A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana

Abstract

BackgroundIn Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.Methods and FindingsWe conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers.ConclusionsAlcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.

Why do we have sex? Reflections from a Stepping Stones participatory action research with youth LGBTI in Johannesburg

“…These contexts are often characterised by alcohol and other stimulants being readily available. Other studies of risk behaviour amongst the youth present similar findings, in which different states of intoxication were found to be influential in the choices many individuals made with regards to risky sexual behaviour (Fritz et al 2002;Van Heijden and Swartz 2014;Kalichman et al 2007;Weiser et al 2006). Lane et al (2008) suggest that alcohol consumption influence the socialising pattern and depth of many young people, including same-sex coupling and is associated with unprotected sex.…”

An assessment of sex work in Swaziland: barriers to and opportunities for HIV prevention among sex workers

“…Alcohol use before sex has been associated with less likelihood of condom use (Kongnyuy & Wiysonge, 2007;Mmbaga et al, 2007;Weiser et al, 2006). McCready and Halkitis (2008) have also reported use of methamphetamine among MSM in order to escape the responsibility of using condoms.…”

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

“…multiple sexual partners, unprotected vaginal and anal intercourse, inconsistent condom use, and paying for or selling sex) (Alem, Kebede, Mitike, Enqusellase & Lemma, 2006;Lurie et al, 2008;Weiser et al, 2006). A number of theories have been proposed to explain the complex relationship between alcohol consumption and sexual risk behaviour, including the psychoactive effects of alcohol on sexual decision-making, expectations surrounding the effects of alcohol, high-risk settings and risk-taking personality characteristics (Bryant, 2006;Corte & Sommers, 2005;Kalichman, Simbayi, Jooste, Cain & Cherry, 2006;Morojele et al, 2006).…”