A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana
Identifieur interne : 002862 ( Pmc/Curation ); précédent : 002861; suivant : 002863A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana
Auteurs : Sheri D. Weiser [États-Unis] ; Karen Leiter [États-Unis] ; Michele Heisler [États-Unis] ; Willi Mcfarland [États-Unis] ; Fiona Percy-De Korte [États-Unis] ; Sonya M. Demonner [États-Unis] ; Sheila Tlou [Botswana] ; Nthabiseng Phaladze [Botswana] ; Vincent Iacopino [États-Unis] ; David R. Bangsberg [États-Unis]Source :
- PLoS Medicine [ 1549-1277 ] ; 2006.
Abstract
In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.
We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers.
Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.
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DOI: 10.1371/journal.pmed.0030392
PubMed: 17032060
PubMed Central: 1592342
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Demonner</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Tlou, Sheila" sort="Tlou, Sheila" uniqKey="Tlou S" first="Sheila" last="Tlou">Sheila Tlou</name><affiliation wicri:level="1"><nlm:aff id="aff6">Department of Nursing, University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Department of Nursing, University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Phaladze, Nthabiseng" sort="Phaladze, Nthabiseng" uniqKey="Phaladze N" first="Nthabiseng" last="Phaladze">Nthabiseng Phaladze</name><affiliation wicri:level="1"><nlm:aff id="aff6">Department of Nursing, University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Department of Nursing, University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Iacopino, Vincent" sort="Iacopino, Vincent" uniqKey="Iacopino V" first="Vincent" last="Iacopino">Vincent Iacopino</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7">Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of Minnesota, Minneapolis, Minnesota</wicri:regionArea></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R" last="Bangsberg">David R. Bangsberg</name><affiliation wicri:level="1"><nlm:aff id="aff3">Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8">Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17032060</idno><idno type="pmc">1592342</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592342</idno><idno type="RBID">PMC:1592342</idno><idno type="doi">10.1371/journal.pmed.0030392</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">002863</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002863</idno><idno type="wicri:Area/Pmc/Curation">002862</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002862</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana</title><author><name sortKey="Weiser, Sheri D" sort="Weiser, Sheri D" uniqKey="Weiser S" first="Sheri D" last="Weiser">Sheri D. Weiser</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation></author><author><name sortKey="Leiter, Karen" sort="Leiter, Karen" uniqKey="Leiter K" first="Karen" last="Leiter">Karen Leiter</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Heisler, Michele" sort="Heisler, Michele" uniqKey="Heisler M" first="Michele" last="Heisler">Michele Heisler</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Veterans Affairs Ann Arbor Health System and Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Veterans Affairs Ann Arbor Health System and Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan</wicri:regionArea></affiliation></author><author><name sortKey="Mcfarland, Willi" sort="Mcfarland, Willi" uniqKey="Mcfarland W" first="Willi" last="Mcfarland">Willi Mcfarland</name><affiliation wicri:level="1"><nlm:aff id="aff2">Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5">San Francisco Department of Public Health, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>San Francisco Department of Public Health, San Francisco, California</wicri:regionArea></affiliation></author><author><name sortKey="Korte, Fiona Percy De" sort="Korte, Fiona Percy De" uniqKey="Korte F" first="Fiona Percy-De" last="Korte">Fiona Percy-De Korte</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Demonner, Sonya M" sort="Demonner, Sonya M" uniqKey="Demonner S" first="Sonya M" last="Demonner">Sonya M. Demonner</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Tlou, Sheila" sort="Tlou, Sheila" uniqKey="Tlou S" first="Sheila" last="Tlou">Sheila Tlou</name><affiliation wicri:level="1"><nlm:aff id="aff6">Department of Nursing, University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Department of Nursing, University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Phaladze, Nthabiseng" sort="Phaladze, Nthabiseng" uniqKey="Phaladze N" first="Nthabiseng" last="Phaladze">Nthabiseng Phaladze</name><affiliation wicri:level="1"><nlm:aff id="aff6">Department of Nursing, University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Department of Nursing, University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Iacopino, Vincent" sort="Iacopino, Vincent" uniqKey="Iacopino V" first="Vincent" last="Iacopino">Vincent Iacopino</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physicians for Human Rights, Cambridge, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Physicians for Human Rights, Cambridge, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7">Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of Minnesota, Minneapolis, Minnesota</wicri:regionArea></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R" last="Bangsberg">David R. Bangsberg</name><affiliation wicri:level="1"><nlm:aff id="aff3">Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8">Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, California</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS Medicine</title><idno type="ISSN">1549-1277</idno><idno type="eISSN">1549-1676</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.</p></sec><sec id="st2"><title>Methods and Findings</title><p>We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers.</p></sec><sec id="st3"><title>Conclusions</title><p>Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Fritz, Ke" uniqKey="Fritz K">KE Fritz</name></author><author><name sortKey="Woelk, Gb" uniqKey="Woelk G">GB Woelk</name></author><author><name sortKey="Bassett, Mt" uniqKey="Bassett M">MT Bassett</name></author><author><name sortKey="Mcfarland, Wc" uniqKey="Mcfarland W">WC McFarland</name></author><author><name sortKey="Routh, Ja" uniqKey="Routh J">JA Routh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mnyika, Ks" uniqKey="Mnyika K">KS Mnyika</name></author><author><name sortKey="Klepp, Ki" uniqKey="Klepp K">KI Klepp</name></author><author><name sortKey="Kvale, G" uniqKey="Kvale G">G Kvale</name></author><author><name sortKey="Ole King Ori, N" uniqKey="Ole King Ori N">N Ole-King'ori</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Simbayi, Lc" uniqKey="Simbayi L">LC Simbayi</name></author><author><name sortKey="Kalichman, Sc" uniqKey="Kalichman S">SC Kalichman</name></author><author><name sortKey="Jooste, S" uniqKey="Jooste S">S Jooste</name></author><author><name sortKey="Mathiti, V" uniqKey="Mathiti V">V Mathiti</name></author><author><name sortKey="Cain, D" uniqKey="Cain D">D Cain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morrison, Cs" uniqKey="Morrison C">CS Morrison</name></author><author><name sortKey="Sunkutu, Mr" uniqKey="Sunkutu M">MR Sunkutu</name></author><author><name sortKey="Musaba, E" uniqKey="Musaba E">E Musaba</name></author><author><name sortKey="Glover, Lh" uniqKey="Glover L">LH Glover</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kapiga, Sh" uniqKey="Kapiga S">SH Kapiga</name></author><author><name sortKey="Lyamuya, 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">pmed</journal-id><journal-id journal-id-type="publisher-id">plme</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17032060</article-id><article-id pub-id-type="pmc">1592342</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.0030392</article-id><article-id pub-id-type="publisher-id">06-PLME-RA-0211R2</article-id><article-id pub-id-type="sici">plme-03-10-07</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Epidemiology/Public Health</subject><subject>HIV/AIDS</subject><subject>Sexual Health</subject></subj-group><subj-group subj-group-type="System Taxonomy"><subject>HIV Infection/AIDS</subject><subject>Health education (including prevention and promotion)</subject><subject>Sexual Health</subject><subject>Safe sex</subject></subj-group></article-categories><title-group><article-title>A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana</article-title><alt-title alt-title-type="running-head">Alcohol and Risky Sex in Botswana</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Weiser</surname><given-names>Sheri D</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Leiter</surname><given-names>Karen</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Heisler</surname><given-names>Michele</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>McFarland</surname><given-names>Willi</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Korte</surname><given-names>Fiona Percy-de</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>DeMonner</surname><given-names>Sonya M</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tlou</surname><given-names>Sheila</given-names></name><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Phaladze</surname><given-names>Nthabiseng</given-names></name><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Iacopino</surname><given-names>Vincent</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Bangsberg</surname><given-names>David R</given-names></name><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="aff" rid="aff8">8</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Physicians for Human Rights, Cambridge, Massachusetts, United States of America</aff><aff id="aff2"><label>2</label>Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America</aff><aff id="aff3"><label>3</label>Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</aff><aff id="aff4">Veterans Affairs Ann Arbor Health System and Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America</aff><aff id="aff5"><label>5</label>San Francisco Department of Public Health, San Francisco, California, United States of America</aff><aff id="aff6"><label>6</label>Department of Nursing, University of Botswana, Gaborone, Botswana</aff><aff id="aff7"><label>7</label>Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America</aff><aff id="aff8"><label>8</label>Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America</aff><contrib-group><contrib contrib-type="editor"><name><surname>Farrell</surname><given-names>Michael</given-names></name><role>Academic Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">National Addiction Centre, United Kingdom</aff><author-notes><corresp id="cor1">* To whom correspondence should be addressed. E-mail: <email>Sheri.Weiser@ucsf.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>10</month><year>2006</year></pub-date><pub-date pub-type="epub"><day>10</day><month>10</month><year>2006</year></pub-date><volume>3</volume><issue>10</issue><elocation-id>e392</elocation-id><history><date date-type="received"><day>15</day><month>3</month><year>2006</year></date><date date-type="accepted"><day>14</day><month>7</month><year>2006</year></date></history><permissions><copyright-statement> © 2006 Weiser et al.</copyright-statement><copyright-year>2006</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p></license></permissions><abstract><sec id="st1"><title>Background</title><p>In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.</p></sec><sec id="st2"><title>Methods and Findings</title><p>We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers.</p></sec><sec id="st3"><title>Conclusions</title><p>Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.</p></sec></abstract><abstract abstract-type="toc"><p>Alcohol use is associated with multiple risks for HIV transmission in men and women. The findings underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.</p></abstract><abstract abstract-type="editor"><title>Editors' Summary</title><sec id="sb1a"><title>Background<bold>.</bold></title><p>Human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), is most commonly spread through unprotected sex with an infected partner. HIV enters the body through the lining of the sex organs, rectum, or mouth, and destroys immune system cells, leaving the infected person susceptible to other viruses and bacteria. Although HIV education and prevention campaigns emphasize the importance of safe sex in reducing HIV transmission, people continue to become infected by having unprotected sex (that is, not using a condom) with either a nonmonogamous partner or multiple sexual partners, or in situations where they are paying for or selling sex. Research in different populations suggested that heavy alcohol use is associated with risky sexual behaviors. This is because alcohol relaxes the brain and body, reduces inhibitions, and diminishes risk perception. Drinking alcohol may further increase the risk of becoming infected with HIV through its suppressive effects on the immune system.</p></sec><sec id="sb1b"><title>Why Was This Study Done?</title><p>Alcohol abuse is widespread in sub-Saharan Africa where most HIV infections occur and has been associated with risky sexual behaviors. It may therefore be one of the most common, potentially modifiable HIV risk factors in this region. However, research to date has concentrated on the association between alcohol consumption and risky sex in people attending HIV-treatment clinics or recruited at beer halls, and these populations may not be representative of the general population of sub-Saharan Africa. In this study, the researchers have investigated the potential role of alcohol in perpetuating the HIV epidemic by undertaking a population-based study on alcohol use and high-risk sexual behaviors in Botswana. Nearly a quarter of adults are infected with HIV here, and alcohol abuse is also common, particularly in the townships.</p></sec><sec id="sb1c"><title>What Did the Researchers Do and Find?</title><p>The researchers recruited a random cross-section of people from the five districts of Botswana with the highest number of HIV-infected individuals and interviewed all 1,268 participants using a questionnaire. This included general questions about the participants (for example, their age and marital status) and questions about alcohol use, sexual behavior, and knowledge of HIV. Overall, 31% of the men in the study and 17% of the women were heavy drinkers—more than 21 drinks/week for men, 14 for women; a drink is half a pint of beer or a glass of wine. Heavy alcohol use was associated with being male, being in an intergenerational relationship (at least 10 years age difference between partners; intergenerational sex facilitates the continued spread of HIV in sub-Saharan Africa), having had more education, and living with a sexual partner. Among men, those who drank heavily were three to four times more likely to have unprotected sex or multiple partners or to pay for sex than nondrinkers. Among women, there was a similar association between heavy drinking and having unprotected sex or multiple partners, and heavy drinkers were eight times as likely to sell sex as nondrinkers. For both men and women, the more they drank, the more likely they were to have risky sex. The study did not address behavior among same-sex partnerships.</p></sec><sec id="sb1d"><title>What Do These Findings Mean?</title><p>This study indicates that heavy alcohol consumption is strongly and consistently associated with sexual risk behaviors in both men and women in Botswana. Because of the study design, it does not prove that heavy alcohol use is the cause of such behaviors but provides strong circumstantial evidence that this is the case. It is possible that these results may not apply to neighboring African countries—Botswana is unique in being relatively wealthy and in its government being strongly committed to tackling HIV. Nevertheless, taken together with the results of other studies, this research strongly argues for the need to deal with alcohol abuse within HIV prevention programs in sub-Saharan Africa. Strategies to do this could include education campaigns that target both alcohol use and HIV in schools and in social venues, including beer halls. But, stress the researchers, any strategy that is used must consider the cultural and social significance of alcohol use (in Botswana, alcohol use is a symbol of masculinity and high socioeconomic status) and must simultaneously tackle not only the overlap between alcohol use and risky sexual behavior but also the overlap between alcohol and other risk behaviors such as intergenerational sex.</p></sec><sec id="sb1e"><title>Additional Information</title><p>Please access these Web sites via the online version of this summary at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1371/journal.pmed.0030392">http://dx.doi.org/10.1371/journal.pmed.0030392</ext-link>.</p><list list-type="bullet"><list-item><p><ext-link ext-link-type="uri" xlink:href="http://www.niaid.nih.gov/factsheets/hivinf.htm">US National Institute of Allergy and Infectious Diseases factsheet on HIV infection and AIDS</ext-link></p></list-item><list-item><p><ext-link ext-link-type="uri" xlink:href="http://aidsinfo.nih.gov">US Department of Health and Human Services information on AIDS</ext-link></p></list-item><list-item><p><ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/hiv">US Centers for Disease Control and Prevention information on HIV/AIDS</ext-link></p></list-item><list-item><p><ext-link ext-link-type="uri" xlink:href="http://pubs.niaaa.nih.gov/publications/aa57.htm">US National Institute on Alcohol Abuse and Alcoholism patient information on alcohol and HIV/AIDS</ext-link>]</p></list-item><list-item><p><ext-link ext-link-type="uri" xlink:href="http://www.aidsmap.com">Aidsmap, information on HIV and AIDS</ext-link> provided by the charity NAM,which includes some information on HIV infections and alcohol</p></list-item><list-item><p><ext-link ext-link-type="uri" xlink:href="http://www.avert.org/aidsbotswana.htm">AVERT information on HIV and AIDS in Botswana</ext-link></p></list-item></list></sec></abstract><counts><page-count count="9"></page-count></counts><custom-meta-group><custom-meta><meta-name>citation</meta-name><meta-value>Weiser SD, Leiter K, Heisler M, McFarland W, Percy-de Korte F, et al. (2006) A population-based study on alcohol and high-risk sexual behaviors in Botswana. PLoS Med 3(10): e392. DOI: <ext-link ext-link-type="doi" xlink:href="10.1371/journal.pmed.0030392">10.1371/journal.pmed.0030392</ext-link></meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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