San Francisco gay bars join forces with HIV researchers to support smart drinking
In San Francisco, a team of researchers recently published a study in AIDS and Behavior describing the effects of a structural intervention to help patrons of gay bars reduce binge drinking and pace their alcohol use. A three-pronged approach—which included installing water dispensers in bars, displaying messaging in bars about pacing alcohol use, and giving people real-time feedback about their blood alcohol concentration—had a significant effect on how much people drank and how well they paced their alcohol intake throughout the night.
“Alcohol use is one of those things that tends to be overlooked,” said Jen Hecht, MPH, senior director of program strategy and evaluation at San Francisco AIDS Foundation.
“A lot people use it, which may be one reason why not a lot of attention is paid to it. But for men who have sex with men, alcohol use is one driver of the HIV epidemic in San Francisco.”
Substances that impair judgment and decision-making, including alcohol, have been found to be associated with HIV risk behaviors such as condomless anal sex.
Researchers worked with two gay bars in San Francisco to deliver all three components of the intervention. Water dispensers were installed that provided easy, free access to water to patrons. In-bar media messaging campaign materials encouraged people to pace their alcohol intake and drink water throughout the night.
Project staff also delivered a “normative feedback” component of the intervention to patrons leaving the bars. With the patron’s consent, researchers conducted a blood alcohol concentration (BAC) assessment using a breathalyzer and compared their BAC reading to the BAC scores of all other bar patrons.
This individual component of the intervention, said Hecht, was meant to allow participants the opportunity to reflect on how their drinking compares to that of their peers. People may be more apt to consider reducing how much they are drinking if they realize their drinking falls above the “norms” of how much other people are consuming.
A total of 1,293 male-identified people exiting the two intervention bars or the two control bars participated in the study. Men who had consumed at least one alcoholic beverage that evening, who agreed to participate in the study, answered an anonymous survey about their drinking and also had their BAC measured using a hand-held breathalyzer testing device.
On average between both the control and intervention bars, participants spent 1.3 hours in the bar they were leaving and consumed an average of 4.3 drinks during that time.
There were two phases to the study: a pre-intervention phase and a post-intervention phase. First, researchers collected data from people coming out of the intervention and control bars before the intervention was implemented. There were no significant differences in alcohol consumption or participant characteristics during this phase of the study.
Second, researchers observed levels of drinking and BAC of people coming out of the both control and intervention bars after the intervention was put in place.
Researchers observed a few notable differences when they analyzed data from the intervention bars and control bars from the second phase.
- People coming out of the intervention bars had a significantly lower BAC and significantly lower binge drinking scores (defined as 5 or more drinks in one setting) than people coming out of bars that did not install water dispensers or post the media campaign materials.
- People coming out of intervention bars were also significantly less likely to have a BAC over the California driving limit (30% of people) compared to people coming out of control bars (42.6% of people).
The normative feedback component of the intervention, where people saw their BAC and were able to compare it to their peers, also had an effect on participants. A significantly higher percentage (12.8%) of people who received the normative feedback component of the study reported that they were interested in decreasing their drinking compared to people who did not receive this component of the study (6.8%).
Researchers estimate that every month, 2.7 million drinks are consumed by gay men in San Francisco. Hecht said that the team focused on changing the environment in which people drink because there are several environmental factors that may encourage heavy drinking in San Francisco.
“For one, bars are an important social space for the queer community,” said Hecht. “But also, there are a large number of bars in a small space: predominantly in the Castro, but also in SoMa and other neighborhoods in the city. This leads to competition between bars to host longer and longer happy hours, and provide cheaper and cheaper drinks.”
In addition to environmental factors that may cause people to drink more than they normally would, there are also social norms and community-level factors in San Francisco that influence how much people drink.
“We did a number of interviews as part of another project where we were asking people why they drink, how they drink and how they feel about drinking,” said Hecht. “We heard things like, ‘As long as you’re not home drinking alone, there’s really no limit on the amount that you should drink.’ We also heard that blacking out is common and normal, and that there are expectations that when you’re out with friends to have a good time, being a ‘hot mess’ is OK.’”
Hecht said this intervention and study are borne out of a harm reduction and client-centered approach to helping people consider their substance use and its impact on sexual health and wellbeing.
“We support people and want them to have a good time, and we want people to be happy with their drinking. We just want people to be able to have a great time—and not wonder, ‘what happened last night?’ Or, wake up and worry that they have to get an STI or HIV test because of how much they drank last night.’”
The results of this pilot study went on to influence a safer drinking campaign called Cheers Queers. The campaign featured San Francisco nightlife personalities on print and online materials which led participants to in-person counseling sessions.
Future research, said Hecht, will continue to follow up on some outstanding questions raised by this study, including whether the in-bar intervention has any effect on directly reducing sexual risk behaviors.
Men who have sex with men in the San Francisco Bay Area interested in receiving harm reduction counseling or support for drugs or alcohol may contact the Stonewall Project online or by calling 415-487-3100. Find more information about Cheers Queers, a social marketing campaign to share messages about drinking more safely, and take a 3-minute confidential survey to see how your drinking stacks up to how others drink in San Francisco.
Charlebois, E., Plenty, A., Lin, J., Ayala, A and Hecht, J. Impact of a structural intervention to address alcohol use among gay bar patrons in San Francisco: The PACE Study. AIDS and Behavior, 2017.