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

Matthew Chersich UGent, Wilkister Bosire, Nzioki King'ola, Marleen Temmerman UGent and Stanley Lüchters UGent (2014) GLOBALIZATION AND HEALTH. 10.
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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
SOUTH-AFRICA, GENDER-BASED VIOLENCE, CAPE-TOWN, TRANSMITTED INFECTIONS, DRINKING VENUES, USE DISORDERS, UNSAFE SEX, SENSATION SEEKING, HIV prevention, Cohort study, Kenya, AUDIT test, SUB-SAHARAN AFRICA, INFECTION CLINIC PATIENTS, Sub-Saharan Africa, Alcohol
journal title
GLOBALIZATION AND HEALTH
Global. Health
volume
10
article number
22
pages
11 pages
Web of Science type
Article
Web of Science id
000335178700003
JCR category
PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
JCR impact factor
2.25 (2014)
JCR rank
27/147 (2014)
JCR quartile
1 (2014)
ISSN
1744-8603
DOI
10.1186/1744-8603-10-22
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
5663017
handle
http://hdl.handle.net/1854/LU-5663017
date created
2014-07-30 14:00:30
date last changed
2017-03-23 15:01:19
@article{5663017,
  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.},
  articleno    = {22},
  author       = {Chersich, Matthew and Bosire, Wilkister and King'ola, Nzioki and Temmerman, Marleen and L{\"u}chters, Stanley},
  issn         = {1744-8603},
  journal      = {GLOBALIZATION AND HEALTH},
  keyword      = {SOUTH-AFRICA,GENDER-BASED VIOLENCE,CAPE-TOWN,TRANSMITTED INFECTIONS,DRINKING VENUES,USE DISORDERS,UNSAFE SEX,SENSATION SEEKING,HIV prevention,Cohort study,Kenya,AUDIT test,SUB-SAHARAN AFRICA,INFECTION CLINIC PATIENTS,Sub-Saharan Africa,Alcohol},
  language     = {eng},
  pages        = {11},
  title        = {Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers},
  url          = {http://dx.doi.org/10.1186/1744-8603-10-22},
  volume       = {10},
  year         = {2014},
}

Chicago
Chersich, Matthew, Wilkister Bosire, Nzioki King’ola, Marleen Temmerman, and Stanley Lüchters. 2014. “Effects of Hazardous and Harmful Alcohol Use on HIV Incidence and Sexual Behaviour: a Cohort Study of Kenyan Female Sex Workers.” Globalization and Health 10.
APA
Chersich, M., Bosire, W., King’ola, N., Temmerman, M., & Lüchters, S. (2014). Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers. GLOBALIZATION AND HEALTH, 10.
Vancouver
1.
Chersich M, Bosire W, King’ola N, Temmerman M, Lüchters S. Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers. GLOBALIZATION AND HEALTH. 2014;10.
MLA
Chersich, Matthew, Wilkister Bosire, Nzioki King’ola, et al. “Effects of Hazardous and Harmful Alcohol Use on HIV Incidence and Sexual Behaviour: a Cohort Study of Kenyan Female Sex Workers.” GLOBALIZATION AND HEALTH 10 (2014): n. pag. Print.