Sex-related alcohol expectancies and high-risk sexual behaviour among drinking adults in Kampala, Uganda

Abstract

Alcohol consumption, a risk factor for HIV transmission in sub-Saharan Africa, is considered high in Uganda. The study was conducted to determine whether sex-related expectations about the effects of alcohol help explain the association between alcohol use and risky sexual behaviors in a population-based sample of adults in Kampala. A two-stage sampling procedure was used to identify residents in one division of Kampala for a cross-sectional study. Associations between alcohol use (current and higher-risk drinking) and high-risk sexual behaviors (multiple regular partners and casual sex) were tested. Final models included a sex-related alcohol outcome expectancy (AOE) summary score. In age-sex-adjusted models, having multiple regular partners was associated with current drinking (Odds Ratio (OR)=2.76, 95% Confidence Intervals (CI)=1.15, 6.63) and higher-risk drinking (OR=3.35, 95%CI=1.28,8.71). Associations were similar but not statistically significant for having a causal sex partner. Sex-related AOE were associated with both alcohol use and high-risk sexual behavior and attenuated relationships between multiple regular partners and both current drinking (OR=1.94, 95%CI=0.57,6.73) and higher-risk drinking (OR=2.44, 95%CI=0.68,8.80). In this setting sexual behaviors related with alcohol consumption were explained, in part, by sex-related expectations about the effects of alcohol. These expectations could be an important component to target in HIV education campaigns.

Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior

“…These associations may also be bidirectional; depression, and one’s risk of experiencing and perpetrating IPV, may be exacerbated by alcohol use [48, 52]. Our findings similarly add to a growing literature that establishes each of these conditions as independent predictors of HIV risk behavior and HIV/STI acquisition [5–8, 18, 28–30]. Less research, however, has examined how men’s experiences of IPV affects their HIV risk, which in our study was associated with HIV risk behavior.…”

“…Research throughout sub-Saharan Africa points to intimate partner violence (IPV), alcohol consumption, and depression as vulnerabilities for HIV [5–10]. In Uganda, all three conditions are prevalent and each have been linked in the literature to HIV risk.…”

“…IPV is particularly high in Uganda, with 27% of women reporting experiencing physical IPV in the prior 12 months [11]. Alcohol use, which is also high in Uganda, is similarly associated with low or inconsistent condom use, greater number of sex partners, and more extramarital sex [5–8], as well as HIV risk behavior across settings [12–15]. Finally, the link between depression and HIV risk has been established in the broader literature [16].…”

“…Such a holistic approach requires understanding of co-occurrence of individual conditions like alcohol consumption and depression along with societal determinants of health such as IPV that increase HIV risk behavior and HIV acquisition. While studies from Uganda and sub-Saharan Africa have identified individual or dual associations of risky sexual behavior with high alcohol consumption, IPV and depression [5–8, 18, 28–32], few studies have looked into the effect of the co-occurrence of all three of these factors on HIV risk behaviors in sub-Saharan Africa [33]. The global literature focusing on syndemics , or the co-occurrence of multiple diseases or conditions which exacerbate the effect of the conditions on health, suggests that the multiple pathways that link HIV risk with IPV, alcohol use, and depression are complex and multidimensional [34, 35].…”

Alcohol use, expectancies and HIV-related sexual risk: a cross-sectional survey of male migrant workers in South India

“…Prior research has shown that alcohol-related expectancies—i.e., beliefs about what will occur if one drinks—mediate vulnerability to alcoholism (Darkes, Greenbaum, & Goldman, 2004; Read & O’Connor, 2006; Wardell, Read, Colder, & Merrill, 2012) and that alcohol plays a significant role in decreasing inhibitions to seek sexual services and facilitating sexual violence or unprotected sex (Berg et al, 2010; Kiene, Simbayi, Abrams, & Cloete, 2016; Verma et al, 2010). High levels of drinking and positive alcohol and sexual expectancies are associated with seeking other partners and having multiple or casual partners (Nash, Katamba, Mafigiri, Mbulaiteye, & Sethi, 2016; Singh et al, 2010). Positive expectancies are also commonly cited as reasons for alcohol use (Rodríguez et al, 2010).…”