility, like restricting the hours and locations of alcohol sales and eliminating the packaging of alcohol in small 100 ml plastic sachets. These are too affordable (as little as Shs200 each) for youths, she says. “When people are looking at alcohol access, consumption, and exposure, they don’t look at HIV risk and transmission, but there are very high risks there,” says Rogers Mutaawe, UYDEL’s senior programme manager.

Apart from the costs of treating alcohol-related illnesses and addictions, the World Bank estimates that treating HIV/Aids will cost Uganda Shs3.75 trillion by 2025, up from Shs938 billion in 2008, according to its 2012 Fiscal Dimension of HIV/Aids in Africa report.

“In the long run, it’s going to be economically smarter to have a strong alcohol policy” that addresses the four ‘Ps’ of marketing: product, place, price, and promotion, says Jernigan.
“[Alcohol] advertising is about intentional cultural change: getting people in Uganda to drink at earlier ages, getting women to drink, getting people to drink regularly,” he says. “Uganda gets to decide how it wants its culture to change, not the alcohol industry.”

A problem of self regulation

In a self-regulated industry without a modern alcohol policy to address the current consumption and marketing environments, advertisements for alcohol appear in schoolyards, near churches and in disadvantaged areas, among other places in Uganda’s capital.

Putting ads in vulnerable areas or near places of worship is outlawed in more developed countries, like South Africa, where a 2013 bill banned almost all forms of alcohol marketing, says David Kalema, vice-president of the Uganda Alcohol Policy Alliance.

“Nine out of 10 alcohol advertisements encourage responsibility, but none provide information about what that means,” according to a study of American alcohol advertisements co-authored by Jernigan. The study, published in September, also found that “when responsibility messages were accompanied by a product tagline or slogan, the messages were displayed in smaller font than the tagline or slogan 95 per cent of the time.”

The Kampala Capital City Authority also leaves the alcohol industry to self-regulate its marketing, confirms Peter Kaujju, KCCA spokesperson. The only billboards Kaujju acknowledged the KCCA has removed over content were advertisements for condoms. “Consumption of alcohol is beyond the messages and media,” Kaujju argues. “We need to sensitise our people to know drinking is harmful.”