Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study

Abstract

While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.

The relationship between alcohol consumption and risk of HIV in married men in Sub-Saharan Africa

“…Furthermore, a meta-analysis conducted in 2020 focusing on reduced adherence found that the overall prevalence of ART nonadherence was almost twice as high (34 vs. 18%) among men and women who used alcohol [29]. These findings have also been confirmed by studies in specific regions, such as Uganda and South Africa, as well as among specific populations, including MSM and women only [30][31][32][33][34].…”

Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action

“…Among PWH, SU is associated with adverse HIV treatment outcomes, including decreased ART initiation, suboptimal adherence to ART [13,14], and early mortality [15,16]. The limited data on harmful patterns of alcohol consumption in Africa, specifically heavy episodic drinking (HED; sometimes termed binge drinking), highlight HED as a risk factor for risky sexual behavior, HIV infection, and poor engagement in each step of the HIV care cascade [14,[17][18][19][20].…”

The Involvement of Age, Gender, and Personality Variables in Alcohol Consumption during the Start of the COVID-19 Pandemic in Romanian University Students

“…In many countries, the harmful consumption of alcohol by students has become a public health problem. Harmful use of alcohol and heavy episodic drinking have been cited as a cause of death [ 1 ] and have been associated with risk of driving without a seat belt, driving at unacceptable speed and involvement in accidents [ 2 ], increased risk of sexual assault [ 3 ], participating in other risky behaviors such as unprotected sex [ 4 ] and drug use [ 5 ], various diseases [ 6 ] and with decreased academic performance [ 7 ], and they have been associated with many other problems resulting in economic costs. Problematic alcohol consumption (AC) and repeated alcohol intoxication increase the risk of communicable diseases, infections, cancer, and other diseases as a result of immune system inhibition [ 8 ].…”