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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    • "Both men and women were seemingly aware of an underlying assumption that if a woman permitted a man to buy her a drink she would be expected to reward him sexually, failing which, violence could ensue (Stern & Buikema, 2013). This is similar to Townsend et al.'s (2010) This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. "
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    ABSTRACT: Alcohol consumption is strongly associated with sexual risk behavior and HIV infection in sub-Saharan Africa. This article seeks to explore the role of constructions of masculinity in men's drinking and sexual risk behavior in drinking venues (bars and taverns) in 2 rural villages of North West Province, South Africa. Ten focus groups were conducted with 58 bar patrons and servers. Four focus groups consisted of female bar patrons, 4 consisted of male bar patrons, and 2 consisted of male bar managers and servers. The participants' ages ranged from 18 to 43 years, and they were interviewed using focus group discussion guides with open-ended questions. Key themes identified through thematic analysis were (a) men's high levels of alcohol consumption, (b) men's tendency to blame women for men's proneness to risky sex when drinking, (c) men's sexual objectification of women, and (d) the far-reaching consequences of sexism and violence perpetrated by men. Policies to promote gender equality are needed to ensure that men are more gender-sensitive, engage in more balanced gender relationships, and do not uphold any destructive gender stereotypes.
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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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    • "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.
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