Traumatic Stress and the Mediating Role of Alcohol Use on HIV-Related Sexual Risk Behavior

Abstract

Background In South Africa, alcohol contributes to the HIV epidemic, in part, by influencing sexual behaviors. For some, high levels of alcohol consumption may be driven by previous traumatic experiences that result in traumatic stress. The purpose of this study was to quantify the longitudinal association between traumatic stress and unprotected sex among women who attend drinking venues and to assess whether this association was explained by mediation through alcohol use. Methods Data were collected in four waves over a year from a prospective cohort of 560 women who regularly attended alcohol-serving venues in a Cape Town township. Longitudinal mixed models examined: 1) the relationship between traumatic stress and counts of unprotected sex, and 2) whether alcohol use mediated the association between traumatic stress and unprotected sex. Results Most women reported elevated traumatic stress (80%) and hazardous alcohol use (88%) at least once during the study period. In models adjusted for covariates, traumatic stress was associated with unprotected sex (b=0.28, SE=0.06, t=4.82, p<.001). In addition, traumatic stress was associated with alcohol use (b=0.27, SE=0.02, t=14.25, p<.001), and was also associated with unprotected sex (b=0.20, SE=0.06, t=3.27, p<.01) while controlling for alcohol use (b=0.28, SE=0.07, t=4.25, p<.001). The test for the mediated effect established that alcohol use was a significant mediator, accounting for 27% of the total effect of traumatic stress on unprotected sex. Conclusions These results highlight the need to address traumatic stress among female venue patrons as an important precursor of HIV risk due to alcohol use.

Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches

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Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa

“…Risky drinking was found to be a significant predictor of RSB. This finding adds to a growing body of research indicating a strong link between alcohol and sexual risk behaviour [19], especially when drinking occurs during sexual events [5,65]. The use of alcohol explains 23.22% of the variance in RSB.…”

“…A number of explanations could potentially account for this; however, the most notable is the stigma attached to reporting sexual activity and alcohol use. According to South African women's drinking patterns, 24% report alcohol use, and those who do drink tend to drink hazardously [65]. In South Africa, women's drinking habits have remained consistent over time, with little evidence of a decline.…”

Differences in Access to HIV Services and Risky Sexual Behaviors Among Malawian Women at Social Venues Who Do and Do Not Engage in Sex Work

“…Previous research from Malawi and the region point to several potential reasons why these gaps between the three groups exist and where interventions may be targeted to achieve greater impact. Numerous studies have shown that women who frequent alcohol serving venues, like OFSW and OHRW, have an increased prevalence of psychosocial factors that can exacerbate HIV infection risk [14][15][16][17][18][19][20][21]. One study in South Africa found women who attended alcoholserving venues daily had more partners and more unprotected sex than those who didn't [22].…”