Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers

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Abstract

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.

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Most cited references 38

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Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings.

Seth C. Kalichman, Leickness Simbayi, Michelle Kaufman … (2007)

Alcohol consumption is associated with risks for sexually transmitted infections (STI), including HIV/AIDS. In this paper, we systematically review the literature on alcohol use and sexual risk behavior in southern Africa, the region of the world with the greatest HIV/AIDS burden. Studies show a consistent association between alcohol use and sexual risks for HIV infection. Among people who drink, greater quantities of alcohol consumption predict greater sexual risks than does frequency of drinking. In addition, there are clear gender differences in alcohol use and sexual risks; men are more likely to drink and engage in higher risk behavior whereas women's risks are often associated with their male sex partners' drinking. Factors that are most closely related to alcohol and sexual risks include drinking venues and alcohol serving establishments, sexual coercion, and poverty. Research conducted in southern Africa therefore confirms an association between alcohol use and sexual risks for HIV. Sexual risk reduction interventions are needed for men and women who drink and interventions should be targeted to alcohol serving establishments.

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Alcohol use and antiretroviral adherence: review and meta-analysis.

David W Pantalone, Jane Simoni, Christian Hendershot … (2009)

Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by aggregating findings across studies and examining potential moderators. Literature searches identified 40 qualifying studies totaling over 25,000 participants. Studies were coded on several methodological variables. In the combined analysis, alcohol drinkers were approximately 50%-60% as likely to be classified as adherent [odds ratio (OR) = 0.548, 95% confidence interval (CI): 0.490 to 0.612] compared with abstainers (or those who drank relatively less). Effect sizes for problem drinking, defined as meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking or criteria for an alcohol use disorder, were greater (OR = 0.474, 95% CI = 0.408 to 0.550) than those reflecting any or global drinking (OR = 0.604, 95% CI = 0.531 to 0.687). Several variables moderated the alcohol-adherence association. Results support a significant and reliable association of alcohol use and medication nonadherence. Methodological variables seem to moderate this association and could contribute to inconsistent findings across studies. Future research would benefit from efforts to characterize theoretical mechanisms and mediators and moderators of the alcohol-adherence association.

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A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization.

Kristen M. J. Azar, Charles Springer, F Altice … (2010)

Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals. To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA). Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined. Selection criteria included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV- status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized. Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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Author and article information

Contributors

Matthew F Chersich

Wilkister Bosire

Nzioki King’ola

Marleen Temmerman

Stanley Luchters

Journal

Journal ID (nlm-ta): Global Health

Journal ID (iso-abbrev): Global Health

Title: Globalization and Health

Publisher: BioMed Central

ISSN (Electronic): 1744-8603

Publication date Collection: 2014

Publication date (Electronic): 3 April 2014

Volume: 10

Page: 22

Affiliations

[1 ]Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

[2 ]International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium

[3 ]Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

[4 ]International Centre for Reproductive Health, Mombasa, Kenya

[5 ]School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

[6 ]Centre for International Health, Burnet Institute, Melbourne, Australia

[7 ]School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Article

Publisher ID: 1744-8603-10-22

DOI: 10.1186/1744-8603-10-22

PMC ID: 3985581

PubMed ID: 24708844

SO-VID: 4c33c988-9c02-432c-b278-1fd2ca10d5f9

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers

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Tobacco Prevention & Cessation

Most cited references 38

Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings.

Alcohol use and antiretroviral adherence: review and meta-analysis.

A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization.

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