The findings are presented under 4 themes, in line with the study objectives. These include the extent and acceptability of alcohol use in the district, patterns of alcohol use, perceptions of problems associated with alcohol use as well as the help-seeking behavior of persons with alcohol use related problems.
Reasons for alcohol use and social acceptance
Production and consumption of alcohol was noted to be a common practice in the district. This was largely attributed to the fact that Kamuli is a sugarcane growing district, and sugarcane is used in the production of local brew in addition to sugar. Participants affirmed that many households in the district rely on alcohol production as their main economic activity; making alcohol readily available, accessible and affordable, with minimal restriction to the young people. It was further reported that in some areas, regular heavy drinkers would at times go to the local breweries and were allowed to consume alcohol for free when they did not have money. Crude spirit processed from sugarcane was reported to be the most popular alcoholic drink used by the majority of the people in this area. The same product was reported to be a major business commodity attracting buyers from outside the district. Other relatively improved alcoholic beverages such as bottled/canned beer were reported to be available but less affordable and therefore not a preferred choice. Mixing brands of alcohol was reported to be a common practice among some of the heavy drinkers to realize the effect of intoxication more rapidly.
“…some alcoholics prefer mixing Beer, locally produced Waragi, Malwa, Mwenge-bigere, Avon, Pass-palm, Malasi and Kuber into one container so that they feel the real effect of alcohol. But for that one, if you’re not senior or have never taken this mixture, you can end up defecating in public” (Respondent 4, FGD1, Alcohol drinkers).
Respondents identified several reasons for alcohol consumption most notable of which was relaxation, socialization and the urge to drive away shyness and boldly approach potential sexual partners.
“… like me who has no strength when having sex with a woman, alcohol gives me appetite to have sex. It boosts my energy so that I fulfill my duty of satisfying a woman sexually and she feels happy.” (Respondent 3, FGD1; Alcohol drinkers.)
Others drink as a way of coping with losses, problems and dealing with their frustrations and unhealthy domestic relationships.
“…you realize that some of us have wives who are very quarrelsome. You never have peace when with her at home. So, I rather spend time in drinking places than being at home with a quarrelsome wife. I only go home to sleep, to avoid quarrelling or fighting with her. It is o.k. to abuse me when am drunk…because I will have no energy to respond” (respondent 4, FGD 1 Alcohol drinkers).
Introducing children to alcohol at an early stage was noted to be a common practice in this community. Children from families involved in alcohol production or sale, as a source of income often get directly involved in production and sale of alcohol. It emerged that some parents administer alcohol to children as medicine, with a belief that it cures cough, flu, malaria and kills intestinal germs. It was further reported that some parents proudly introduce their children to alcohol, especially the boys and are happy to have their sons drink, just like them. Furthermore, some of the participating heavy drinkers rationalized their drinking by referring to the bible since Jesus converted water to wine as one of the miracles, while others contended that it is very okay to drink on earth since there will be no alcohol in Heaven. The religious leaders on the other hand expressed their disapproval of alcoholism. They argued that the bible denounces alcoholism, and most alcoholics are entrapped into the vice, behaving under the control of the devil.
Alcohol consumption was therefore reported to be common and generally acceptable, as society tends to be less concerned about one’s drinking habits if he/she does not inconvenience others. Social events such as weddings, parties and other traditional festivities tend to be associated with excessive alcohol consumption.
Despite being legally and socially acceptable, some of the participants, especially health workers and leaders expressed mixed feelings towards alcohol consumption, describing alcoholics as wasted and irresponsible people who should not be trusted or respected. However, some others, especially the heavy drinkers had more positive views of alcohol as a beverage that has existed since time immemorial, a source of livelihood for families, and an important item traditionally used in paying pride price in many cultures. The drinking culture was said to be deeply entrenched in the community to the extent that some heavy drinkers formed support groups to promote their interests as alcoholics.
Most respondents believed that alcohol has no substantial health benefits to the individuals who consume it, apart from the short-lived pleasure and opportunity to interact with fellow alcoholics. They observed that, the major beneficiaries of the alcohol industry are individuals involved in production and sale of alcohol (as it is a source of income to them) as well as government through taxation.
Patterns of alcohol use
Alcohol consumption was reported to be common across all categories of people in the district, irrespective of sex and religion. Born-again Christians and Muslims were however reported to drink in secrecy because their religions denounce alcoholism. Consumption among females was reported to be relatively lower, except those who work in bars and elderly women, especially widows. On the other hand, males were noted to start drinking alcohol at an early age.
“…since alcohol is readily available in the homes, children begin drinking as early as four years and by the time they reach their 18years, they are already experts. They said, a child of 14years can even drink more than a mature person. Such young alcoholics consequently age so fast”
Heavy alcohol drinkers were reported to be very social as they often drink in groups, as couples, families or peers. They apparently rationalize the behavior with the belief that alcohol drunk in isolation is not tasty and therefore always look out for their mates to drink together. In this way many can also get free alcohol. Underage drinking was particularly cited as one of the very serious problems in the community, since many minors take on drinking at a very early stage, mixing various brands of alcohol; at times combined with other illicit drugs. While alcohol was reported to be readily available and accessible in the district, consumption was reported to be particularly high in the sugarcane growing areas, where brewing is a key economic activity. The harvesting seasons as well as festive seasons were specifically said to be the peak periods, characterized by very heavy alcohol consumption beginning early in the day until late.
Perceived health related problems
Heavy alcohol consumption was reported to be associated with some health problems, including susceptibility to sexually transmitted infections. The participants affirmed that due to excitement and impaired judgment, heavy drinkers often get involved in risky behaviours under the influence of alcohol; including irresponsible sexual behaviours that lead them to contracting various sexually transmitted infections, including HIV. Unmarried elderly women involved in the production, sale and consumption of alcohol were reported to seduce boys, buying them alcohol in exchange for sex.
“…those old women around 40 years, who have constructed houses for themselves have gone beyond as far alcohol consumption is concerned. They are the major producers of locally made alcohol and in the process, they seduce young boys by buying for them alcohol in order to have sex with them and some of these boys have been married off by these women” (FGD 1, male alcoholics)
Some of the heavy drinkers admitted having had unprotected sex, at times with fellow alcoholics under the influence of alcohol and regretting it later.
“…and where we are getting problems is that men give women…they buy alcohol for women and at the end of the day, you find three men using the same woman because all of them have bought for her.” (KII 02, Local leader)
Alcohol was also reported to be associated with poverty as alcoholics spend a lot of money on alcohol, depleting their meager resources and yet they continue being unproductive since they spend most of their time either in bars or at home sleeping after heavy drinking sprees. This often results in failure to meet the family’s basic needs, including children’s school fees consequently leading to problems such as domestic violence and child neglect.
Seeking help for alcohol related health problems was reported to be rare except in emergencies, when one is experiencing a life-threatening condition due to alcohol. In most cases, it will be the family members, relatives or concerned significant others who attempt to seek help for their relatives or devise means of assisting them to stop their alcoholic habits after realizing adverse health effects.
“…you think a drunkard can seek help by himself? No. Even if he falls sick, he doesn’t mind and if a friend happens to visit him during that time of his sickness and offers him some money to buy the drugs, he will use that money to buy alcohol. It is either a family or concerned relatives who struggle to see that they look for all ways of stopping this person from drinking, having realized the negative impacts.” (FGD 02, Lay people [non-alcoholics]).
Voluntary help-seeking among alcoholics was thus reported to be extremely rare. Attempts to seek help from health facilities were reported to be made usually after acute intoxication and loss of consciousness or after sustaining severe physical injuries. While there were some health facilities within the district known to offer some help to those who wish to quit, some of the participants didn’t believe that health facilities can offer any help to alcohol dependants to reduce or stop their drinking. Those abusing alcohol in particular did not see any reason for seeking help at health facilities. Furthermore, the few persons with alcohol use disorders who seek help at health facilities were said to often present other physical health problems which the health workers focus on, overlooking the former. This consequently results in low detection and low reporting of alcohol use disorders at health facilities.
There were also reports of a very crude means of offering help (by lay people) to those abusing alcohol during acute intoxication by administering human urine; and some were reported to have lost lives in the process. Interventions to help persons abusing alcohol were reported to be hampered by the reluctance of the local authorities to enforce corrective measures partly because some of them are also involved either in the production or sale of alcohol. The law that prohibits consumption and sale of alcohol to minors is thus not implemented in this setting. The enforcement is further hampered by the local political leaders’ fear of annoying their potential voters, yet they themselves also usually buy and give out alcohol when soliciting for votes.
“…now you see these days politics is a determining point in everything. Sometimes we take some issues to the local leaders but since they don’t want to destroy their votes, sometimes they don’t respond. They say that when they talk to these people and force them to take at least limited alcohol, or stop them, they will not give them votes.”