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A significant under-addressed issue in global health is the interaction between alcohol use and sexual encounters among adolescents, particularly in sub-Saharan Africa. A study conducted by Columbia Mailman School of Public Health and the Muhimbili University of Health and Allied Sciences (MUHAS) in  explored the factors that influence young people's access to and use of alcohol, and subsequent engagement in safe or unsafe sexual behaviors, from the perspective of young people themselves. The results showed that alcohol use intersects with a spatial dimension in relation to where youths are consuming alcohol and subsequently engaging in sex which, in turn, influences young people's likelihood of using condoms and practicing safer sex. The findings are published online in the Archives of Sexual Behavior.

"This study aimed to understand the spaces in which young people are engaging in sex after drinking alcohol, the ways in which space is influenced by social and cultural perspectives and the economic realities of their lives and, that in turn, influence their likelihood of using condoms in such contexts," said Marni Sommer, DrPH, RN, associate professor of Sociomedical Sciences at Columbia Mailman School, who led the study.

Using qualitative methods, the researchers explored the experiences and perspectives of 177 adolescent girls and boys in and out of school in four sites across Dar es Salaam, Tanzania. These included in-depth interviews with the adolescents as well as adults; mapping alcohol density outlets and advertising around schools and youth centers, and participatory activities conducted with adolescent boys and girls in and out of school.

The alcohol context in Tanzania, as in many sub-Saharan African countries, has been under-studied, despite data indicating heavy episodic drinking (21 percent males; 14 percent females) among Tanzanians. Sommer and colleagues felt it was important to conduct research to better understand the ways in which the use of alcohol among young people in urban areas of sub-Saharan Africa, particularly those with a high-density of alcohol outlets, is intersecting with their sexual encounters, and how this dynamic is influencing the practice of safer sex.

"Our findings indicate that the spatial dimension is influenced by time, gender, age, economics, and social norms around the carrying of and use of condoms, with interventions needed that address the gendered sanctioning of youth carrying condoms in Tanzania, and increase the availability of condoms where alcohol is sold and consumed," said Sommer.

An earlier study led by Sommer and Dr. Sylvia Kaaya at MUHAS of adolescent boys in rural and urban Tanzania revealed the intense peer pressure boys experience from older adolescent boys and men to consume alcohol to demonstrate their manhood, and how the use of alcohol helped them to overcome their shyness around approaching or "seducing" girls.

Unique to the latest study was the inclusion of adolescent girls and boys in a range of participatory activities, such as photovoice, mapping, and story writing, that enabled insights into the alcohol-sex dynamics from the perspectives of young people themselves.

Based on the findings that emerged from the study, Sommer recommends that future research identify new and innovative ways to assure that condoms are more widely accessible for youth engaging in sex. She also sees a critical need for structural and environmental interventions that both reduce youth access to alcohol, and increase the availability and accessibility of condoms in spaces and situations where alcohol is sold or consumed.

"It is key to keep youth at the center of public health research focused on improving their sexual and reproductive health," said Sommer. "They are the knowers of their own lives, and often have the most useful insights for how to best address the vulnerabilities they encounter in daily life."