“No hay control” ("There is no control") was the expression that many participants used to describe problem drinking in the community. On one hand, participants presented the perceived benefit of controlled alcohol use, such as enhancing social interaction by putting away vergüenza (embarrassment), temor (fear), and miedo (fear) and facilitating talk, sing, and dance, giving the feeling of warmness and energy in the cold harsh Andean environment, and motivating day laborers to accomplish physically demanding work in the chacra (field) effectively. Likewise, alcohol is seen as an enhancer of achieving a certain objective in negotiations as well. Offering alcohol in discussions was explained as symbolic presentation of sincerity, trust, and commitment to build close relationships, and believed to facilitate the negotiation of important issues in business and marriage.
On the other hand, participants expressed that alcohol use involving borrachera (intoxication) was problematic, while designating drinking as costumbre (habit, custom) in everyday life. Lack of control over behaviour stemming from acute intoxication was tied to individual health consequences and family and social problems, such as family conflict and separation, violence, sexual abuse, and unwanted adolescent pregnancy. While stressing the need to address these negative consequences, participants made multiple references to absence of control at multiple levels.
Parents’ lack of control over their children’s alcohol use
When asked about the general alcohol use in the community, the majority of participants raised concerns over adolescent alcohol use that was being initiated before the legal drinking age of 18 years old. Participants repeatedly stated that “children are abandoned,” attributing underage drinking to a lack of parental control and supervision. Others said that children drink with friends in an attempt to create a substitute family situation to counteract feelings of loneliness and absence of parental emotional support.
Many participants from Carmen Alto explained that this precarious family environment was due to children are relocated to urban areas for the purpose of education while their parents remain in rural areas. Relocation of children for education in Socos is not as common as in Carmen Alto. In Socos, parents often embark on short-term travel to the selva (the Amazonian jungle) or to other cities to earn money to meet household economic needs. The children then live with relatives such as cousins and grandparents. During my fieldwork in 2016, a 15-year-old girl died after being sexually and physically assaulted by several intoxicated adolescents at a party in a neighbouring district. The assault occurred in a house with no adult supervision or presence. This incident was often mentioned as an example of how children are placed in an insecure situation without parental care, supervision, or control. During one focus group in Carmen Alto, participants described this context:
P6: It has been an invasion [of land], parents have come [as] they wanted to occupy a plot of land, and they have brought their children. They brought their kids here so that the kids can study. And then parents are in chacra (field). Who is going to control this kid?
P7: No one.
P5: When a friend comes, and then they go to drink.
P4: They go to fiesta, and then they drink.
P5: Disco.
P6: This largely happens in this community.
(Carmen Alto, female, focus group)
Persistent economic hardship forces parents to work long hours, which results in separating parents from children and/or limiting their time with children. One 48-year-old female focus group participant from Carmen Alto stated: “I have seen mother and father are dedicated to chacra (plot of land). They are gone at 4 o’clock in the morning because of the lack of an economy”.
Participants further stated that, compared with their own upbringing, parents are having a hard time controlling their children. They recalled that their parents and elders played a role in disciplining them when they were children. With punishment using chicote (whip) that is considered as useful to “give good orientation” (Socos, male, age 71, interviewee), parents and elders used this approach to inculcate obedience and respect in the hierarchical family environment.
When it comes to parental control of children’s alcohol use, study participants reported that children were today becoming “rebellious and dominate their parents” (Carmen Alto, obstetrician, interviewee) by misusing their understanding of human rights and knowledge of institutional protection. “Parents were previously stricter and never let children go out in the night” (Carmen Alto, male, age 20, focus group). Most participants still largely considered the chicote as an effective and acceptable disciplinary tool. In this context, “DEMUNA” and “law” were frequently cited as barriers for parents to control their children’s alcohol use. DEMUNA (the Municipal Office of the Ombudsperson for Children and Adolescents (Defensoría Municipal del Niño, Niña y Adolescente) was established in 1993 to promote and protect the rights of children and adolescents. It has the responsibility to intervene any time the human rights of children and adolescents are violated. In addition, in December 2015, Peru adopted a law prohibiting the use of physical and other humiliating punishment with children and adolescents (No 30403 “Ley que prohibe el uso del castigo físico y humillante contra los niños, niñas y adolescents”). The law, social services, and intervention by DEMUNA to protect women and children from violence were largely appreciated. A 60-year-old female focus group participant in Socos stated: “Now the law prevents men from hitting women”. At the same time, others see some parents having difficulty controlling their children’s misbehavior because the parents fear that their children will report them to DEMUNA, claiming that their parents’ discipline is an abuse of children’s rights.
“I think now we cannot pressure children. They drink and say ‘[If] you say something, then I am going to report you [to DEMUNA]’ and mother has this fear of being accused.”
(Socos, nurse, interviewee)
Drinkers’ lack of control over themselves
Men’s problem drinking explained by machismo. Lack of control was also mentioned to describe the way adult drinkers consume alcohol. A female nurse in Carmen Alto stated that “There is no control of oneself” while describing drinkers lying asleep on the street and family members suffering from harmful alcohol use. Lack of control is applied not only to chronic dependence on alcohol but also to an acute bought of heavy drinking that leads to intoxication being seen at community fiestas and social gatherings with family, friends, and co-workers on the weekend, and which often continue until dawn. As many male focus group participants in Socos described, men “drink excessively without controlling themselves”, which leads to their expressing their problems, crying, or becoming aggressive, sometimes to the point of violence. The gendered division of labor in the family in relation to drinking seemed to excuse men’s lack of control over their alcohol consumption. Young male focus group participants from Carmen Alto considered that married women with children drink less than single women because the former are responsible for taking care of children. During my fieldwork, I frequently witnessed women drinking with men during community fiestas, family gatherings, as well as in recreo. Nevertheless, most women consumed only a small amount of alcohol and often left earlier than men, suggesting that their alcohol use, while frequent, is distinct from that of the men. Female intoxication is largely frowned upon, as a nurse in Socos stated: “We see men being borracho (intoxicated) but seeing some women borracha is bad.” With this cultural norm, a 60-year-old female focus group participant in Socos mentioned, “some couples drink together and the wife needs to control herself”.
Many participants referred to the cultural concept of machismo to explain “little control with respect to male drinkers” (Carmen Alto, psychologist, interviewee). Machismo was generally cited to describe gender inequality in current everyday life. When a focus is specifically on drinking, community participants, police officers, schoolteachers, and health professionals similarly defined machismo as men’s justification for spending ‘hard-earned money’ on drinking as an entitlement from being a ‘breadwinner’. The common answer to the question, “Who drinks more? Women or men?” was “The one who has more money; men.” (Socos, male, age 20, focus group). Casual laborers and construction workers often go out drinking “out of happiness when they receive wages” (Socos, female, focus group). The Andean way of sharing drinks among those who are present, that is, buying two bottles in turn once the last bottle is emptied, and continuing to drink until all the money is spent or the alcohol runs out is entangled with the practice of machismo. During a bout of drinking, men show not only physical toughness by holding their alcohol but also by their ability to purchase drinks for others. The duration of one bout of drinking and the total number of drinks “depends on the money” (Carmen Alto, male, age 19, focus group) and “If you have money, you can [continue drinking] till dawn or continue” (Carmen Alto, male, age 20, focus group).
The importance of controlling one’s alcohol consumption was commonly expressed by participants. A common practice among Andean individuals engaged in labor-intensive agricultural work is to drink a “minimal proportion” of alcohol to “feel motivated to continue working”. In contrast, drinking a “maximum proportion [of alcohol] can result in economic loss” (Carmen Alto, female, age 31, focus group). One 48-year-old male focus group participant in Carmen Alto stated: “If you do not control alcohol, alcohol controls you. For this reason, it is necessary to know up to what point you can drink. There are others who do not have this kind of control.” On one hand, men try to exhibit control over the household economy and their health by “calculat[ing] the quantity of beer” they pour into the glass as they know that it is their turn to buy another round of drinks if they empty the bottle (Carmen Alto, male, age 50, focus group). At the same time, they know “who buys and who does not buy”, as being seen as a free rider (i.e., only drinking alcohol that friends buy) has a risk of “not being invited for the next time” (Carmen Alto, male, age 50, focus group). Male participants also explained the difficulty in controlling their drinking and spending while practicing machismo, especially when competitiveness accelerates drinking. A young male focus group participant in Socos stated: “Before you become drunk, you think. When you drink, the alcohol [level] goes up, and you start losing control of yourself. You practically forget everything for the moment.... Now the experience is that while you are drunk, you could be what you wish to be without control....”. Many male community participants stated that they often end up feeling regretful (arrependimiento, pesares) and guilt (culpa) the following day when they remember what they did and how much they spent on alcohol the previous night.
Facilitator: What do you do after drinking? What do you do on the following day? How do you feel and what do you do?
P3: Take a cold shower.
P12: Reflect.
Facilitator: What do you reflect on? About why you drank?
P12: Why….yeah, about what kind of things I have done. I remember, maybe I may have done something bad or I was not respectful to someone, or maybe, I misbehaved, how many cases I drank.
P1: How much I spent.
P12: How much I spent.
Interviewer: Yes, like damaging the economy of your family?
P12: Yeah, I analyze whether I have damaged, maybe…[whether] I drank for free while friends spent all the money.
(Socos, male, focus group)
Men’s spending on alcohol and notions of responsibility. The apparent lack of control in men’s drinking reflects not only excessive alcohol use but also men’s identity-making and power representation in public and domestic spaces. In the domestic space, men’s spending money on alcohol was criticized for the negative impact it had on the household economy. It was noted that this type of spending could lead to conflict between spouses. Some female participants showed their frustration with their husbands’ spending on alcohol by describing that “It is worse when a drunken husband responds, ‘I do not drink with your money’” (Socos, female, age 48, focus group).
Health workers and high school teachers often cited the concept of “cultura etílica”, which expresses an individual’s responsible drinking and self-control based on the awareness of the amount of alcohol they can manage and still fulfill their social and employment responsibilities. A psychologist explained that cultura etílica is “control, [with awareness that] I am drunk and I can cause some problem because I know how I am,” unlike “others [who] have many responsibilities the next day and know how they are but they do not control” (Carmen Alto, psychologist, focus group). Among community participants, it is also commonly understood that people “should drink rationally (racionalmente) only up to the point [they] can afford” (Carmen Alto, male, age 48, focus group).
P5: Instead of spending money on alcohol, it is better to eat.
P4: It is better to eat no matter how little.
P6: You should fill yourself up with 100 Soles, not with beer.
P4: Sometimes we spend in vain.
Julián: Spending in vein
P3: When we are drinking with friends, we challenge ourselves. And then we use our money and nothing remains for our wife.
(Socos, male, focus group)
Some men are reported to spend a disproportionate amount of money on alcohol, often to the point of spending all received wages during a weekend or life savings at a fiesta patronal, even though both they and their spouses work to cover household expenses. While participants often joked that “people work to drink” in Ayacucho (Socos, male, age 21, focus group), spending earnings on alcohol rather than on household expenses as a demonstration of manliness was questioned and considered a lack of responsibility. A high school teacher in Socos described some parents’ attitude thusly: “There are people who do not have money to buy food for their child. [But they have money] to buy 5 cases of beer and drink all the night.” Some community participants particularly evangelists, health professionals, and high school teachers characterized men’s spending on alcohol consumption to be reckless extravagance in contradiction with the economic situation of Ayacucho where some “children are still without bread” (Socos, male, age 63, focus group).
Lack of control over alcohol supply
Expansion of the alcohol market by increased advertising, promotion, and availability. Participants also noted the normalization of drinking described as costumbre (custom, habit), which was attributed to the lack of control over the expanding alcohol market. One young male focus group participant in Socos described it by stating: “If you leave [home], you see people drinking on the street, [and] at the corner. There is no respect…At one corner, you see one fiesta, and at another corner, you see another.” The easy availability of alcohol has also shaped drinking practices in the community. While the traditional community fiestas still play a role in strengthening social relations through the practice of Andean reciprocal support, ayni, many participants no longer attributed to fiestas the values and meanings that they once held. For instance, a schoolteacher in Carmen Alto stated:
[Traditional] fiesta is commercial. Now it is already a commercial activity because now everything is about selling. For example, I see people want to make money, profit in the fiesta patronal…Yes, it used to be something cultural, but in the past few years, it is not any longer. The economic aspect is added. Profit.
(Carmen Alto, schoolteacher, focus group)
Many community participants shared this sentiment. One elderly male participant in Socos described the organizing of traditional fiestas of Catholic Saints as being costlier as it becomes “more modern”, stating that nowadays, “Only the one who has money can be mayordomo (host of the community festival),” who “takes the responsibility [of hosting the fiesta] with money with caprice [not with faith]” (Socos, male, age 71, interviewee).
On one hand, in resource-scarce rural settings in the Andean highlands like Socos, community fiestas with collective drinking are still considered to be a practical mechanism to sustain subsistence living by strengthening and maintaining the bond of relatedness among family and community members. One 50-year-old female focus group participant in Socos stated: “In techada de casa (house building), we help each other and drink and dance, this is how we build casa (house). In techada de casa, we become close to each other, drink, if we do not do it, there is nothing.”
Participants in both districts often compared the availability of alcohol to staple food. As one stated: “Bread can run out, but beer is always [available] at each store, it is ever-present” (Carmen Alto, female, age 43, focus group). In addition, participants in both districts noted the increase in drinking venues such as recreo and events such as festivals and music concerts, the improved road conditions and accessibility of transportation between Ayacucho and Socos, and the availability of low-cost alcoholic beverages mixed often with soda drinks.
Participants described the expansion of the local alcohol market by saying: “Beer is a gold mine”, and “Everyone now wants to open his cantina (bar) all over the world” (Carmen Alto, male, age 20, focus group). Despite the poor economic conditions, alcohol is affordable and accessible. This includes caña (sugarcane alcohol) and trago (alcohol), which are thought to make people drunk rapidly and be harmful to health. One nurse in Socos stated: “caña damages our brain more and [it is better] to choose beer.” These types of alcohol can be easily found at local vendors who also sell alcohol on credit to regular customers, facilitating access even to those who have limited resources. The diversification of alcoholic beverages was also noticeable; as one 43-year-old female focus group participant from Carmen Alto stated: “Now those businesses are innovating that theme of beer. Now there is beer made of quinua (quinoa) and trigo (grain)”. Also, when I returned to Ayacucho in March 2019, I saw Budweiser, which had become available in the Peruvian market in 2017 [38], being sold for the first time during Carnival. Such global beer brands sold by the Peruvian brewery Backus—Budweiser, Corona, and Stella Artois—are reported to have increased in volume by 73% and resulted in a 63% increase in profit in 2018 from the previous year [39].
Participants often stressed how advertising by alcoholic beverage companies and media created demand for alcohol. There are no legally binding regulations on alcohol advertising or sales promotion in Peru [1]. Participants often explained the perceived increase in alcohol use among adolescents and women as due to the influence of advertising through a wide range of media.
P10: And the advertisement also influences a lot. For example, on TV, we see young girls drinking, right? In the TV commercial, we see women drinking...
P3: In the advertisement, we see girls drunk and you think that they are cute.
P10: There are women and young girls who are becoming like that. Those women also buy beer to drink with men.
(Socos, health professional, focus group)
An advertisement for Pilsen beer that proclaims “Thursday is a day of buddies” [Jueves de Patas] is another frequently cited example. Participants were conscious that this was a marketing strategy to add an occasion to drink during the week, as drinking on the weekend with colleagues, friends, and family members is already an established drinking practice.
P5: Cheap alcohol drinks that do not even have any brand or any registration, I think, need to come from the top [government] to avoid [unofficial] factories of those alcohol. We need to cut these alcoholic beverages. Up to now they do advertisement for “Jueves de Patas” (Thursday for buddies) and “Viernes de Amigos” (Friday for friends).
P7: Fathers’ day, Friends’ day, everything [about drinking is] everywhere in the city.
P6: From the same manufacturer. Jueves patita ha ha ha …
P5: Because everything about this is to motivate drinking.
(Socos, high school teachers, focus group)
With the felt impact on alcohol availability, the alcohol industry is blamed for creating alcohol-related problems in the community while making profits off of consumption. Participants repeatedly mentioned Peru’s largest brewery, Backus, which became part of the international AB Inbev group after its fusion with SABMiller group in 2016 [40]. Participants see Backus as making huge profits: “[Alcohol] business is making millionaires, Backus is a millionaire” (Carmen Alto, male, age 20, focus group).
Capitalizing on vulnerability. In parallel with excessive alcohol use at community fiestas and weekend social gatherings, participants expressed that alcohol use can be a means of coping with psychological distress for “some [who] do not know how to manage problem and seek alcohol” and “think that they can solve problems while being drunk” (Carmen Alto, male, age 20, focus group). They described solitary drinkers—those who drink as a means of coping with hardships such as family conflict, financial concern, and breakup who gradually develop alcoholismo (alcoholism). Some participants suggested that the alcohol companies take advantage of this vulnerability to pursue profits. Community participants framed problem drinking as the result of market forces that push the rural poor unable to find a solution to their problems to consume alcohol.
Previously, possibly in the 80s and 70s, here in our community, people used to celebrate, organize activities with the purpose of reevaluating our costumbres (customs, habits). Day by day, they do not organize fiestas with this purpose. We do fiestas with the purpose of getting people to consume alcohol, and this is the purpose of business. Those who benefit are only big business. How much revenue do we generate for Backus? Whatever quantity, people like, people like to organize fiestas, every weekend, fiesta in Arenales, [fiesta] in San Luis, now for the Day of All Saints. We have a number of fiestas. Then, those businesses benefit, and we do harm to ourselves, people in the rural area. People who are not prepared. People who cannot solve their problems dedicate themselves to alcohol. “I drink to take refuge in alcohol” [they say].” (Socos, male, focus group)
The active promotion of alcohol for economic gain was contrasted with the economic hardships and precarity of those who were consuming alcohol. This sentiment was summarized by one participant, who stated: “Some people who have economic problems take refuge in alcohol even though they do not have [money] to buy other types of things” (Socos, health professional, focus group).
Absence of Government Control. Alcohol sales have been increasing in Peru, exemplified by a 24.6% increase in Backus’s sales of beer from 2012 (S./3,160.2 mil) to 2017 (S./3,939.0 mil) [38, 41]. Community participants often blamed the local government for not tightly controlling the sale of alcohol to minors or the sale of clandestine alcohol beverages, and for not limiting the hours of the day when alcohol is sold. While witnessing alcohólicos who use alcohol as a means of coping with personal misfortune and misery, some community participants continue to blame the government. A female focus group participant in Carmen Alto stated:
An alcohólico doesn't seem to become alcoholic because he wanted to, but there are reasons. They can be infidelity, others can be a factor related to work, lack of economic resources, and if he has a family, the more he drinks, the more fights [due to] the consumption of alcohol…Yes, the authorities are to be blamed for allowing stores to sell alcohol…there is ethyl alcohol which they sell, mixed with water, and that is what causes them to become ill, and that really gives me pena (sadness), when I see an alcohólico…
Participants perceive this seeming expansion of the alcohol market as tied to the unwillingness of the government to control it.
With this drinking including [drinking by] minors, when people drink, there is more revenue for the government because of more consumption. Although people say there would be pills, medication [for addiction], the government will not approve it because there is more revenue for the government wherever there is a factory for alcohol, or even coca. For this reason, drinking will not disappear.
(Socos, male, age 54, focus group)
The local government collects tax from flourishing business activities in the entertainment zone of Carmen Alto. One Saturday night in Carmen Alto, I saw many women opening street stalls in front of bars and recreo to sell food to hungry drinkers, while paying the municipality some monthly fee to use the street for their business. Community participants in Carmen Alto partly attributed the seeming reluctance of the local government to control local alcohol sale to its alleged motive of keeping the tax revenue from the alcohol consumption and related business activities.