Associations between alcohol misuse and risks for HIV infection among men who have multiple female sexual partners in Cape Town, South Africa.
ABSTRACT 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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ABSTRACT: This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable "high risk sexual behaviour" defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one "high risk sexual behaviour" than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25-34 and 35-44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.AIDS Care 01/2012; DOI:10.1080/09540121.2011.647676 · 1.60 Impact Factor
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ABSTRACT: Whether intimate partner violence (IPV) perpetration and victimization are associated with human immunodeficiency virus (HIV) risk behaviors is seldom investigated in Russia. The present study hypothesized that patients from a sexually transmitted infection center in Russia who perpetrated IPV or were victims of IPV would be more likely to have HIV risk behaviors including injection drug use, multiple partners, and inconsistent condom use than those who were not involved with IPV. We used a self-administered questionnaire to collect information from 381 patients on demographics, health status, injection drug use, sexual behaviors, and violence involving sexual partners between 2008 and 2009. After including sociodemographics, lifetime IPV perpetration was significantly associated with having had multiple sexual partners among male patients (odds ratio [OR] = 2.61, p < .05). IPV victimization was significantly associated with injection drug use among male and female patients (OR = 5.22, p < .05) and with inconsistent condom use among female patients (OR = 8.93, p < .05). IPV perpetration and victimization were common among male and female study participants and were associated with greater HIV risk behaviors. HIV prevention programs in Russia should address the risks associated with IPV among people at risk for HIV.Journal of Traumatic Stress 02/2012; 25(1):86-93. DOI:10.1002/jts.21658 · 2.72 Impact Factor
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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