Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa

Abstract

BackgroundAlcohol misuse is a key factor underlying the remarkable vulnerability to HIV infection among men and women in sub-Saharan Africa, especially within urban settings. Its effects, however, vary by type of drinking, population group and are modified by socio-cultural co-factors.MethodsWe interviewed a random sample of 1465 men living in single-sex hostels and 1008 women in adjacent informal settlements in inner-city, Johannesburg, South Africa. Being drunk in the past week was used as an indicator of heavy episodic drinking, and frequency of drinking and number of alcohol units/week used as measures of volume. Associations between dimensions of alcohol use (current drinking, volume of alcohol consumed and heavy episodic drinking patterns) and sexual behaviours were assessed using multivariate logistic regression.ResultsMost participants were internal migrants from KwaZulu Natal province. About half of men were current drinkers, as were 13% of women. Of current male drinkers, 18% drank daily and 23% were drunk in the past week (women: 14% and 29% respectively). Among men, associations between heavy episodic drinking and sexual behaviour were especially pronounced. Compared with non-drinkers, episodic ones were 2.6 fold more likely to have transactional sex (95%CI = 1.7–4.1) and 2.2 fold more likely to have a concurrent partner (95%CI = 1.5–3.2). Alcohol use in men, regardless of measure, was strongly associated with having used physical force to have sex. Overall effects of alcohol on sexual behaviour were larger in women than men, and associations were detected between all alcohol measures in women, and concurrency, transactional sex and having been forced to have sex.ConclusionsAlcohol use and sexual behaviours are strongly linked among male and female migrant populations in inner-city Johannesburg. More rigorous interventions at both local and macro level are needed to alleviate alcohol harms and mitigate the alcohol-HIV nexus, especially among already vulnerable groups. These should target the specific dimensions of alcohol use that are harmful, assist women who drink to do so more safely and address the linkages between alcohol and sexual violence.

Association between alcohol use and HIV status: findings from Zambia and Zimbabwe

“…Our findings reinforces results from previous studies [1, 3, 6, 8, 12] that alcohol is a potential risk factor for HIV and will stimulate scholarly debate and support the need for further research to establish whether a causal relationship exists between alcohol consumption and HIV status. Such empirical studies will contribute towards understand of structural drivers of HIV and the development of comprehensive evidence-based policies and population-specific HIV prevention interventions.…”

“…This attests to earlier observations [4, 8, 11] that alcohol consumption may increase risk-taking behaviors among individuals who may not have taken the same risk when they are sober, which potentially exposes them to HIV infection. For example, sex under the influence of alcohol was associated with a greater likelihood for paying for sex, use of physical force to have sex [12] and unprotected sex [11]. Alcohol consumption has also been suggested to increase the risk of becoming infected with HIV through its suppressive effects on the immune system [3].…”

Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey

“…There is a large body of evidence [25] to support the effectiveness of screening, brief interventions and referral to treatment (SBIRT) for alcohol-related problems, with these interventions being suitable for a range of settings such as emergency room settings, [26] workplace settings [27] and primary healthcare settings. [28] In keeping with previous findings, [16,29] our results suggest that being male and being a student were associated with the onset of alcohol use. This is of concern, since a systematic review conducted in 2016 confirms that hazardous alcohol consumption continues to be the most prevalent public health issue encountered by university students.…”

Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon

“…This finding is consistent with a previous study in Cambodia which reported that FBWs consume alcohol and some engaged in transactional sex [ 19 ]. Among women in the general population, similar findings in South Africa [ 37 , 38 ] and Uganda [ 39 ] also reported that heavy alcohol consumption was associated with transactional sex. The above finding supports available evidence that alcohol consumption is associated with a number of risky sexual behaviours including transactional sex[ 25 , 28 ], unprotected sex and inconsistent condom use [ 40 , 41 ].…”