Associations between alcohol misuse and risks for HIV infection among men who have multiple female sexual partners in Cape Town, South Africa

Medical Research Council, Cape Town, South Africa.
AIDS Care (Impact Factor: 1.6). 12/2010; 22(12):1544-54. DOI: 10.1080/09540121.2010.482128
Source: PubMed


The occurrence of high rates of alcohol consumption in a context of high HIV prevalence in South Africa poses a significant health challenge for this country. This paper aims to answer three questions that could further our knowledge regarding the links between alcohol use and HIV infection: (a) "Are problem drinkers more likely to have multiple concurrent partners than those who are not?"; (b) "Are condoms applied less effectively and less consistently by problem drinkers compared to those who are not?"; (c) "Are the female sexual partners of problem drinkers different from those who are not?" Two cross-sectional HIV bio-behavioural surveillance surveys using Respondent-Driven Sampling were conducted in two peri-urban settings on the outskirts of Cape Town, South Africa. Eight hundred and forty-eight men aged 25-55 years who have multiple, concurrent female sexual partners were recruited. Problem drinkers had a score of ≥3 on the CAGE questionnaire. Questions enquired about partner numbers, condom use and partner traits. Multivariate logistic regression models were developed to determine significant associations between outcome variables and problem drinking. Fifty-eight percent of men were problem drinkers. Compared to non-problem drinkers, problem drinkers were significantly more likely to report having any symptom of a STI; not using condoms due to drinking; inconsistent condom use with all partner types; that their most recent once-off partner was unemployed; having met their most recent partner at an alcohol-serving venue; and having had a once-off sexual relationship. Alcohol may fuel once-off sexual encounters, often characterised by transactional sex and women's limited authority to negotiate sex and condom use; factors that can facilitate transmission of HIV. HIV prevention interventions specifically targeting drinkers, the contexts in which problem drinking occurs and multiple sexual partnering are urgently needed.

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    • "These sampling weights allowed us to adjust for participants' different social network sizes (i.e., different numbers of potential recruits) and homophily within recruitment dyads (i.e., the tendency of recruiters to recruit others similar to themselves), thereby minimizing the bias introduced by the sampling method. Although there is currently no consensus on appropriate regression modeling of RDS data (Johnston, Malekinejad, Kendall, Iuppa, & Rutherford, 2008), sampling weights are an increasingly accepted approach (Garfein et al., 2009; Jenness et al., 2011; Townsend et al., 2010; Wayal et al., 2011). To maximize statistical power, we imputed any missing data. "
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    ABSTRACT: Abstract Immigrant Sexual minority Latino men-who may or may not self-identify as gay-constitute a minority within a minority. Often labeled "hidden" and "hard-to-reach," and marginalized along multiple dimensions, it is a sub-group about whom little is known. Informed by a Social Ecological Framework, we sought to describe key social variables for 190 such men in rural North Carolina and to test associations with three sexual outcomes: consistent condom use, number of sex partners, and sexual compulsivity. Participants reported limited English-language use, predominantly Latino close friends, middle levels of social support despite numerous social ties, and frequent experiences of discrimination. There were unique sets of correlates for each sexual outcome. Findings may inform health promotion interventions and guide future research.
    Journal of Homosexuality 12/2013; 61(8). DOI:10.1080/00918369.2014.872507 · 0.78 Impact Factor
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    • "Conservative gender norms, roles and attitudes [4,16], perpetration of physical or sexual violence against a female intimate partner and other women [19-22], transactional sex, alcohol abuse [23], and multiple concurrent partners [24,25] are significant markers of HIV risk. Risky sexual practices of men are also strongly correlated with less gender equitable attitudes [26,27]. "
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    ABSTRACT: Background Notions of ideal manhood in South Africa are potentially prescriptive of male sexuality thus accounting for the behaviors which may lead to men being at greater HIV risk. We tested the hypothesis that gender and relationship constructs are associated with condom use among young men living in rural South Africa. Methods 1219 men aged 15–26 years completed a cross-sectional baseline survey from an IsiXhosa questionnaire asking about sexual behaviour and relationships. Univariate and bivariate analyses described condom use patterns and explanatory variables, and multinomial regression modeling assessed the factors associated with inconsistent versus consistent and non-condom use. Results 47.7% of men never used condoms, when 36.9% were inconsistent and 15.4% were consistent with any partner in the past year. Condom use patterns differed in association with gender relations attitudes: never users were significantly more conservative than inconsistent or consistent users. Three gender positions emerged indicating that inconsistent users were most physically/sexually violent and sexually risky; never users had more conservative gender attitudes but were less violent and sexually risky; and consistent users were less conservative, less violent and sexually risky with notably fewer sexual partners than inconsistent users. Conclusions The confluence of conservative gender attitudes, perpetration of violence against women and sexual risk taking distinguished inconsistent condom users as the most risky compared to never condom users, and rendered inconsistent use one of the basic negative attributes of dominant masculinities in the Eastern Cape, South Africa. This finding is important for the design of HIV prevention and gender equity interventions and emphasizes the need for a wider roll-out of interventions that promote progressive and healthy masculine practices in the country.
    BMC Public Health 06/2012; 12(1):462. DOI:10.1186/1471-2458-12-462 · 2.26 Impact Factor
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    • "Studies from various populations have documented the role of alcohol in the engagement of risky sexual behaviors.10–11 These studies report that individuals who misuse alcohol are more likely to report greater intention to engage in risky sexual behaviors,12 more likely to report having multiple sexual partners,13–14 less likely to use condoms during sex,15 and more likely to have sex with someone who they have just met (unintended).7,16 The underlying assumption of these studies (ie, global association studies) is that drinking alcohol in excessive amounts can increase the likelihood that an individual will engage in unplanned sexual activities or will not use protection when having sex (ie, unsafe sexual practices).17 "
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    ABSTRACT: We examine the association between self-reported alcohol misuse and alcohol use within 2 hours of having sex and the number of sexual partners among a sample of African-American and Latino emergency department (ED) patients. Cross-sectional data were collected prospectively from a randomized sample of all ED patients during a 5-week period. In face-to-face interviews, subjects were asked to report their alcohol use and number of sexual partners in the past 12 months. Data were analyzed using multiple variable negative binomial regression models, and effect modification was assessed through inclusion of interaction terms. The 395 study participants reported an average of 1.4 (standard error = 0.11) sexual partners in the past 12 months, 23% reported misusing alcohol, and 28% reported consuming alcohol before sex. There was no statistically significant association between alcohol misuse and the number of sexual partners; however, alcohol before sex was associated with a larger number of sexual partners in the past year. Moreover, among those who misused alcohol, participants who reported alcohol before sex were 3 times more likely to report a higher number of sexual partners (risk ratio = 3.2; confidence interval [CI] =1.9-5.6). The association between alcohol use before sex and number of sexual partners is dependent upon whether a person has attributes of harmful drinking over the past 12 months. Overall, alcohol use before sex increases the number of sexual partners, but the magnitude of this effect is significantly increased among alcohol misusers. Alcohol misusers and those who reported having more than 1 sexual partner were more likely to cluster in the same group, ie, those who used alcohol before sex. Efforts to reduce the burden of sexually transmitted diseases, including human immunodeficiency virus, and other consequences of risky sexual behavior in the ED population should be cognizant of the interplay of alcohol and risky sexual behaviors. EDs should strive to institute a system for regular screening, brief intervention, and referral of at-risk patients to reduce negative consequences of alcohol misuse, including those of risky sexual behaviors.
    The western journal of emergency medicine 05/2012; 13(2):151-9. DOI:10.5811/westjem.2011.6.6676
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