Alcohol Consumption in Ethiopia
(Literature Review)
Table of Contents
1. Background
2. Alcohol Consumption in Ethiopia
3. Types and Sources of Alcohol in Ethiopia
3.1 Non-commercial, Illicit Alcohol
3.2 Factory Drinks
4. Profile of Alcohol Users
5. Frequency, amount and Context of Alcohol Drinking
6. Reasons for drinking Alcohol
7. Alcohol, Khat, Sexual Behavior and Condom Use
8. Alcohol Policy
9. Barriers to adopting responsible drinking behavior
10. Facilitators to adopting responsible drinking behavior
Acronyms and Abbreviations
ABV
Alcohol by Volume
AIDS
Acquired Immune Deficiency Syndrome
BSS
Behavioral Surveillance Survey
CSA
Central Statistics Agency
CSWs
Commercial Sex Workers
EPHA
Ethiopian Public Health Association
HIV
Human Immunodeficiency Virus
ICAP
International Center for alcohol Policies
ISY
In-school Youths
OSY
Out of School Youth
SNNPR
Southern Nations, Nationalities and People’s Region
STI
Sexually Transmitted Infections
WHO
World’s Health Organization
Glossary
Arada a person considered as modern and cool
Areque home-distilled alcohol beverage.
Borde local beer made from maize, sorghum, barley.
Chebsie The consumption of alcohol after chewing Khat
Khat
a green leafed stimulant drug.
Tej
a honey wine
Tella
a home brewed beer made of barley and wheat
1.
Background
Alcoholic beverages are drinks containing ethyl alcohol or ethanol which is an intoxicating
ingredient. It is produced by the fermentation of yeast, sugars and starches mainly derived from
cereal grains. It often slow down the function of the central nervous system and can impair
judgment and alter a person’s emotions, abilities and behaviors. Yet, the production and
consumption of such kind of alcoholic beverages occurs in most cultures around the world. It
plays an important role in social events and interactions mainly because when consumed in
small amounts, it can help a person feel relaxed and less anxious. But if consumed in a larger
amount, alcoholic beverages may have a negative impact on one’s health as well as social and
financial well-being.
In Ethiopia, although alcohol is an integral part of peoples’ lives, especially during holidays,
celebrations and recreations, there is a lack of reliable data in the country regarding the
amount of alcohol produced, sold and consumed as well as the health problems inherent by it.
This literature review explores the limited researches, aiming to provide an insight into the
actual situation of alcohol consumption in the country, especially in relation to its contribution
to the spread of HIV/AIDS.
2.
Alcohol Consumption in Ethiopia

The WHO Global Status Report on Alcohol released in 2004 showed that in Ethiopia, a
total of recorded 0.91 liters of pure alcohol are consumed per capita each year by
people aged
15 and above while the unrecorded (non-commercial) alcohol
consumption is estimated to be 1.0 liters of pure alcohol per capita. This data may seem
low when compared with other African counties like Nigeria which is nearly 19.7 liters
per capita, making it one of the countries with high level of alcohol consumption.

Data from the 2003 world Health survey conducted among adult men and women aged
18 and above indicate that the mean value (in grams) of pure alcohol consumed per day
among male and female drinkers was 23.6 with the highest being among males (27.8).
From the participating 4920 males and 2377 females, 4.1% (7.7% male and 0.4% female)
of them have also been identified as heavy episodic drinkers as they consume five or
more standard drinks in one sitting at least once a week.

In addition to these, a 1994 prevalence study of alcohol dependence and problem
drinking among representative sample of 10203 adults in Addis Ababa, has found that
the total prevalence rate of alcohol dependence is 1.1% (2.5% for males and 0.3% for
females). Since prevalence rate is constantly change, one should put in mind that the
current prevalence rate may be much higher than this.

In 2007, a nationwide study was conducted on Alcohol and Khat consumption and the
association with HIV/AIDS prevention, care and support. It involved over 10,000
participants from rural and urban areas (male and female aged 15-59) from selected 12
woredas (that have high HIV prevalence, based on antenatal clinic based HIV sentinel
surveillance reported in the 6th AIDS report) in eight regions (Tigray, Afar, Oromia,
Amhara, SNNPR, Addis Ababa, Dire Dawa, Benishangul Gumez). Results of this study
show that the prevalence of alcohol consumption and Khat chewing is high in all the
selected woredas of the regions and is progressively increasing from time to time.
However, percent of respondents who ever drank alcohol varies from one region to the
other, ranging from 9% in Duphti, Afar, to 70.2% in Adama, Oromia Region. But most
generally, the prevalence is greater than or equal to 20% in the woredas of all the
regions except for Dire Dawa and Duphti in Afar.
The table below shows the summary of alcohol and Khat consumption in all the woredas.
Prevalence of the Behaviors
Low
Moderate
High
Percentages of respondents who
Dire Dawa
Dilla
Adama
ever drank alcohol
Duphti
Assosa
Bahir Dar
< 20 (Low), 20-39 (Moderate), 40 <
Dessie
Maychew
(High)
Jimma
Addis Ababa
Awassa
(Gulelle,Kirkos)
Adama
Dilla
ever chewed Khat
Awassa
Dire Dawa
<10 (Low), 10-19 (Moderate), 20<
Bahir Dar
Duphti
(High)
Assosa
Dessie
Addis Ababa
Jimma
Percentages of respondents who
Maychew
(Gulelle,Kirkos)
3.
Types and Sources of Alcohol in Ethiopia
Alcoholic beverages are generally divided into three different types i.e. wine, beer and distilled
spirits. Beer and wine are produced by the fermentation of sugar or starches from cereal grains.
The alcohol concentrations of these beverages are usually lower when compared to distilled
spirits which has higher alcohol content as it is produced by fermentation followed by
distillation. Ethiopia is supplied with all these different types, ranging from imported wine and
liquors (distilled spirits like whisky, vodka, gin), to beers produced by local factories and noncommercial (traditional) drinks.
3.1 Non-commercial or illicit alcohol Beverages
In this review, non-commercial (Illicit) alcohol is defined as traditional alcohol drinks produced
for home consumption or limited local trade. According to ICAP (2008), it may also include a
range of non-beverage alcohols (derived from medicinal compounds, automobile products like
benzene, and cosmetics), a relatively widespread phenomenon in some areas, particularly
among problem drinkers in the lowest socioeconomic status.
The very fact that such kinds of illicit or non-commercial beverages are unrecorded makes it
obviously difficult to assess their accurate alcohol contents or how much of this types of local
drinks are being produced and consumed compared to legally sold alcohols. Yet, they remain to
be the most widely consumed alcohol as they are inexpensive and easily accessible than factory
produced beverages. For this reason, factory produced drinks tend to be mainly consumed by
people who can afford the more expensive price and by urban dwellers while locally produced
and home-brewed alcoholic beverages are predominantly used in the rural areas and by people
living in the urban areas who cannot afford factory made drinks. For instance, young people,
(as young as 14 yrs old and university students) tend to consume local beverages like Areque
and Tella as their main source of alcohol since these drinks are easily accessible to them and
cannot afford other kinds of factory drinks (EPHA,2007).
These traditional or locally produced alcohols are also quite significant in economic terms.
Many households in the country, especially women engage in the production and sales of these
beverages as their main source of income to support themselves and their families. Some of the
popular locally produced and home-brewed beer, wine and distilled alcohol beverages are the
following:

Tella is a home brewed beer made of barley and wheat. The alcohol content varies from
place to place, but usually it is 6% to 7% ABV. Filtered tella has higher alcohol content.
This drink is usually perceived as a harmless social drink and is usually prepared by
women except in monasteries and church compounds. Tella is almost never sold in bars
but in small houses “tella bets”. It is also the beverage of choice for family occasions and
religious celebrations (mahebers). It is very popular and highly valued as its production
requires considerable skill and patience. It is, by far, the most commonly consumed
alcoholic beverage in the country and assumed that over two million hectoliters of it is
brewed annually in households and drinking houses in Addis Ababa (Sahle and Gashe,
1991 cited in Gizaw, 2006).

Shamita is another traditional beverage (beer), which is low in alcohol content. It can be
made in an overnight fermentation of mainly roasted barley flour and, consumed as
meal-replacement (Bacha et al., 1999 cited in Gizaw, 2006).

Tej is a honey wine with alcohol content varying from 8% to 14% ABV. It is prepared
from honey, water and leaves of Gesho. Previously, it was for people in the upper class,
but now it is widespread among all social groups, consumed on holidays and at
weddings as well as served in hotels and bars (Tej bets) across the country.

Borde is a local beer mostly consumed by people in southwestern parts of the country. It
is considered as a drink for people in the lower socio-economic status. It is prepared by
women from fermented maize, sorghum, barley, or a mixture of the three. Bordè can be
very thick and serve as a substitute for meals during long trips. It is also used for medical
and ritual purposes. Consumers believe that it enhances lactation and mothers are
encouraged to drink substantial amounts of it after giving birth (Kebede et al., 2002
cited in Gizaw, 2006).

Araqé, or katikala is a home-distilled beverage with alcohol content ranging from 30% to
almost 50% ABV. This beverage is more expensive than the other drinks and is popularly
viewed as very strong and dangerous to consume. Araki is brewed in rural and semiurban areas and is used more commonly by farmers and semi-urban dwellers than by
people who live in the cities. And in cities, people who drink araqe are predominantly
from lower class or those who have become dependent on alcohol and cannot afford to
buy industrially produced alcohol beverages.
Of these traditionally fermented beverages however, the most popular ones are tej (honey
wine), tella (a malt beverage like beer) and areki (distilled liquor). These drinks are widely
served on festive occasions and at social gatherings.
3.2 Factory Drinks
Aside from locally fermented drinks, factory beer is the other type of beverage which is mostly
consumed, especially in urban areas. There are currently five breweries in Ethiopia namely BGI
Group, Dashen, Harar, Meta and Bedele Factories and Meta Beer, Kidus Giorgis Bira, Harar Bira,
Bati Bira, castel and Dashen Bira are the most popular factory beers with strengths usually
ranging from 4% to 6% ABV. In addition to these, the national alcohol and liquor factory is the
biggest factory producing liquors like Areque and gin.
According to the Statistical Abstract of 2007 produced by CSA, breweries in Ethiopia are said to
have produced 1.56 million hectoliter of beer during 2006 and this represented 37% of all
beverages produced by commercial producers in the country. In addition to this, 15% of all
beverages produced further included wine and other alcoholic spirits (liquors) while the
remaining were soft drinks (www.habeshabreweries.com).
There are hard facts indicating that beer market in Ethiopia has been growing and the demand
for it is rising. Consumption of these factory beers are also said to be largely urban. These beer
factories have made substantial publicity to step up consumption, mainly through supporting
sports and other events. According to EPHA (2007), next to tella, factory beer and draft are thus
found to be the most consumed alcohol drinks during the last 12 months in all the selected
areas especially in Awassa (52.2%), Dire Dawa (65.4%) and Addis Ababa (46.5%).
4.
Profile of Alcohol Users

EPHA’s Study conducted in 2007 showed that the habit of alcohol drinking is more
common among males than females. When looking at the socio-demographic
characteristics of people who ever drank alcohol, there are more males 49.7% than
females 33.9%. In support of this, findings from the 2005 Behavioral Surveillance survey
have also showed that the use of Khat and alcohol are much more common among
males than females. However, the habit of consuming alcohol and Khat is also increasing
from time to time among females.

Aside from the gender difference, marital status is also found to play an important part
on the level of alcohol consumption as people, who are single, divorced or people in
non-marital relationships are found to use alcohol more than those who are married.
However, no marked difference was observed among people from different education
and economic background (EPHA, 2007).

With regard to residency or location of subjects who ever drunk alcohol, majority are
found to be urban dwellers accounting for 66% (Ibid).

Alcoholic drinks are consumed by all age groups. When looking at the percentage of
people who ever drunk alcohol, 30.5% of the young adults aged 15-24 have indicated
that they have had alcohol drinks at least once in their life. It seems as age increases,
the likelihood of people to consume alcohol increases as well however, young people
seem to be the most involved in alcohol and Khat consumption than any other
population group (Ibid).

The Behavioral Surveillance Survey conducted in 2005, has further showed that use of
khat and alcoholic drinks is much more common among the OSY than ISY.
5.
Frequency, amount and context of Drinking Alcohol
The amount, frequency and the contexts in which drinking occurs are very important to look
into to understand the situation of alcohol consumption. While some people only drink on
weekends and in bars, others may have alcohol integrated into their daily life. In relation to
this, according to EPHA (2007), most of the study participants from the different regions are
occasional drinkers. With regards to frequency of alcohol consumption during the last 12
months, majority of the respondents said once a week, in almost all the regions ranging from
7.9% in Addis Ababa to 25.2% in Maychew, Tigray Region. The next majority further reported
that they drink alcoholic beverages two to four times in a week period of time.
Amount of alcohol drinks consumed on a typical drinking day range from 1 to 5/6 standard
drinks. But, relatively fewer people consume 5 to 6 drinks, while majority have 2 to 4 drinks. As
indicated earlier, tella (the home brewed harmless social drink with an alcohol content ranging
from 6% to 7% ABV) and factory beer/draft are the most popular drinks across the country.
Beer is highly consumed in Awassa, Dire Dawa and Addis Ababa while tella is highly consumed
in Adama, Assosa, Bahir Dar, Dessie, Dupthti, Jimma and Addis Ababa (Ibid).
Holidays are the most common time of drinking in all the regions ranging from 67.6% in
Assossa, 64.1% in Dessie to 21.6%, 28.3 and 28.2% in Bahir Dar, Awassa and Jimma respectively
followed by evening (night) times, the highest being in Awassa (48%) and Addis Ababa (38%).
According to the report, the most common place were drinking takes place is in the
respondent’s own home followed by in bars/ clubs and tella bets.
Participants of the study further indicated that they usually drink alcohol with their group of
friends while only some of them said alone or with their marital partner. Since women are not
culturally allowed to drink alcohol especially in public, they tend to drink with their spouses or a
family member while men are more likely to go out of their house and drink on their own or
with friends. Alcohol use is considered as part of their construction of maleness so they can go
out and have a drink wherever and with whoever they want. However, these alcohol-serving
places like bars are often contact places for sexual encounters, increasing their chances of being
exposed to risky sexual behaviors.
6.
Reasons for Drinking Alcohol
People drink alcohol for a lot of different reasons but the most common one is to relax and
have a good time. Peer pressure, accessibility, cultural acceptability, parental involvement and
low self esteem (to boost confidence) are some of the other underlying factors associated with
alcohol and Khat consumption. In this particular study conducted by EPHA (2007), main reason
for drinking alcohol has also been identified to be, to relax while the next majority reported
that they drink alcohol because people they hang out with drink as well.
Some people also drink alcoholic beverages to avoid or 'forget' their problems and anxieties,
like from problems arising from economic stress. Poverty is a serious problem among most
people in the country due to lack of access to higher education and high unemployment rate.
There is also a great shortage of public recreational areas which leaves most with little options
on how to spend their days. So, to escape from their unpleasant reality, most people
particularly young men turn to chewing khat, drinking alcohol and exploring sex with multiple
partners (Getenet, 2006).
Migration to urban areas also contributes to one’s vulnerability to alcohol and khat
consumption. Nowadays, many adolescents (10-19 yrs) and young (15- 24 yrs) students migrate
from rural areas to urban towns to attend school or in search of job. They often rent a house
and live all by themselves or with a group of friends of their own age without parental (adult)
control or guidance (Nassir, 2004; Bishop-Sambrook, 2004). This will in turn increase their
vulnerability to alcohol and khat consumptions as well as risky sexual behaviors as they leave
their families and enter an environment where sexual risk-taking and substance use is more
common than in their rural homes. It is considered as a chance to experience life to the fullest as
there are no family, no restraints. Peer pressure often easily influences them in a way that can
increase their risk. They chew Khat and consume alcohol without fully understanding the ill
effects that the behavior would bring to them.
7.
Alcohol, Sexual Behavior and Condom Use
Alcohol abuse is related to a wide range of health (physical, mental) and social harms (such as
crime, unemployment, accidents and marital problems). It also increases the chances of people
to take risks, including with their sexual health. For this reason, since the beginning of the
pandemic, substance abuse is generally believed to be one of the associated factors for sexual
risk behavior in HIV transmission. Hard drugs like heroin and cocaine may not be readily
available in Ethiopia but studies suggest that khat (a locally produced psycho-stimulant) and
alcoholic beverages are commonly and widely used.
Researches from different parts of Africa and elsewhere indicate that drinking alcohol often
contributes to an individual’s probability to engage in risky sexual behaviors. People who drink
a lot of alcohol are likely to have more sexual partners, are less likely to use condoms (correctly
and consistently) and more likely to be HIV positive. For instance, a study done among HIV
Counseling and Testing attendees in Addis Ababa revealed that those who drink alcohol were
more likely to test HIV positive than those who were non drinkers due to their probability of
being exposed to unprotected sex (Assefa, 2005). Another case control study has also revealed
an association between Khat chewing, alcohol drinking and unprotected sex (Abebe, 2005 cited
in Getenet and Melesse, 2008). This is mainly because; although people may be aware or have
enough knowledge about preventive measures, consistent and correct condom use is often
low, especially when under the influence of alcohol and/or other substances.
EPHA’s study has also identified a significant association between alcohol intake and
unprotected sex. Alcohol or drug use during last sex was the highest in Addis Ababa (7.7%) and
Bahir Dar (4.6%) and the lowest in Duhpti (0.4%) and Jimma (1.5%). Multiple sexual
relationships which increases one’s risk to HIV are also found to be more likely to occur among
males than females; in urban than rural areas; among the never married than married, and
most importantly among those who ever drunk alcohol and among those who used khat and
alcohol during last sex.
In different occasions, alcohol and Khat use were thus dominantly reported as behaviors that
expose people to multiple sexual partnerships and unprotected sex. Although the physical
effects of Khat has been shown by some studies, its role on its own in altering sexual behavior
has not been studied or reported. While some attribute sexual impotence to Khat use, others
report otherwise. For example, a study assessing the self-reports of sexual risk behavior among
youths (15–24 years old) in Addis Ababa, reported that increased sexual activity was
significantly associated with being male, aged 20 years or over, out-of-school, and khat/alcohol
consumption. Chewing Khat which is usually followed by the consumption of alcohol (termed as
Chebsie) were thus identified as potential risk factor for the spread of HIV, as it often increases
sexual desire and facilitates indulgence into unprotected sex, multiple sexual relationships,
visiting CSWs and having casual sex (“one night stands”) in a context of a long-term committed
relationship.
In addition to this, alcohol may also enhance power over others by facilitating aggressive
behavior which may also be the context for men’s violence against women, either in attacks of
the intimate partner or more generally in sexual assault (rape). Such situations greatly increase
vulnerability to HIV/AIDS, especially for women. It can result in direct transmission of HIV
during forced or coercive sexual intercourse with an HIV infected person or indirectly through
increasing vulnerability to risky sexual behavior as women who live in abusive relationships or
victims of rape are less likely to be able to negotiate the conditions of sexual intercourse,
especially to suggest self protective measures like condom use (Pulerwitz et al, 2000 cited in
Chege, 2005).
A study conducted on casual sex-debuts among female adolescents in Addis Ababa also showed
that alcohol and khat consumption are strongly linked with the incidence of early sexual
initiation. They, often in combination do not facilitate clear decision making rather provide
fertile environment for the execution of unprotected sex. Chewing Khat and drinking alcohol
were reported to be common among groups of young people who call themselves arada or
‘modernized’ (Taffa et al, 2002). It is also evident that there is a significant gender difference in
drinking behavior. As indicated earlier, when compared with women (girls), men (boys) are
more likely to drink and to consume more alcohol.
Apparently, drinking alcohol and chewing khat are often used as a symbol of masculinity and as
a means of relaxation, recreation and means of improving communication skills for
socialization. So, in order to have “fun” and to get peers’ approval coupled with need to be
considered as Arada, many young people (especially males) have ended up in engaging
themselves in alcohol and Khat consumption, increasing their risk for HIV.
In general, even though research on the relationship between alcohol use, sexual behavior, risk
taking, condom use and STI/HIV vulnerability, especially in the general population is scanty,
available data demonstrate links between alcohol use and risky sexual behaviors (like
unprotected sex, early sexual initiation, multiple sexual relationships and visiting CSWs) that
are exposing individuals to the virus.
8.
Alcohol Policy
At policy level, the government seems to have not introduced any kind of measures in response
to alcohol drinking, contributing to the ongoing irresponsible drinking followed by risky sexual
behaviors. There are no time and place restrictions for sales of alcohol, days of sale and density
of outlets.
There are no regulations on alcohol producers and their advertisement or
sponsorship practices except that spirits are banned from national television and radios.
Breweries sponsor a lot of sports and youth events, promotional events, and advertise on
billboards and mass media which indiscriminately reach minors.
The legal age limit for
purchasing alcohol is 18, yet this law is rarely enforced (See annex for more information on
alcohol policy).
A clear alcohol policy could begin to have an impact on the alcohol problem in the country by
discouraging excessive alcohol use through defining and strengthening existing laws that are
weak regarding liquor licensing, alcohol production, sales and consumption. It will call for
sensitization and increased awareness of alcohol related health problems, especially with its
relation to the spread of HIV/AIDS.
9.
Barriers to Adopting Responsible Drinking Behavior
There are many barriers to adopting responsible drinking behavior. The following are some of
them:
 Social and Peer Pressure (everybody is doing it; desire to get peers’ approval)
 Denial and neglect that one has a drinking problem (so he/she cannot get help)
 Cultural influence, norms that promote social drinking at different occasions.
 There is a low risk perception of alcohol consumption. While many may be aware of the
harmful effects of alcohol, they believe it is only the problem of alcoholics. The
limits/level of what is safe (responsible) and unsafe (irresponsible) is also not known by
most people.
 Accessibility of alcoholic drinks (wide availability, affordability)
 Economic Stress, using alcohol as a way of coping with life
 Limited recreational activities
 Lack of awareness creation and prevention education about the health risks of alcohol.
 Prioritization of trade over health of alcohol and Khat sellers (feeling irresponsible
enough to sell alcohol to minors and on school environments).
 Lack of laws and weak enforcements of the existing ones.
 Limited services available (counseling and treatment)
10.
Facilitators to Adopting Responsible Drinking Behavior

Positive role models; like people who are able to manage their stress, their resources
and their time properly which leave little time for them to abuse alcohol.

Communities offer opportunities for social change, as every community has a set of
social capital that can be used to bring about behavioral change. Religious and
community leaders, elders for example, remain to be very influential in the lives of
many people. Community based associations such as Idir, mahber are also social assets
and networks which can be used to disseminate information as well as to introduce new
values and practices towards responsible drinking behavior and the HIV risk inherent by
irresponsible alcohol consumption.

Supportive environment (interacting with non-drinkers, restrictions on availability of
alcohol and Khat (limits on the times and conditions of alcoholic beverage sales,
minimum-age limits)

Stricter laws and increased enforcements

Effective education and communication to allow informed positive choices and change
risky drinking behaviors.

Accessible treatment, Healthcare providers (substance abuse treatment service givers),
counselors and VCT service providers by integrating substance abuse counseling.
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