Epidemiology of Alcohol Misuse and Illicit Drug Use Among Young People Aged 15–24 Years in Fishing Communities in Uganda

Abstract

Background: We determined the prevalence of and risk factors for alcohol misuse and illicit drug use among young Ugandans in fishing communities, a recognised “key population” for human immunodeficiency virus (HIV) infection. Methods: We conducted a cross-sectional survey among young people (15–24 years) in fishing communities in Koome, Uganda, in December 2017–July 2018. Using Audio-Assisted Self-Interviewing, we collected data on socio-demographic characteristics and alcohol use, including the Alcohol Use Disorders Identification Test (AUDIT) and timeline follow-back calendar (TLFB). Blood samples were analysed for HIV, herpes simplex virus 2 (HSV2), and Phosphatidyl ethanol (PEth 16:0/18:1). Urine samples were analysed for illicit drugs. Results: Among 1281 participants (52.7% male, mean age 20 years), 659 (51.4%) reported ever drinking alcohol, 248 (19.4%) had 12-month-AUDIT ≥ 8, and 261 (20.5%) had whole-blood PEth 16:0/18:1 concentration ≥ 20 ng/mL, indicating significant consumption. In multivariable analyses, PEth 16:0/18:1 ≥ 20ng/mL, AUDIT ≥ 8 and binge drinking (≥6 standard drinks per drinking occasion in the previous month from TLFB) were all strongly associated with older age, low education, smoking, and HSV2. Illicit drug use prevalence was 5.2% and was associated with older age, low education, being single, and smoking. Conclusion: Levels of alcohol misuse were high among young people in fishing communities and associated with HSV2, a proxy for risky sexual behaviour. Alcohol and illicit drug harm reduction services and HIV prevention programs in Uganda should prioritise young fisherfolk.

Epidemiological Findings of Alcohol Misuse and Dependence Symptoms among Adolescent Girls and Young Women Involved in High-Risk Sexual Behavior in Kampala, Uganda

“…Older age (20–24 years) was associated with alcohol misuse and dependence symptoms. The present findings are similar to other studies done among young people in Uganda [ 11 , 12 ]. Global reports also show that harmful drinking, while not prevalent in those below 19 years, increases in the 20–24 year age group [ 1 ].…”

“…Global reports also show that harmful drinking, while not prevalent in those below 19 years, increases in the 20–24 year age group [ 1 ]. The present study outcomes were also highly associated with current illicit drug use, an association that has also been found among young fisher folk in Uganda [ 11 ]. The most important physical, biological, and psychological development between childhood and adulthood occurs before the age of 20 years.…”

“…Among AGYW in the present study the proportion with AUDIT ≥8 was higher than that reported among young people in fishing communities, another key population in East Africa [ 11 ]. The burden of alcohol misuse among the participants was even greater, as half of those who misused alcohol were in the high-risk category (AUDIT ≥16) and, not all of those with dependence symptoms were alcohol dependent on the AUDIT score.…”

“…In addition findings from a recent study among 15–24-year-old university students in south-east Asia indicate that the prevalence of alcohol consumption is 20.3% and is associated with being male, smoking, peer alcohol consumption, and truancy [ 9 ]. In SSA, surveys among 12–24-year-old students and employed youth in Tanzania (using the Alcohol Use Disorder Identification Test (AUDIT) and timeline-follow-back-calendar (TLFB) methods), and disadvantaged slum dwellers in Uganda (Cut-Annoyed-Guilty-Eye-Opener (CAGE) questionnaire) showed the prevalence of alcohol use disorders to be in the ranges of 12–47% and 11–50%, respectively [ 10 , 11 , 12 ]. Alcohol use in these studies was associated with being male, having disposable income, and engaging in higher risk sexual behavior [ 10 , 12 ].…”

“…A recent study among young fisher-folk (15–24 years), a recognized key population in Uganda, used a range of measures to estimate alcohol use including AUDIT, TLFB, and phosphatidyl ethanol (PEth) blood levels with reliable results across all three measures. AUDIT scores ≥8 and PEth values ≥20 ng/mL were 19.4% and 20.5%, respectively [ 11 ]. Older age, low education, smoking, and infection with herpes simplex virus-2 were associated with the observed outcomes.…”