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Globalization and Health
Published in: Globalization and Health 1/2014

Open Access 01-12-2014 | Research

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

Authors: Matthew F Chersich, Wilkister Bosire, Nzioki King’ola, Marleen Temmerman, Stanley Luchters

Published in: Globalization and Health | Issue 1/2014

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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.
Appendix
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Metadata
Title
Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers
Authors
Matthew F Chersich
Wilkister Bosire
Nzioki King’ola
Marleen Temmerman
Stanley Luchters
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2014
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/1744-8603-10-22

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