High Rates of Unprotected Sex Occurring Among HIV-Positive Individuals in a Daily Diary Study in South Africa: The Role of Alcohol Use

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 49; no. 2; pp. 219 - 226
• Main Authors: Kiene, Susan M, Simbayi, Leickness C, Abrams, Amber, Cloete, Allanise, Tennen, Howard, Fisher, Jeffrey D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-10-2008; Lippincott Williams & Wilkins; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Alcohol use; Alcoholism; Biological and medical sciences; Disease prevention; Female; Fundamental and applied biological sciences. Psychology; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Interviews as Topic; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Models, Statistical; Regression analysis; Risk; Sexual behavior; South Africa - epidemiology; Studies; Unsafe Sex; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virology; South Africa; Africa; Cape Town South Africa; South Africa, Western Cape, Cape Town; Immunopathology; Seropositivity; condoms; Condom; Microbiology; prospective cohort study; Alcoholism; Sexual behavior; Sex; Retroviridae; AIDS; Immune deficiency; Lentivirus; sexual partners; HIV seropositivity; alcohol drinking; Virology; Infection; Virus; Prevention; Viral disease; Cohort study; South Africa; Human immunodeficiency virus
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0b013e318184559f

OBJECTIVES:The objectives of this study were to assess the prevalence of unprotected sex and to examine the association between alcohol consumption before sex and unprotected sex among HIV-positive individuals in Cape Town, South Africa.
METHODS:For 42 days, daily phone interviews assessed daily sexual behavior and alcohol consumption. Logistic and Poisson generalized estimating equation models were used to examine associations between alcohol consumption before sex and subsequent unprotected sex.
RESULTS:During the study which yielded 3035 data points, 58 HIV-positive women and 24 HIV-positive men drank an average of 6.13 drinks when they drank and reported 4927 sex events, of which 80.17% were unprotected. More than half (58%) of unprotected sex events were with HIV-negative partners or with partners with unknown HIV status. Extrapolating from the data using likelihood of infection per act estimates, we calculated that an estimated 2.95 incident HIV infections occurred during the study. Drinking alcohol before sex by the female partner or the male partner, or by both partners increased the proportion and number of subsequent unprotected sex events. However, these associations held only when the quantity of alcohol consumed corresponded to moderate or higher risk drinking.
CONCLUSIONS:Among HIV positive individuals, engaging in moderate or higher risk drinking before sex increases the likelihood and rate of unprotected sex. Prevention efforts need to address reducing alcohol-involved unprotected sex among HIV-positive persons.