Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers
Identifieur interne : 002840 ( Ncbi/Merge ); précédent : 002839; suivant : 002841Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers
Auteurs : Matthew F. Chersich [Afrique du Sud, Belgique] ; Wilkister Bosire [Kenya] ; Nzioki King La [Kenya] ; Marleen Temmerman [Belgique] ; Stanley Luchters [Belgique, Afrique du Sud, Australie]Source :
- Globalization and Health [ 1744-8603 ] ; 2014.
Abstract
To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.
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.
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
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.
Url:
DOI: 10.1186/1744-8603-10-22
PubMed: 24708844
PubMed Central: 3985581
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Chersich</name><affiliation wicri:level="4"><nlm:aff id="I1">Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="I2">International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent</wicri:regionArea><orgName 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wicri:level="1"><nlm:aff id="I4">International Centre for Reproductive Health, Mombasa, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>International Centre for Reproductive Health, Mombasa</wicri:regionArea><wicri:noRegion>Mombasa</wicri:noRegion></affiliation></author><author><name sortKey="King La, Nzioki" sort="King La, Nzioki" uniqKey="King La N" first="Nzioki" last="King La">Nzioki King La</name><affiliation wicri:level="1"><nlm:aff id="I4">International Centre for Reproductive Health, Mombasa, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>International Centre for Reproductive Health, Mombasa</wicri:regionArea><wicri:noRegion>Mombasa</wicri:noRegion></affiliation></author><author><name sortKey="Temmerman, Marleen" sort="Temmerman, Marleen" uniqKey="Temmerman M" first="Marleen" last="Temmerman">Marleen Temmerman</name><affiliation wicri:level="4"><nlm:aff id="I2">International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name><affiliation wicri:level="4"><nlm:aff id="I2">International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="I5">School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I6">Centre for International Health, Burnet Institute, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Health, Burnet Institute, Melbourne</wicri:regionArea><wicri:noRegion>Melbourne</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I7">School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Public Health and Preventive Medicine, Monash University, Melbourne</wicri:regionArea><wicri:noRegion>Melbourne</wicri:noRegion></affiliation></author></analytic><series><title level="j">Globalization and Health</title><idno type="eISSN">1744-8603</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Aims</title><p>To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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 <italic>Trichomonas vaginalis</italic>. The adjusted hazard ratio of HIV incidence was 9.6 comparing women with hazardous drinking to non-drinkers (95% CI = 1.1-87.9).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Rehm, J" uniqKey="Rehm J">J Rehm</name></author><author><name sortKey="Kehoe, T" uniqKey="Kehoe T">T Kehoe</name></author><author><name sortKey="Rehm, M" uniqKey="Rehm M">M Rehm</name></author><author><name sortKey="Patra, J" uniqKey="Patra J">J Patra</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rehm, J" uniqKey="Rehm J">J Rehm</name></author><author><name sortKey="Mathers, C" uniqKey="Mathers C">C Mathers</name></author><author><name sortKey="Popova, S" uniqKey="Popova S">S Popova</name></author><author><name sortKey="Thavorncharoensap, M" uniqKey="Thavorncharoensap M">M Thavorncharoensap</name></author><author><name sortKey="Teerawattananon, Y" uniqKey="Teerawattananon Y">Y Teerawattananon</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Global Health</journal-id><journal-id journal-id-type="iso-abbrev">Global Health</journal-id><journal-title-group><journal-title>Globalization and Health</journal-title></journal-title-group><issn pub-type="epub">1744-8603</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24708844</article-id><article-id pub-id-type="pmc">3985581</article-id><article-id pub-id-type="publisher-id">1744-8603-10-22</article-id><article-id pub-id-type="doi">10.1186/1744-8603-10-22</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Chersich</surname><given-names>Matthew F</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I2">2</xref><xref ref-type="aff" rid="I3">3</xref><email>matthew.chersich@wits.ac.za</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Bosire</surname><given-names>Wilkister</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>Ombidi@icrhk.org</email></contrib><contrib contrib-type="author" id="A3"><name><surname>King’ola</surname><given-names>Nzioki</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>Nzioki@icrhk.org</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Temmerman</surname><given-names>Marleen</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>marleen.temmerman@ugent.be</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Luchters</surname><given-names>Stanley</given-names></name><xref ref-type="aff" rid="I2">2</xref><xref ref-type="aff" rid="I5">5</xref><xref ref-type="aff" rid="I6">6</xref><xref ref-type="aff" rid="I7">7</xref><email>sluchters@burnet.edu.au</email></contrib></contrib-group><aff id="I1"><label>1</label>Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff><aff id="I2"><label>2</label>International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium</aff><aff id="I3"><label>3</label>Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff><aff id="I4"><label>4</label>International Centre for Reproductive Health, Mombasa, Kenya</aff><aff id="I5"><label>5</label>School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff><aff id="I6"><label>6</label>Centre for International Health, Burnet Institute, Melbourne, Australia</aff><aff id="I7"><label>7</label>School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia</aff><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>3</day><month>4</month><year>2014</year></pub-date><volume>10</volume><fpage>22</fpage><lpage>22</lpage><history><date date-type="received"><day>27</day><month>10</month><year>2013</year></date><date date-type="accepted"><day>24</day><month>3</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 Chersich et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2014</copyright-year><copyright-holder>Chersich et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><self-uri xlink:href="http://www.globalizationandhealth.com/content/10/1/22"></self-uri><abstract><sec><title>Aims</title><p>To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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 <italic>Trichomonas vaginalis</italic>. The adjusted hazard ratio of HIV incidence was 9.6 comparing women with hazardous drinking to non-drinkers (95% CI = 1.1-87.9).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract><kwd-group><kwd>Alcohol</kwd><kwd>Sub-Saharan Africa</kwd><kwd>HIV prevention</kwd><kwd>Cohort study</kwd><kwd>Kenya</kwd><kwd>AUDIT test</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Afrique du Sud</li><li>Australie</li><li>Belgique</li><li>Kenya</li></country><region><li>Gauteng</li><li>Province de Flandre-Orientale</li><li>Région flamande</li></region><settlement><li>Gand</li><li>Johannesbourg</li></settlement><orgName><li>Université de Gand</li><li>Université du Witwatersrand</li></orgName></list><tree><country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Chersich, Matthew F" sort="Chersich, Matthew F" uniqKey="Chersich M" first="Matthew F" last="Chersich">Matthew F. Chersich</name></region><name sortKey="Chersich, Matthew F" sort="Chersich, Matthew F" uniqKey="Chersich M" first="Matthew F" last="Chersich">Matthew F. Chersich</name><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name></country><country name="Belgique"><region name="Région flamande"><name sortKey="Chersich, Matthew F" sort="Chersich, Matthew F" uniqKey="Chersich M" first="Matthew F" last="Chersich">Matthew F. Chersich</name></region><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name><name sortKey="Temmerman, Marleen" sort="Temmerman, Marleen" uniqKey="Temmerman M" first="Marleen" last="Temmerman">Marleen Temmerman</name></country><country name="Kenya"><noRegion><name sortKey="Bosire, Wilkister" sort="Bosire, Wilkister" uniqKey="Bosire W" first="Wilkister" last="Bosire">Wilkister Bosire</name></noRegion><name sortKey="King La, Nzioki" sort="King La, Nzioki" uniqKey="King La N" first="Nzioki" last="King La">Nzioki King La</name></country><country name="Australie"><noRegion><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name></noRegion><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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