Vox pops: (one and two) A Future In Doubt: Youth Alcohol Abuse in Namibia

Hi Chaps!

Every Saturday morning in Windhoek witnesses a stampede to the city’s Bottle Stores (that’s Off-Licences to you Brits, Liquor Stores to you Yanks). Today was no exception. And, yes, I was part of it. But as I watched a guy the size of a gorilla loading 30 plus cases of beer into his bakkie, I suddenly remembered that after the Leonard and Gender Based Violence post I’d promised a follow up post on the dubious role alcohol plays in some Namibian lives.

Here it is! Some of the stats are staggering! And the two Vox Pops at the end make for sobering reading!

A FUTURE IN DOUBT: YOUTH ALCOHOL ABUSE IN NAMIBIA.

(An Issue Paper researched and written by myself for UNICEF)

Alcohol abuse is currently becoming acknowledged as a root cause, or at very least the trigger, for many of the social ills threatening the well-being and development of Namibian society including adult and minor rape, domestic violence, child neglect, crime, poverty, disease, lack of productivity/absenteeism in the work place, road fatalities, unprotected sex, unplanned pregnancies and the spread of potentially lethal sexually transmitted diseases (STDs), most notably HIV-AIDS.

Although, according to a nationwide government Knowledge Attitudes and Practice (KAP) study,  39% of the adult population has never touched alcohol of any kind, largely on religious, and to a lesser degree, cultural grounds, and while currently some 44% of all Namibians are abstaining from liquor, those individuals who make up the remaining population percentage, and who do drink, frequently do so to excess.

Furthermore, alcohol abuse is by no means confined to the adult population. Despite laws prohibiting sales to anybody under 18, consumption of alcohol  is widespread among juveniles and even occurs regularly in the pre-teen population.

Drinking Patterns.

The weekly average alcoholic beverage consumption of a drinking Namibian is 10 litres (the equivalent of 33 standard size bottles – “dumpies”- of beer). For heavy drinkers this average rises to 78 beers (or the equivalent). Commercially produced bottled beer is not exclusively the drink of choice. Wine (especially cheap boxed wine), “hot stuff” such as brandy, gin or vodka, home brewed beer (the most popularly drink accounting for 67% of national alcohol consumption and 73% of all female consumption) alcoholic porridges, soups, and even illegally distilled liquor spiked with ingredients such as animal body parts, tobacco, battery acid,  and paint thinner to increase the potency of its effects, are routinely consumed in large quantities in contemporary Namibia, sometimes with fatal consequences.

One particularly dangerous phenomenon in Namibia has been identified by various studies in the prevailing ‘drink to get drunk’ mentality. This is prevalent among adults but also youth and although alcohol consumption to excess is traditionally associated with masculinity it now extends to Namibia’s female population.

As one health advisory issued by domestic NGOs, Catholic AIDS Action and NAWALife, notes, social drinking occurs and is widespread but many other people see alcohol as a quick path to oblivion and drink hard and fast to achieve it. Whatever the motives – unemployment, family problems, poor work prospects or living conditions, a desire to get drunk, party  etc. -  this mind-set establishes a fertile and well documented breeding ground for the development of both alcohol abuse behavioural patterns and chronic alcoholism.

The advisory concludes, “We (Namibians) have some of the most dangerous drinking habits in the world.”

Availability.

One of the key contributing factors to the drinking epidemic is the low price of alcohol and its availability. Alcohol is not just prominently advertised on bill boards, TV, radio and in the print media, but is also readily obtainable throughout the country. To take one example, the Khomas Region (which includes the capital, Windhoek) has more than 600 legally registered permanent alcoholic drink outlets including restaurants (22), nightclubs (34), grocery stores (90), wholesale liquor warehouse outlets(31), hotels(58), special-license holders(185), bottle stores (77) and shebeens (75). Supermarkets and gas stations have also started selling wine and/or beer. No definitive count has been made of unregistered shebeens operating in both urban and rural areas in Khomas Region. But these unlicensed establishments which sell liquor from small shacks or rooms in private houses are proliferating despite recent attempts by Government to close them down.

Ease of Underage Access.

Although liquor sales from shops are prohibited from Saturday afternoons to Monday mornings and on National Holidays, it is possible to purchase alcohol (legally or otherwise) 24 hours a day, seven days a week. Mainstream  establishments stringently adhere to the “no sales to under eighteens” rule but it is not difficult for children to obtain drink elsewhere; either from small shops, friends, relatives or shebeens. This ease of access is evidenced in various papers and reports. In the  Ministry of Health and Social Services (MoHSS) KAP study, for example, of 2,832 interviews nationwide, two thirds of interviewees agreed with the statement “It is easy for the youth to get access to alcohol at shops in this community” and one half acknowledged that it was easy for young people to obtain home brewed alcohol locally.

And young in this case means just that. A UNICEF Knowledge, Attitudes, Practice and Behaviour (KAPB) Study (2006) reports that one in ten of a sample group of 10-14 year olds had already taken alcohol at some point, the median starting age being 10.5 years. Another study (Johns Hopkins University) places the figure even higher with twenty percent of respondents admitting to taking their first drink by the age of ten. Government psychologists at the Windhoek Mental Health Centre routinely treat under-tens who have turned to alcohol after running away from home, being bullied at school and so on. Whatever the precise statistics are – and nation-wide drinking habits vary considerably- it is an incontestable reality that many Namibians encounter alcohol from a very early age. And that society in general is becoming increasingly acceptant and tolerant of alcohol use and abuse even by minors.

Why They Start.

Many young people start drinking not because they were weaned onto fermented porridge but because of other external factors. When asked what influenced them to start drinking (and smoking) the most frequent answer is peer pressure; “because my friends were drinking,” “I wanted to be part of the crowd.” etc. Other motives commonly referred to include availability, thirst, curiosity, the fact that alcohol is intimately connected with parties and celebrations, and a desire for entertainment.

Only five percent of alcoholics interviewed by MoHSS attributed their current behaviour to infant drinking. A smaller minority implicated sorcery.

Curiously, given the fact that 32% of 10-14 year old children in the UNICEF study received their first alcohol, not from shops or peers, but from their own parents or guardians, and that well over half of them were exposed to drunken behaviour in their homes (and 45% witnessed their parents/caregivers drunk) this dysfunctional familial influence was largely overlooked by interviewees.

It is nevertheless a crucial stimulus given that alcohol abuse is often “learned behaviour” and that exposure to a drunken living environment increases the probability of children exhibiting alcohol risk behaviour by a factor of 3.53(UNICEF).

Youth Attitudes To Drink.

Attitudes among youth to alcohol are ambivalent. While young people point out its plus points – drinking as a means of relaxing, celebrating weddings, having fun, forgetting problems, boosting self-confidence, taking place in exciting environments such as pool halls or bars with music or TV with the chance to meet friends and members of the opposite sex -  there is a general sense that alcohol is a bad thing that encourages fights, arguments violence and careless sex. ‘Fighting’ and ‘sleeping around’ were the most commonly identified problems likely to occur according to youth respondents to the MoHSS survey.

Indeed in most surveys young people’s negative perceptions of alcohol out-number the positive. This does not, however, generally act as a deterrent. Neither does the fact that many young people in the 15-21 age bracket admit to having had problems with the police, fights, personal physical injuries (just under a quarter of adults and juveniles surveyed by government nationwide have sustained drink-related injuries), arguments, exposure to sexually risky encounters, crime,  and other damaging incidents directly connected to their own alcohol consumption.

The Coalition On Responsible Drinking (CORD), a diverse alliance of stakeholders including government, UNICEF, police, breweries and church groups that has as its objective building a nation of responsible drinkers, is active in youth education programmes. These include advertisements, printed material, road shows, and workshops. Current funding and logistical constraints, however, currently inhibit intervention roll-out on the scale that is necessary in a nation as large and culturally diverse as Namibia.

Alcohol and HIV Spread.

Namibia has one of the highest HIV rates in the world. The 2004 National HIV Sentinel Survey (MoHSS) estimated infection at 19.7 percent of the population and the linkage between alcohol and the spread of HIV-AIDS both in the adult population and among young people is clearly established. Drinking increases the probability of HIV risk behaviour by a factor of 3.51 (UNICEF KAPB Study). The vast majority of all peer groups interviewed in the John Hopkins study identified alcohol as the most influential factor in their sexual behaviour, confirmed that it leads to impaired judgement, unprotected and unplanned sex, and rape. The peer groups also attributed its influence as extremely significant to the spread of HIV. The same groups had all observed an increase in violence between men and women and an increase in alcohol use in their communities.

Sexual behavioral patterns among the 10-14 age group are of concern. Forced sex is common accounting for 42 percent of first sexual acts (24% in the 15-21 age group). Sex with much older men also frequently occurs, with alcohol playing a common role in coercion. Furthermore an increasing number of young people are being driven to take multiple partners by a desire for reward, including food, money and alcohol (Johns Hopkins study).

Conclusion and Recommendations.

The issue of wide-spread alcohol abuse by youth (and the attendant spread of other social problems, notably HIV) clearly requires aggressive but sensitive interventions. The problem, however, is not just entrenched, but pervasive and difficult to combat. Complicating the matter is that alcohol abuse by young people is not a problem that stands alone. It is often inextricably linked to family and social environment.

Statistics show a correlation between heavy drinking and a lack of education and opportunity  (leading to poor work prospects, an apathetic view of the person’s future, enforced idleness which in turn leads to substance abuse which then undermines decision making capacity which leads to promiscuity and the spread of disease). This makes education a logical prevention intervention priority.

Lack of knowledge, however, is not so much a problem, rather it is the lack of empowerment to act out what they know (Johns Hopkins Community Assessment Findings), necessitating a roll out of life skills programmes by organizations such as the health and education sector and CORD.

Many young people are initially drawn to shebeens, not because of drink, but because shebeens  provide the only readily accessible entertainment (music, TV, social inter-action, etc. plus a feeling of maturity and independence).  Helpful in this respect  would be the provision of alternative ways of constructively occupying and developing the bodies and minds of Namibia’s young people, be it in the form of organised social clubs,  entertainment places offering music/TV equivalent to (or exceeding) those offered by shebeens, sporting facilities, practical life and work skills training to improve prospects of employment etc.

Government has programmes in place addressing the promotion of responsible drinking, the risks attendant with alcohol abuse and the advantages of sobriety and multi-media campaigns are in place. Encouragingly a high percentage of Namibians say they have already been exposed to such educational information. Radio is proving to be by far the most effective medium of communication; 77% of respondents to the MoHSS KAP survey had heard at least one radio programme on the issue, with TV coming second, 30.8%, pamphlets third, 36.7% and presentations, 24.5% (there was a positive link between presentation attendance and hearing a radio programme).

Less encouragingly, but offering a timely opportunity for intervention, comparatively few people (less than fifty percent) were aware of facilities, organisations or individuals involved in alcohol abuse prevention, counseling, treatment and, particularly, rehabilitation. Currently only a handful of rehabilitation facilities are operational, the number of beds is small and youth access to such services is limited.

• Restricting access to alcohol by young people by necessity requires the restriction of outlets, particularly illegally operated shebeens, and the arrest and prosecution of those individuals and establishments caught selling liquor to under-eighteens and illegally making home brewed drink. This role should fall to the law enforcement agencies of local and central government.

• There is an urgent need for CORD to be strengthened and revitalized in order for it to expand its work in the fields of Prevention, Legislation/Enforcement and Treatment

• An increase in liquor taxation, as advocated by CORD, would also serve as a deterrent.

• The proliferation of liquor advertising (bill boards, TV, radio, posters, promotions, competitions etc.) should be countered by the prominent involvement of celebrities (musicians, athletes, TV personalities etc) and public figures admired by the youth as advocates of responsible drinking.

• A national “no alcohol” day should also be declared and media celebrities enlisted to promote it.

• Public access to information on the negative consequences of alcohol abuse should be mandatory in the form of health warnings on liquor and beer containers, advertising and in industry-sponsored events. Although radio advertisements for liquor have already begun to include the “enjoy responsibly” message, overall the industry, which clearly has a social responsibility to make efforts to ensure that its products are not being abused and are not made attractive and available to youth, needs to take a more proactive stance.

• An increase in numbers of rehabilitation facilities – particularly those focused on under 18s – is essential as is a public awareness campaign to inform the public of the existence of such facilities.

• Programmes on how to deal with families that are dysfunctional due to alcohol and drug abuse, could also assist in normalising community environments. This requires a significant increase in the number of trained social workers in this field.

• Multi-sectoral approaches and co-operation are essential to empower the young people of Namibia to change the destructive role of alcohol in their lives, and the lives of those who surround them, and regain their sense of having a future.

Ultimately in order to address the scourge of alcohol abuse in Namibia a dramatic shift in the societal and home paradigm is required. The country needs a growth in formal sectors coupled with waged employment, elevated levels of education, realistic possibilities for life-style improvement and for the youth to develop a feeling of purpose.

Young Namibians need to be nurtured by their home and social environments to live life, not try to escape it with the assistance of a bottle.

SOURCE DOCUMENTS:

Knowledge, Attitudes, Practice and Behaviour (KAPB) study in Namibia (2006). UNICEF

Baseline & Mid-term Results from the Household Surveys, Network Analyses Community Assessment Findings (2005 & 2006). Johns Hopkins University.

Integrated Early Childhood Development (IECD): A Baseline Study on Maternal & Child Care Practices and Resources in Namibia (2003). Ministry of Women Affairs & Child Welfare, Ministry of Health & Social Services, UNICEF.

Alcohol Usage and Youth Pilot Study (2003). Research Faciliation Services.

Nationwide KAP Baseline Survey on Alcohol and Drug Use and Abuse in Namibia (2002). Social Impact and Policy Assessment Company (SIAPAC) for MoHSS and Directorate of Developmental Social Services.

Structural Conditions for the Progression of the HIV/AIDS Pandemic in Namibia (2004). Debie LeBeau

“What Do You Do For Life If You Don’t Drink”: The meanings of alcohol for young Namibian women (1999). Anne Skjelmerud, Centre for partnership in Development (DiS).

Substance Use Among the Youth in Namibia (1998) DiS, MoHSS, UNAM

VOX POP ONE.

“Like how I do it, I don’t do it slow, I want to be there. I just take one drink first. I see it is not enough, so I take another one, till I am at that level where I can move (drink) faster.”

“The point was to get drunk. After getting drunk you feel good. If you are drunk you feel sleepy, your head seems to be moving around, like when you lie in bed, the room seems to move, that was very nice for us. We liked that feeling.”

“I never smoked, but some girls did, because they say that if you smoke you get more drunk. The point was to get drunk.”

“Me, I drink one beer – but then my throat opens and I can find myself drinking the whole crate. One tot will tell me this is not enough, let the whole bottle come.”

“I took it from my drunken grandfather the first time and from then on I just wanted it.”

“One reason to drink is to clear that hangover. Then you get in the mood for that drink.”

“Beer is more healthy than any other drink. It brings milk to the breast when you breastfeed.”

Extracts from interviews with young Namibian girls and  women. “What do you do for life if you don’t drink? The meanings of alcohol for young Namibian women” (1999) DiS. Anne Skjemerud.

VOX POP TWO.

“I fell prey to peer pressure. Having a lot of friends around me who were alcohol abusers it didn’t take me long to indulge. Experience is a hard teacher because she gives the test first then the lesson later…I’ve brought it (HIV) on myself and am reaping what I sowed.”

“Many drink alcohol to forget their problems for a few hours, others to enjoy the feeling of being drunk – believe me, there are such kinds of people, and others is just idle.”

“I drank a lot to not feel alone. My courage lies in a bottle. I can’t go a day without it. The doctors said the three words – you have HIV. I only told ****** (my boyfriend). He got so emotional he committed suicide.”

“Some people under the influence of alcohol feel using a condom will kill the mood.”

“You know there were two parties consenting to the sex decision but there is a third party present. That is alcohol.”

“When you leave your place you are not ready for sexual contact but, because of the alcohol offered to you, you end up having sex with one of them.”

“How painful it is to lose a beloved one from AIDS and how it hurts watching the person you love dying slowly.”

Extracts from prize-winning autobiographical essays by Polytechnic of Namibia students. Essay contest sponsored by UNICEF as part of HIV and Alcohol Awareness Campaign.

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[1] See UNICEF Issue Paper on Domestic Violence and Violence Against Women and Children (2007).

Tags: Alcohol abuse, Johns Hopkins, UNICEF Namibia, Vox Pop, Youth Alcohol Abuse