TY - JOUR
T1 - Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour
T2 - A cohort study of Kenyan female sex workers
AU - Chersich, Matthew F.
AU - Bosire, Wilkister
AU - King'ola, Nzioki
AU - Temmerman, Marleen
AU - Luchters, Stanley
N1 - Funding Information:
We thank the Ministry of Health, Government of Kenya for their support. We would like to sincerely thank the entire ICRH research team in Mombasa for their commendable contributions to the study. Many thanks to Dr Annalene Nel of the International Partnership for Microbicides for support to the study. We also acknowledge the staff at the Chaani clinic and the Kisauni drop-in centre. Lastly, we thank all study participants for their invaluable contribution. Financial support for this study was provided by the International Partnership for Microbicides (IPM). The authors also gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program. We acknowledge the contribution of the EU DIFFER project to Matthew Chersichs input on this paper.
PY - 2014/3/3
Y1 - 2014/3/3
N2 - Aims: To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.Methods: A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression.Results: Participants had high levels of hazardous (17.3%, 69/399) and harmful drinking (9.5%, 38/399), while 36.1% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4.1-fold higher sexual violence (95% CI adjusted odds ratio [AOR] = 1.9-8.9) and 8.4 higher odds of physical violence (95% CI AOR = 3.9-18.0), while hazardous drinkers had 3.1-fold higher physical violence (95% CI AOR = 1.7-5.6). No association was detected between AUDIT category and pregnancy, or infection with Syphilis or Trichomonas vaginalis. The adjusted hazard ratio of HIV incidence was 9.6 comparing women with hazardous drinking to non-drinkers (95% CI = 1.1-87.9).Conclusions: Unsafe sex, partner violence and HIV incidence were higher in women with alcohol use disorders. This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence. Experimental evidence is required demonstrating that interventions to reduce alcohol use can avert unsafe sex.
AB - Aims: To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.Methods: A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression.Results: Participants had high levels of hazardous (17.3%, 69/399) and harmful drinking (9.5%, 38/399), while 36.1% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4.1-fold higher sexual violence (95% CI adjusted odds ratio [AOR] = 1.9-8.9) and 8.4 higher odds of physical violence (95% CI AOR = 3.9-18.0), while hazardous drinkers had 3.1-fold higher physical violence (95% CI AOR = 1.7-5.6). No association was detected between AUDIT category and pregnancy, or infection with Syphilis or Trichomonas vaginalis. The adjusted hazard ratio of HIV incidence was 9.6 comparing women with hazardous drinking to non-drinkers (95% CI = 1.1-87.9).Conclusions: Unsafe sex, partner violence and HIV incidence were higher in women with alcohol use disorders. This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence. Experimental evidence is required demonstrating that interventions to reduce alcohol use can avert unsafe sex.
KW - AUDIT test
KW - Alcohol
KW - Cohort study
KW - HIV prevention
KW - Kenya
KW - Sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=84898023568&partnerID=8YFLogxK
U2 - 10.1186/1744-8603-10-22
DO - 10.1186/1744-8603-10-22
M3 - Article
C2 - 24708844
AN - SCOPUS:84898023568
SN - 1744-8603
VL - 10
JO - Globalization and Health
JF - Globalization and Health
IS - 1
M1 - 22
ER -
