Intoxication at Last Sexual Intercourse and Unprotected Sex among HIV-Positive and HIV-Negative Individuals in Uganda: An Event-Level Analysis

Abstract

This study examined, for the first time, the association between intoxication at last sexual intercourse and unprotected sex separately among HIV-positive and HIV-negative individuals. Data were derived from a nationally-representative survey of Uganda in 2011. Multivariable logistic regression analyses of the intoxication-unprotected sex association included adjustment for sociodemographic and behavioral covariates that were also examined as moderators of the association. Among HIV-positive individuals, intoxication was associated with unprotected sex, whereas among HIV-negative individuals, the intoxication-unprotected sex association was moderated by knowledge that condoms prevent HIV transmission. The odds of unprotected sex was 2.67 times greater among HIV-negative individuals who were unaware that condoms prevent HIV, an association not observed among those who possessed such knowledge. The results suggest that the intoxication-unprotected sex link be incorporated within Ugandan National HIV Prevention Strategies among HIV-positive and HIV-negative individuals. HIV-negative individuals who are unaware that condoms prevent HIV should be targeted for interventions focusing on increasing HIV transmission knowledge especially on the role of condoms in preventing the disease. The latter interventions should also identify those sociocultural and political beliefs about condom use that may serve as barriers to consistent condom use.

Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya

“…Most studies have relied on self-reported indicators of sexual behavior, 5,7,8 which underestimate unprotected sex due to recall and social-desirability biases. 27 Additionally, the AUDIT provides a reliable and standard measure of alcohol use, capturing social and psychological aspects of drinking in addition to the quantity and frequency of consumption.…”

“…3 However, evidence for an association between alcohol use and unprotected sex is limited among African women, who comprise 58% of people living with HIV in the region. 4 Analyses focused on women have generally been cross-sectional, 5–8 and most have used inconsitent and primarily self-reported sexual risk endpoints 5,7,8 or non-validated measures of alcohol use. 6 Few have examined associations separately in HIV-positive women.…”

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

“…While the event-level literature in the U.S. is well-developed— >20 event-level studies had been conducted prior to the year 2000 (Weinhardt & Carey, 2000), with a continued proliferation since (Vosburgh, Mansergh, Sullivan & Purcell, 2012)—we found only six unique studies (Fisher, Cook, & Kapiga, 2010; Kerridge, Castor, Tran, Barnhart, & Pickering, 2014; Kerridge, Tran, & Hasin, 2015; Kiene, Simbayi, Abrams, & Cloete, 2016; Kiene et al, 2008; Kiene & Subramanian, 2013; Myer, Mathews, & Little, 2002; Tumwesigye, Wanyenze, & Greenfield, 2012) that collected event-level data on alcohol and condom use in all of SSA, a region that contains ~46 countries and the majority of HIV infected persons. Given the importance of person-level and contextual factors in the association between alcohol use and sexual risk behavior found in the U.S., and the mixed findings of U.S.- event-level data, there is a need for additional event-level research in SSA, where the co-occurrence of alcohol use and HIV risk is the highest in the world.…”

“…The findings from the six published studies in SSA are thus far inconclusive: while some of the studies found a significant association between event-level alcohol consumption and unprotected sex (Kerridge et al, 2014; Kerridge et al, 2015; Kiene et al, 2016; Kiene et al, 2008; Tumwesigye et al, 2012), one found the association was significant for men only (Kiene & Subramanian, 2013), one found no significant association (Myer et al, 2002), and two found that condom use was more likely in events where alcohol was consumed immediately prior to the sexual intercourse with casual partners (Fisher et al, 2010; Kiene & Subramanian, 2013). Only two studies focused on HIV-infected adults (Kerridge et al, 2015; Kiene et al, 2016; Kiene et al, 2008). Kiene et al (2008) collected daily data with a sample of 82 South African PLWH over a period of 42 days; Kerridge et al (2015) asked a population-based sample of HIV-uninfected ( n = 14,350) and HIV-infected ( n =1,118) Ugandan adults about the circumstances of their most recent sexual event.…”

“…Only two studies focused on HIV-infected adults (Kerridge et al, 2015; Kiene et al, 2016; Kiene et al, 2008). Kiene et al (2008) collected daily data with a sample of 82 South African PLWH over a period of 42 days; Kerridge et al (2015) asked a population-based sample of HIV-uninfected ( n = 14,350) and HIV-infected ( n =1,118) Ugandan adults about the circumstances of their most recent sexual event. Both studies found a significant association between event-level alcohol consumption and unprotected sex for both women and men at moderate to high levels of consumption, particularly when both partners (as opposed to only one partner) were consuming alcohol.…”