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Background   HIV  remains a major cause of preventable morbidity and mortality in  K enya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for  HIV  transmission and progression. Our objective was to estimate the portion of  HIV  infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on  HIV  infections and deaths.    Methods  We estimated outcomes over a time horizon of 20 years using a computer simulation of the  K enyan population. This computer simulation integrates a compartmental model of  HIV  transmission with a mechanistic model of  HIV  progression that was previously validated in sub‐ S aharan  A frica. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on  HIV  transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of  AIDS ). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age‐discordant relationships, and high activity subgroups. Outcomes included number of new  HIV  infections, number of  AIDS  deaths, and infectivity (number of new infections per infected person per year).    Results  Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new  HIV  infections in  K enya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive‐behavioral therapy‐based intervention in  K enya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing  AIDS  deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence.    Conclusions  A substantial number of new  HIV  infections in  K enya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to  HIV .

Impact of Interventions Targeting Unhealthy Alcohol Use in Kenya on HIV Transmission and AIDS ‐Related Deaths