Top

Published in:

01-12-2013 | Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)

Alcohol Use and Sexual Risk Behaviors among Individuals Infected with HIV: A Systematic Review and Meta-Analysis 2012 to Early 2013

Authors: Lori A. J. Scott-Sheldon, Paige Walstrom, Kate B. Carey, Blair T. Johnson, Michael P. Carey, the MASH Research Team

Published in: Current HIV/AIDS Reports | Issue 4/2013

Abstract

The purpose of this meta-analytic study is to summarize the current science concerning the (a) prevalence of alcohol use, (b) prevalence of sexual risk behaviors, and (c) association between alcohol use and sexual risk behaviors among people living with HIV/AIDS (PLWHA). Studies were included if they sampled PLWHA, evaluated both alcohol use and sexual risk behavior (e.g., condom use, multiple partners), and were published between January 1, 2012, and April 1, 2013. Comprehensive electronic database searches located 728 published studies with relevant keywords; 17 studies (k = 19 reports) were included. Findings indicate that a substantial proportion of PLWHA use alcohol and engage in sexual risk behaviors. Among PLWHA, alcohol use was significantly associated with unprotected sex (d ₊ = 0.23, 95 % CI = 0.05, 0.40; k = 5). Secondary prevention programs for PLWHA that address alcohol use in the context of sexual behavior are needed.

Joint United Nations Programme on HIV/AIDS (UNAIDS). Global Report: UNAIDS Report on the Global AIDS Epidemic. 2012. http://www.unaids.org/en/resources/publications/2012/name,76121,en.asp. Accessed July 17 2013.

Centers for Diease Control and Prevention. HIV Surveillance Report, 2011; vol. 23. 2013. http://www.cdc.gov/hiv/library/reports/surveillance/2011/surveillance_Report_vol_23.html. Accessed July 17 2013.

The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. 2010. http://aids.gov/federal-resources/national-hiv-aids-strategy/nhas.pdf. Accessed August 2 2013.

Fisher JD, Smith L. Secondary prevention of HIV infection: the current state of prevention for positives. Curr Opin HIV AIDS. 2009;4(4):279–87. doi:10.1097/COH.0b013e32832c7ce5.PubMedCrossRef

Crepaz N, Marks G, Liau A, Mullins MM, Aupont LW, Marshall KJ, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS (London, England). 2009;23(13):1617–29. doi:10.1097/QAD.0b013e32832effae.CrossRef

Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr (1999). 2005;39(4):446–53.CrossRef

Eaton LA, Kalichman SC. Changes in transmission risk behaviors across stages of HIV disease among people living with HIV. J Assoc Nurses AIDS Care. 2009;20(1):39–49. doi:10.1016/j.jana.2008.10.005.PubMedCrossRef

Blackard JT, Mayer KH. HIV superinfection in the era of increased sexual risk-taking. Sex Transm Dis. 2004;31(4):201–4.PubMedCrossRef

Campbell MS, Gottlieb GS, Hawes SE, Nickle DC, Wong KG, Deng W, et al. HIV-1 superinfection in the antiretroviral therapy era: are seroconcordant sexual partners at risk? PLoS ONE. 2009;4(5):e5690. doi:10.1371/journal.pone.0005690.PubMedCrossRef

10.

Bryant KJ. Expanding research on the role of alcohol consumption and related risks in the prevention and treatment of HIV/AIDS. Subst Use Misuse. 2006;41(10–12):1465–507. doi:10.1080/10826080600846250.PubMedCrossRef

11.

Steele CM, Josephs RA. Alcohol myopia. Its prized and dangerous effects. Am Psychol. 1990;45(8):921–33.PubMedCrossRef

12.

• Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS--a systematic review. Alcohol Alcohol. 2010;45(2):159–66. doi:10.1093/alcalc/agp091. A systematic review of meta-analyses and narrative reviews conducted to date on the association between alcohol use and HIV. This review documents the (a) association between alcohol use and sexual risk behaviors and (b) effect of alcohol use on worsening the disease course.PubMedCrossRef

13.

Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health. 2010;55(3):159–66.PubMedCrossRef

14.

Fisher JC, Bang H, Kapiga SH. The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis. 2007;34(11):856–63.PubMedCrossRef

15.

Shuper PA, Joharchi N, Irving H, Rehm J. Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: review and meta-analysis. AIDS Behav. 2009;13(6):1021–36. doi:10.1007/s10461-009-9589-z.PubMedCrossRef

16.

Falagas ME, Grigori T, Ioannidou E. A systematic review of trends in the methodological quality of randomized controlled trials in various research fields. J Clin Epidemiol. 2009;62(3):227–31. doi:10.1016/j.jclinepi.2008.07.012. 31 e1-9.PubMedCrossRef

17.

Alcaide ML, Jones DL, Chitalu N, Weiss S. Chlamydia and gonorrhea infections in HIV-positive women in Urban Lusaka, Zambia. J Global Infect Dis. 2012;4(3):141–4. doi:10.4103/0974-777x.100566.CrossRef

18.

Braunstein SL, Wijgert JH, Vyankandondera J, Kestelyn E, Ntirushwa J, Nash D. Risk factor detection as a metric of STARHS performance for HIV incidence surveillance among female sex workers in Kigali, Rwanda. Open AIDS J. 2012;6(Special Issue 1):112–21.PubMedCrossRef

19.

Bruce D, Kahana S, Harper GW, Fernandez MI. The A. Alcohol use predicts sexual risk behavior with HIV-negative or partners of unknown status among young HIV-positive men who have sex with men. AIDS Care. 2012. doi:10.1080/09540121.2012.720363.PubMed

20.

Clarke A, Kerr S, Honeybrook A, Cooper DA, Avihingsanon A, Duncombe C, et al. Adherence and risk behaviour in patients with HIV infection receiving antiretroviral therapy in Bangkok. Open Virol J. 2012;6:23–8. doi:10.2174/1874357901206010023.PubMedCrossRef

21.

Desmond K, Milburn N, Richter L, Tomlinson M, Greco E, van Heerden A, et al. Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa: prevalence and correlates. Drug Alcohol Depend. 2012;120(1–3):113–8. doi:10.1016/j.drugalcdep.2011.07.004.PubMedCrossRef

22.

Dirks H, Esser S, Borgmann R, Wolter M, Fischer E, Potthoff A, et al. Substance use and sexual risk behaviour among HIV-positive men who have sex with men in specialized out-patient clinics. HIV Med. 2012;13(9):533–40. doi:10.1111/j.1468-1293.2012.01005.x.PubMed

23.

Ezugwu EC, Agu P, Ohayi SA, Okeke TC, Dim CC, Obi SN. HIV sero-prevalence among pregnant women in a resource constrained setting, South East Nigeria. Niger J Med. 2012;21(3):338–42.PubMed

24.

He H, Wang M, Zhang HB, Song DD, She M, Dong ZX, et al. The unprotected sexual behaviors and its influencing factors among HIV-infected men who have sex with men in Shanghai, China. Zhonghua yu fang yi xue za zhi [Chin J Prev Med]. 2012;46(11):976–81.

25.

Kagimu M, Guwatudde D, Rwabukwali C, Kaye S, Walakira Y, Ainomugisha D. Religiosity for HIV prevention in Uganda: a case study among Christian youth in Wakiso district. Af Health Sci. 2012;12(1):17–25.

26.

Malow RM, Devieux JG, Stein JA, Rosenberg R, Lerner BG, Attonito J, et al. Neurological function, information-motivation-behavioral skills factors, and risk behaviors among HIV-positive alcohol users. AIDS Behav. 2012;16(8):2297–308. doi:10.1007/s10461-012-0246-6.PubMedCrossRef

27.

Pace C, Lioznov D, Cheng D, Wakeman S, Raj A, Walley A, et al. Sexually transmitted infections among HIV-infected heavy drinkers in St Petersburg, Russia. Int J STD AIDS. 2012;23(12):853–8.PubMedCrossRef

28.

Paz-Bailey G, Shah N, Creswell J, Guardado ME, Nieto AI, Estrada MC, et al. Risk behaviors and STI prevalence among people with HIV in El Salvador. Open AIDS J. 2012;6:205–12. doi:10.2174/1874613601206010205.PubMedCrossRef

29.

Rongkavilit C, Naar-King S, Koken JA, Bunupuradah T, Chen X, Saengcharnchai P, et al. A feasibility study of motivational interviewing for health risk behaviors among thai youth living with HIV. J Assoc Nurses AIDS Care. 2012. doi:10.1016/j.jana.2012.02.008.PubMed

30.

Rotheram-Borus MJ, Rice E, Comulada WS, Best K, Elia C, Peters K, et al. Intervention outcomes among HIV-affected families over 18 months. AIDS Behav. 2012;16(5):1265–75. doi:10.1007/s10461-011-0075-z.PubMedCrossRef

31.

Skeer MR, Mimiaga MJ, Mayer KH, O'Cleirigh C, Covahey C, Safren SA. Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS Behav. 2012;16(3):676–89. doi:10.1007/s10461-011-9880-7.PubMedCrossRef

32.

Whetten K, Reif S, Toth M, Jain E, Leserman J, Pence B. Relationship between trauma and high-risk behavior among HIV-positive men who do not have sex with men (MDSM). AIDS Care. 2012;24(11):1453–60.PubMedCrossRef

33.

Rongkavilit C, Naar-King S, Wang B, Panthong A, Bunupuradah T, Parsons JT, et al. Motivational Interviewing Targeting Risk Behaviors for Youth Living with HIV in Thailand. AIDS Behav. 2013. doi:10.1007/s10461-013-0407-2.PubMed

34.

Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.PubMedCrossRef

35.

Fowkes FG, Fulton PM. Critical appraisal of published research: introductory guidelines. BMJ. 1991;302(6785):1136–40.PubMedCrossRef

36.

Miller WR, Brown JM, Simpson TL, Handmaker NS, Bien TH, Luckie LF. What works? A methodological analysis of the alcohol treatment outcome literature. In: Hester RK, Miller WR, editors. Handbook of alcoholism treatment approaches: Effective alternatives. 2nd ed. Needham Heights: Allyn & Bacon; 1995. p. 12–44.

37.

Lipsey MW, Wilson DB. Practical meta-analysis. Applied social research methods series. Thousand Oaks: Sage; 2001.

38.

Borenstein M, Hedges LV, Higgins JPT, Rothestein HR. Introduction to meta-analysis. West Sussex: Willey; 2009.CrossRef

39.

StataCorp. Stata/SE. 12.1 for Windows ed. College Station: StataCorp LP; 2013.

40.

Wilson DB. Meta-analysis macros for SAS, SPSS, and Stata. 2001.

41.

Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206. doi:10.1037/1082-989X.11.2.193.PubMedCrossRef

42.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. doi:10.1002/sim.1186.PubMedCrossRef

43.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. doi:10.1136/bmj.327.7414.557.PubMedCrossRef

44.

Hedges LV. Fixed effects models. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p. 285–99.

45.

World Health Organization. Global burden of disease: Definitions of region groupings. 2013. http://www.who.int/about/regions/en/index.html. Accessed July 26 2013.

46.

Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035–45.PubMedCrossRef

47.

Woolf-King SE, Steinmaus CM, Reingold AL, Hahn JA. An update on alcohol use and risk of HIV infection in sub-Saharan Africa: Meta-analysis and future research directions. Int J Alcohol Drug Res. 2013;2(1):99–110.

48.

Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8(2):141–51. doi:10.1007/s11121-006-0061-2.PubMedCrossRef

49.

Nolen-Hoeksema S. Gender differences in risk factors and consequences for alcohol use and problems. Clin Psychol Rev. 2004;24(8):981–1010. doi:10.1016/j.cpr.2004.08.003.PubMedCrossRef

50.

• Barbor T, Caetano R, Casswell S, Edwards G, Glesbrecht N, Graham K, et al. Alcohol, no ordinary commodity: Research and public policy. 2nd ed. Oxford: Oxford University Press; 2010. This book provides an overview of the evidence establishing alcohol use as a major contributor of the global burden of injury and disease, alcohol-related policies, and intervention and prevention opportunities.CrossRef

51.

Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. doi:10.1056/NEJMoa1105243.PubMedCrossRef

52.

• Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral factors in assessing impact of HIV treatment as prevention. AIDS Behav. 2012;16(5):1085–91. doi:10.1007/s10461-012-0186-1. A commentary on the lack of discussion regarding HIV-related risk behaviors following the success of the National Institute of Health’s HPTN 052 study.PubMedCrossRef

53.

Matt GE, Cook TD. Threats to the validity of research synthesis. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p. 503–29.

54.

Schroder KE, Carey MP, Vanable PA. Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Ann Behav Med. 2003;26(2):104–23.PubMedCrossRef

55.

Del Boca FK, Noll JA. Truth or consequences: the validity of self-report data in health services research on addictions. Addiction. 2000;95 Suppl 3:S347–60.PubMed

56.

Cooper ML. Does drinking promote risky sexual behavior? A complex answer to a simple question. Curr Dir Psychol Sci. 2006;15:19–23.CrossRef

57.

Braunstein SL, Nash D, Kim AA, Ford K, Mwambarangwe L, Ingabire CM, et al. Dual testing algorithm of BED-CEIA and AxSYM Avidity Index assays performs best in identifying recent HIV infection in a sample of Rwandan sex workers. PLoS ONE. 2011;6(4):e18402. doi:10.1371/journal.pone.0018402.PubMedCrossRef

58.

Rotheram-Borus MJ, Richter L, Van Rooyen H, van Heerden A, Tomlinson M, Stein A, et al. Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV. Trials. 2011;12:2. doi:10.1186/1745-6215-12-2.PubMedCrossRef

59.

Kagimu M, Kaye S, Ainomugisha D, Lutalo I, Walakira Y, Guwatudde D, et al. Evidence-based monitoring and evaluation of the faith-based approach to HIV prevention among Christian and Muslim youth in Wakiso district in Uganda. Af Health Sci. 2012;12(2):119–28. doi:10.4314/ahs.v12i2.7.

60.

Harper GW, Fernandez IM, Bruce D, Hosek SG, Jacobs RJ. The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV. AIDS Behav. 2013;17(1):213–23. doi:10.1007/s10461-011-0071-3.PubMedCrossRef

61.

Bruce D, Harper GW, Suleta K. Sexual risk behavior and risk reduction beliefs among HIV-positive young men who have sex with men. AIDS Behav. 2012. doi:10.1007/s10461-012-0155-8.

62.

Bruce D, Harper GW, Fernandez MI. The adolescent medicine trials network for HIV/AIDS I. Heavy marijuana use among gay and bisexual male emerging adults living with HIV/AIDS. J HIV/AIDS Soc Ser. 2013;12(1):26–48. doi:10.1080/15381501.2012.735171.CrossRef

63.

Jacobson JO, Creswell J, Guardado ME, Lee JC, Isabel Nieto A, Paz-Bailey G. Coverage of HIV prevention components among people with long-standing diagnosed HIV infection in El Salvador. Sex Transm Dis. 2012;39(9):694–700. doi:10.1097/OLQ.0b013e3182593b33.PubMedCrossRef

64.

Rice E, Lester P, Flook L, Green S, Valladares ES, Rotheram-Borus MJ. Lessons learned from “integrating” intensive family-based interventions into medical care settings for mothers living with HIV/AIDS and their adolescent children. AIDS Behav. 2009;13(5):1005–11.PubMedCrossRef

65.

Rotheram-Borus MJ, Murphy DA, Miller S, Draimin BH. An intervention for adolescents whose parents are living with AIDS. Clin Child Psychol Psychiatry. 1997;2(2):201–19.CrossRef

66.

Traeger L, O'Cleirigh C, Skeer MR, Mayer KH, Safren SA. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2012;35(5):548–56. doi:10.1007/s10865-011-9383-z.PubMedCrossRef

67.

Safren SA, O’Cleirigh C, Skeer MR, Driskell J, Goshe BM, Covahey C, et al. Demonstration and evaluation of a peer-delivered, individually-tailored, HIV prevention intervention for HIV-infected MSM in their primary care setting. AIDS Behav. 2011;15(5):949–58.PubMedCrossRef

68.

Knauz RO, Safren SA, O’Cleirigh C, Capistrant BD, Driskell JR, Aguilar D, et al. Developing an HIV-prevention intervention for HIV-infected men who have sex with men in HIV care: project enhance. AIDS Behav. 2007;11(1):117–26.CrossRef

69.

Safren SA, O'Cleirigh CM, Skeer M, Elsesser SA, Mayer KH. Project enhance: a randomized controlled trial of an individualized HIV prevention intervention for HIV-infected men who have sex with men conducted in a primary care setting. Health Psychol. 2013;32(2):171–9. doi:10.1037/a0028581.PubMedCrossRef

70.

O’Cleirigh C, Skeer M, Mayer KH, Safren SA. Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress. J Behav Med. 2009;32(5):466–77.PubMedCrossRef

71.

Pence BW, Mugavero MJ, Carter TJ, Leserman J, Thielman NM, Raper JL, et al. Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr. 2012;59(4):409–16. doi:10.1097/QAI.0b013e31824150bb.PubMedCrossRef

72.

Pence BW, Reif S, Whetten K, Leserman J, Stangl D, Swartz M, et al. Minorities, the poor, and survivors of abuse: HIV-infected patients in the US deep South. South Med J. 2007;100(11):1114–22. doi:10.1097/01.smj.0000286756.54607.9f.PubMedCrossRef

73.

Leserman J, Whetten K, Lowe K, Stangl D, Swartz MS, Thielman NM. How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south. Psychosom Med. 2005;67(3):500–7. doi:10.1097/01.psy.0000160459.78182.d9.PubMedCrossRef

74.

Lunze K, Cheng DM, Quinn E, Krupitsky E, Raj A, Walley AY, et al. Nondisclosure of HIV infection to sex partners and alcohol's role: a Russian experience. AIDS Behav. 2013;17(1):390–8. doi:10.1007/s10461-012-0216-z.PubMedCrossRef

75.

Raj A, Kidd JD, Cheng DM, Coleman S, Bridden C, Blokhina EA, et al. Associations between partner violence perpetration and history of STI among HIV-infected substance using men in Russia. AIDS Care. 2013;25(5):646–51. doi:10.1080/09540121.2012.722188.PubMedCrossRef

76.

Tyurina A, Krupitsky E, Cheng DM, Coleman SM, Walley AY, Bridden C, et al. Is cannabis use associated with HIV drug and sex risk behaviors among Russian HIV-infected risky drinkers? Drug Alcohol Depend. 2013. doi:10.1016/j.drugalcdep.2013.01.009.

Title: Alcohol Use and Sexual Risk Behaviors among Individuals Infected with HIV: A Systematic Review and Meta-Analysis 2012 to Early 2013
Authors: Lori A. J. Scott-Sheldon
Paige Walstrom
Kate B. Carey
Blair T. Johnson
Michael P. Carey
the MASH Research Team
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current HIV/AIDS Reports / Issue 4/2013
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI: https://doi.org/10.1007/s11904-013-0177-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Alcohol Use and Sexual Risk Behaviors among Individuals Infected with HIV: A Systematic Review and Meta-Analysis 2012 to Early 2013

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Intimate Partner Violence and HIV: A Review

Validity of Cognitive Screens for HIV-Associated Neurocognitive Disorder: A Systematic Review and an Informed Screen Selection Guide

Treatment of Genotype 1 HCV Infection in the HIV Coinfected Patient in 2014

Treatment Considerations for HIV-Infected Individuals with Severe Mental Illness

Case Management Interventions for HIV-Infected Individuals

Treatment of Genotype 2 and Genotype 3 Hepatitis C Virus (HCV) Infection in Human Immunodeficiency Virus Positive Patients

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page