An update on alcohol use and risk of HIV infection in sub-Saharan Africa: Meta-analysis and future research directions

Abstract

Aims: Sub-Saharan Africa is disproportionately affected by HIV/AIDS, and growing evidence suggests that alcohol consumption is a co-occurring problem in the region. We conducted a meta-analysis on studies of alcohol use and HIV infection in subSaharan Africa in order to assess associations, evaluate heterogeneity in the literature, identify susceptible subgroups, and suggest avenues for future research.Design: We performed a systematic review, including published review articles and electronic database searches, and identified 35 studies on alcohol use and HIV. Setting and participants:All of the studies included in the meta-analysis occurred with adults in sub-Saharan Africa.Measurements: Pooled odds ratio (OR) estimates were calculated using both the fixed inverse variance weighting method and the random effects method when evidence of heterogeneity was present. Findings:The pooled OR estimate for all studies was 1.61 (95% CI: 1.44-1.80). The association between alcohol use and prevalence or incident HIV infection was particularly large among samples who reported problem drinking (OR = 2.17, 95% CI: 1.64-2.87) and drinking in sexual contexts (OR = 1.79, 95% CI: 1.55-2.06). Some evidence of publication bias was present; however, the OR remained statistically significant in small and large studies and with population-based and high-risk samples.

Decreases in self-reported alcohol consumption following HIV counseling and testing at Mulago Hospital, Kampala, Uganda

“…Alcohol use has previously been reported to be less common among women in Uganda [1], and alcohol use is prohibited in the Moslem and Evangelical religions. Persons with HIV in our study were more likely to have ever consumed alcohol (HIV status was associated with past and current hazardous use), which is consistent with the increasing evidence of a link between alcohol consumption and HIV infection [6]. We additionally found that household alcohol use was associated with current hazardous and non-hazardous alcohol use at baseline, with increased risk for hazardous use.…”

“…First, alcohol consumption and drinking venue attendance in SSA have been associated with increased HIV risk behaviors, such as number of sexual partners, unprotected sex, and commercial sex work [3,4], as well as prevalent [5,6] and incident HIV infection [7-9]. Alcohol consumption has also been associated with decreased access to HIV testing [10].…”

Alcohol Consumption and Risky Sexual Behavior Among Persons Attending Alcohol Consumption Venues in Gaborone, Botswana

“…The association between high levels of alcohol use and condom use at last sex was highly significant for females in our study; females with a high alcohol AUDIT score had an over 80 % decreased odds of using condoms at last sex after alcohol use compared to those with low AUDIT score. The higher odds of engaging in risky sexual behavior with higher alcohol consumption is consistent with many other studies conducted in Sub-Saharan Africa that showed higher odds of incident or prevalent HIV among those reporting problem drinking and drinking in sexual contexts (Woolf-King et al 2013). A study in Botswana showed that women with heavy alcohol consumption were associated with higher odds of unprotected sex (Weiser et al 2006).…”

“…Another review of studies conducted in Sub-Saharan Africa (SSA) found gender differences in alcohol use and sexual risk, where among men, alcohol use was associated with risky sexual behaviors, but women's risks were associated with their male partners' drinking habits (Kalichman et al 2007a). A more recent meta-analysis of 35 studies on HIVand alcohol use in SSA found that high levels of alcohol consumption in sexual contexts were especially associated with increased risk of HIV infection (Woolf-King et al 2013). A population-based study in Botswana showed that among both men and women, heavy alcohol use (>21 drinker/week) was associated with unprotected sex with a nonmonogamous partner, multiple sex partners, and buying sex (among men) and selling sex (among women) (Weiser et al 2006).…”

Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

“…In sub-Saharan Africa (SSA), home to more than 75% of the global HIV-infected population (UNAIDS, 2013), alcohol consumption is common and is among the drivers of the HIV epidemic (Hahn et al, 2011, Woolf-King et al, 2013). Unhealthy drinking, a spectrum of alcohol use behaviors ranging from risky drinking to alcohol dependence that are associated with varying degrees of risk to health (Saitz, 2005), is also common (WHO, 2011).…”