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Murray GE, Palfai TP, Kratzer MPL, Maisto SA, Simons JS. Sexual alcohol expectancies moderate the relation between alcohol use and sexual behavior among men who have sex with men. Alcohol 2024; 120:35-40. [PMID: 38101524 PMCID: PMC11250926 DOI: 10.1016/j.alcohol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND HIV transmission remains a significant health concern for men who have sex with men (MSM) in the United States. Heavy episodic drinking (HED) is related to increased rates of condomless anal intercourse (CAI) among MSM, though evidence suggests that this association may vary by individual difference factors. The present secondary analysis tested whether sexual alcohol expectancies (SAEs) moderate the associations between frequency of HED and anal intercourse (AI) with and without a condom among moderate-to-heavy drinking HIV- MSM. METHODS Two hundred and forty-eight moderate-to-heavy drinking MSM completed self-report questionnaires including the Sexual Behavior Questionnaire, the Modified Daily Drinking Questionnaire, and the Sexual Alcohol Expectancies Questionnaire. RESULTS Negative binomial regressions indicated that SAEs moderated the association between frequency of HED and AI with a condom, but not between the frequency of HED and condomless AI (CAI). CONCLUSIONS These results suggest that stronger SAEs play a role in alcohol-related sexual behavior among MSM, but do not provide evidence that SAEs are associated with increased risk for HIV transmission through CAI.
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Affiliation(s)
- Grace E Murray
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, United States.
| | - Tibor P Palfai
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, United States
| | - Maya P L Kratzer
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, United States
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, United States
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Murray GE, Palfai TP, Kratzer MPL, Maisto SA, Beckius BZ, Simons JS. Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study. AIDS Behav 2024:10.1007/s10461-024-04495-9. [PMID: 39230616 DOI: 10.1007/s10461-024-04495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 09/05/2024]
Abstract
Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI.
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Affiliation(s)
- Grace E Murray
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
- Center for Anxiety and Related Disorders, 900 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Brooke Z Beckius
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
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Carels C, Florence M, Adams S, Savahl S. Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7053. [PMID: 37998284 PMCID: PMC10671005 DOI: 10.3390/ijerph20227053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.
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Affiliation(s)
- Cassandra Carels
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa
| | - Maria Florence
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa
| | - Sabirah Adams
- Language Development Group, Centre for Higher Education Development, University of Cape Town, Cape Town 7701, South Africa
| | - Shazly Savahl
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa
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Fredericksen RJ, Whitney BM, Trejo E, Nance RM, Fitzsimmons E, Altice FL, Carrico AW, Cleland CM, Del Rio C, Duerr A, El-Sadr WM, Kahana S, Kuo I, Mayer K, Mehta S, Ouellet LJ, Quan VM, Rich J, Seal DW, Springer S, Taxman F, Wechsberg W, Crane HM, Delaney JAC. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort. BMC Public Health 2021; 21:2002. [PMID: 34736425 PMCID: PMC8567631 DOI: 10.1186/s12889-021-12026-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.
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Affiliation(s)
- R. J. Fredericksen
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - B. M. Whitney
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Trejo
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - R. M. Nance
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Fitzsimmons
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - F. L. Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA
| | - A. W. Carrico
- Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL 33136 USA
| | - C. M. Cleland
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012 USA
| | - C. Del Rio
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA 30322 USA
| | - A. Duerr
- Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA 98109 USA
| | - W. M. El-Sadr
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY 10032 USA
| | - S. Kahana
- National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland 20852 USA
| | - I. Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052 USA
| | - K. Mayer
- The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 USA
| | - S. Mehta
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - L. J. Ouellet
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL USA
| | - V. M. Quan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - J. Rich
- Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI 02904 USA
| | - D. W. Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - S. Springer
- Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT 06510 USA
| | - F. Taxman
- Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA 22030 USA
| | - W. Wechsberg
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - H. M. Crane
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - J. A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba R3E 0T5 Canada
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Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis. Sex Transm Dis 2019; 45:786-790. [PMID: 29944641 DOI: 10.1097/olq.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND High rates of alcohol and other drug use contribute to the ongoing generalized human immunodeficiency virus epidemic in South Africa. Despite the general link between alcohol use and condomless sex, findings from event-level studies of the relationship between alcohol use and condomless sex during the same encounter have been inconsistent. METHODS We conducted event-level analyses of the most recent sexual encounter reported by 636 women who use substances in Pretoria. Data were collected via a questionnaire that included questions about the number of rounds of vaginal and anal sex and condom use during each round. We used multiple logistic regression analyses to model the associations between alcohol use by both partners and having multiple rounds of sex, and alcohol use and condom use during all rounds of sex. RESULTS Over 50% of encounters involved multiple rounds of vaginal or anal sex. Encounters that involved multiple rounds of sex were associated with inconsistent condom use. Encounters in which both partners drank alcohol were more likely to involve condomless sex, as compared with encounters in which one or neither partner drank alcohol. CONCLUSIONS These findings raise the possibility that prior event-level studies, which do not ask about multiple rounds of sex, may underestimate the prevalence of condomless sex. The association between alcohol use by both partners and condomless sex may partially explain inconsistent associations between alcohol use and condom use in event-level studies that did not assess the number of partners drinking.
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Kiene SM, Ediau M, Schmarje KA, Kintu M, Tumwesigye NM. Exploring the Potential of Savings-Led Economic Strengthening HIV Interventions Among High-Risk Economically Vulnerable Fishing Communities in Uganda: Associations Between Use of Commitment Savings, Sexual Risk Behavior, and Problematic Alcohol Use. AIDS Behav 2019; 23:2347-2360. [PMID: 30924063 DOI: 10.1007/s10461-019-02475-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fishing communities are a most-at-risk population for HIV in Uganda. Alcohol use and abuse and economic vulnerability fuel risky sexual practices and lead to increased risk of HIV infection in these communities. Economic strengthening is an emerging intervention approach and interventions promoting saving money via mechanisms with a "soft commitment" in the form of restricting or charging small fees for withdrawals, may serve to reduce spending on alcohol and spending that leads to HIV risk behaviors in cash-based economies. However, little research has been conducted to explore the potential for commitment savings-led economic strengthening interventions to address alcohol use and sexual risk behavior among fisherfolk. This cross-sectional study explored the associations between commitment savings, HIV sexual risk behavior, and problematic alcohol among fisherfolk. We also determined whether commitment savings moderated the associations between problematic alcohol use and risky sexual behaviors. 300 (132 male, 168 female) residents of fishing communities on Lake Victoria, Uganda completed a structured interviewer-assisted interview. Over half (55.3%) used commitment savings by saving money in a bank or savings cooperative or via mobile money. Having problematic alcohol use increased the rate of risky unprotected sex with: all partners (adjIRR 6.08, 95% CI 4.30-8.60) and with casual partners and CSWs/clients (adjIRR 4.90, 95% CI 3.09-7.78), and increased the odds of having met a sex partner at an alcohol venue (adjOR 2.84, 95% CI 1.46-5.51) compared to those without problematic alcohol use. Commitment savings was associated with lower odds of: problematic alcohol use (adjOR 0.50, 95% CI 0.26-0.96), meeting a sex partner at an alcohol venue (adjOR 0.43, 95% CI 0.24-0.78), as well as lower rates of risky unprotected sex with all partners (adjIRR 0.68, 95% CI 0.48-0.96), and with causal partners, CSWs/clients (adjIRR 0.38, 95% CI 0.17-0.85). Use of commitment savings moderated the associations between problematic alcohol use and unprotected sex. However, the moderating effects of commitment savings varied by gender. These findings suggest that promoting saving money in savings mechanisms which involve a commitment may be a potentially viable avenue for HIV prevention among fishing communities and may be particularly helpful for those who have problematic alcohol use.
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Affiliation(s)
- Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
- Alcohol Research Center on HIV, Brown University School of Public Health, Providence, RI, USA.
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- Makerere University School of Public Health, Kampala, Uganda
| | - Katherine A Schmarje
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
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Woolf-King SE, Fatch R, Cheng DM, Muyindike W, Ngabirano C, Kekibiina A, Emenyonu N, Hahn JA. Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1937-1948. [PMID: 29327090 PMCID: PMC6041192 DOI: 10.1007/s10508-017-1131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 11/18/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Debbie M Cheng
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Winnie Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Allen Kekibiina
- Mbarara University of Science and Technology Grants Office, Mbarara, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Kiene SM, Sileo KM, Dove M, Kintu M. Hazardous alcohol consumption and alcohol-related problems are associated with unknown and HIV-positive status in fishing communities in Uganda. AIDS Care 2018; 31:451-459. [PMID: 30022681 DOI: 10.1080/09540121.2018.1497135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Uganda, alcohol consumption is associated with higher HIV prevalence. However, research is needed to better understand how different patterns of alcohol consumption and alcohol-related problems may drive this association. In this cross-sectional study, we examined how hazardous alcohol use and alcohol-related problems such as psychological, physical, and social harms are associated with HIV status in fishing communities in Uganda. 300 (132 male, 168 female) residents of fishing communities in Uganda (75 participants from each of the following occupational groups: fishmongers, alcohol sellers, commercial sex workers (CSW), and fishermen) completed an interviewer-assisted computerized interview. We captured information on sociodemographics and HIV testing history. Prior 12-month hazardous alcohol consumption patterns and alcohol-related problems were assessed with the AUDIT and AUDADIS. 19.7%, 58.0%, and 23.3% of the sample reported being HIV positive, being HIV negative from a test within the prior 12 months, and not knowing their HIV status respectively. 18.7% reported the co-occurrence of hazardous alcohol consumption patterns and alcohol-related problems. 7.7% reported either hazardous alcohol consumption patterns or alcohol-related problems. Compared to non-drinkers, those with co-occurring hazardous consumption and alcohol-related problems had greater odds of being HIV positive (adjOR 2.75, 95% CI 1.17-6.43) and of unknown HIV status (adjOR 3.35, 95% CI 1.52-7.42). Reporting only hazardous consumption levels, only alcohol-related problems, or low-risk drinking, did not increase the odds of being HIV positive or of unknown status. Among those not HIV positive, those with co-occurring hazardous consumption and alcohol-related problems had greater odds of never having had an HIV test (adjOR 3.78, 95% CI 1.63-8.68). The co-occurrence of hazardous alcohol use and alcohol related problems appears to be a prominent risk factor for HIV infection, not knowing one's HIV status, and never testing for HIV in this setting.
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Affiliation(s)
- Susan M Kiene
- a Division of Epidemiology and Biostatistics , School of Public Health, San Diego State University , San Diego , CA , USA.,b Brown University Alcohol Research Center on HIV , Providence , RI , USA
| | - Katelyn M Sileo
- a Division of Epidemiology and Biostatistics , School of Public Health, San Diego State University , San Diego , CA , USA
| | - Meredith Dove
- c Department of Psychology , University of Massachusetts Dartmouth , Dartmouth , MA , USA
| | - Michael Kintu
- d Wakiso Integrated Rural Development Association , Uganda
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Depressive Symptoms, Disclosure, HIV-Related Stigma, and Coping Following HIV Testing Among Outpatients in Uganda: A Daily Process Analysis. AIDS Behav 2018; 22:1639-1651. [PMID: 29081046 DOI: 10.1007/s10461-017-1953-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As efforts to end the HIV epidemic accelerate there is emphasis on reaching those living with undiagnosed HIV infection. Newly diagnosed individuals face a number of psychosocial challenges, yet we know little about depressive symptoms in the weeks immediately following diagnosis and how disclosure, coping, and other factors may affect short and longer-term depressive symptoms. Purposively sampled Ugandan outpatients completed structured interviews immediately prior to testing for HIV, daily for 28 days after receiving their test results, and at 3 and 6 months post-test. The sample included a total of 244 participants: 20 who tested HIV positive at baseline and who provided 342 daily data points, and 224 who tested HIV negative at baseline and who provided 4388 daily data points. We used linear mixed effects modeling to examine changes in depressive symptom scores over the 28 day daily interview period and predictors of depressive symptom scores and changes over time. Results from the mixed modeling revealed that while those diagnosed with HIV showed initially high depressive symptoms following diagnosis, their symptoms decreased significantly and on average fell below the cutoff for possible depression approximately 15 days after diagnosis. Among those who tested HIV-negative, on average their depressive symptoms were below the cutoff for possible depression and did not change over time. Among those diagnosed with HIV, disclosure, especially to a partner, on a particular day was associated with higher depressive symptoms that day. However, those who disclosed to their partner during the 28 days after diagnosis had significantly lower depression scores by the end of the 28 days as well as lower depression scores 3 and 6 months after diagnosis than did those who did not disclose to their partner during the 28 days after diagnosis. Scoring higher on HIV-related stigma on a particular day was associated with higher depressive symptoms that day and engaging in positive coping on a particular day was associated with lower depressive symptoms that day. Positive coping also accelerated the decrease in depressive symptoms over time. These data underscore the importance of timely disclosure to partners and suggest that regular depression screening after diagnosis and provision of mental health services could improve HIV care engagement and treatment outcomes.
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Steward WT, Satyanarayana VA, Heylen E, Srikrishnan AK, Vasudevan CK, Krishnan G, Solomon D, Ekstrand ML. Alcohol use, expectancies and HIV-related sexual risk: a cross-sectional survey of male migrant workers in South India. AIDS Care 2017; 30:656-662. [PMID: 29084445 DOI: 10.1080/09540121.2017.1394964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Male migrant workers (MMWs) in India are vulnerable to developing alcohol-related problems and engaging in unprotected sex, putting them at risk of HIV. Research has shown that alcohol-related expectancies mediate vulnerability to alcoholism. We examined which expectancies were associated with sexual risk and drinking. We surveyed 1085 heterosexual MMWs in two South Indian municipalities, assessing expectancies, sex under the influence, and unprotected sex with female sex workers (FSW) and casual female partners in the prior 30 days. Men more strongly endorsed positive than negative expectancies (t = 53.59, p < .01). In multivariate logistic regression, the expectancy of having more fun helped drive the combination of alcohol and unprotected sex with FSW partners (OR = 1.22, p < .05), whereas the expectancy of better sex helped drive a similar combination with casual partners (OR = 1.24, p < .01). Men concerned about alcohol-induced deficits were less likely to drink with FSW partners (OR = 0.81, p < .01), but more likely to have unprotected sex with them (OR = 1.78, p < .01). To reduce risk, MMWs would benefit from combination prevention approaches that use behavioral strategies to address drinking norms and awareness of risk, while using biomedical strategies to reduce viral transmission when risk does occur.
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Affiliation(s)
- Wayne T Steward
- a Center for AIDS Prevention Studies, Department of Medicine , University of California San Francisco , San Francisco , USA
| | - Veena A Satyanarayana
- b Department of Clinical Psychology , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bengaluru , India
| | - Elsa Heylen
- a Center for AIDS Prevention Studies, Department of Medicine , University of California San Francisco , San Francisco , USA
| | - Aylur K Srikrishnan
- c Y.R. Gaitonde Centre for AIDS Research and Education (YRGCARE) , Chennai , India
| | | | | | | | - Maria L Ekstrand
- a Center for AIDS Prevention Studies, Department of Medicine , University of California San Francisco , San Francisco , USA
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The Information-Motivation-Behavioral Skills Model Revisited: A Network-Perspective Structural Equation Model Within a Public Sexually Transmitted Infection Clinic Sample of Hazardous Alcohol Users. AIDS Behav 2017; 21:1208-1218. [PMID: 27260181 PMCID: PMC5136346 DOI: 10.1007/s10461-016-1446-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The information–motivation–behavioral skills (IMB) model is useful for understanding sexual risk behavior, but has not been tested with hazardously-drinking sexually transmitted infection (STI) clinic patients, a subpopulation at greater HIV risk, or with a network-perspective sexual risk behavior outcome. Participants (N = 569) were STI clinic patients who screened positive for hazardous drinking and risky sexual behavior. Sexual risk behavior (SRB) was operationalized as a latent variable with three indicators: (1) number of sexual partners, (2) number of unprotected sex occasions with primary partner, and (3) number of unprotected sex occasions with non-primary partner(s). Preliminary analyses suggested SRB was best operationalized as a latent variable with two indicators, while unprotected sex with primary partners should be considered separately. In structural models with good fit, the IMB model was generally supported. The IMB model functioned differently for non-primary and multiple partners compared to primary partners in STI clinic patients with hazardous alcohol use.
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Ide JS, Zhornitsky S, Hu S, Zhang S, Krystal JH, Li CSR. Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study. NEUROIMAGE-CLINICAL 2017; 14:750-759. [PMID: 28413777 PMCID: PMC5385596 DOI: 10.1016/j.nicl.2017.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/20/2017] [Accepted: 03/30/2017] [Indexed: 12/19/2022]
Abstract
Alcohol expectancy and impulsivity are implicated in alcohol misuse. However, how these two risk factors interact to determine problem drinking and whether men and women differ in these risk processes remain unclear. In 158 social drinkers (86 women) assessed for Alcohol Use Disorder Identification Test (AUDIT), positive alcohol expectancy, and Barratt impulsivity, we examined sex differences in these risk processes. Further, with structural brain imaging, we examined the neural bases underlying the relationship between these risk factors and problem drinking. The results of general linear modeling showed that alcohol expectancy best predicted problem drinking in women, whereas in men as well as in the combined group alcohol expectancy and impulsivity interacted to best predict problem drinking. Alcohol expectancy was associated with decreased gray matter volume (GMV) of the right posterior insula in women and the interaction of alcohol expectancy and impulsivity was associated with decreased GMV of the left thalamus in women and men combined and in men alone, albeit less significantly. These risk factors mediated the correlation between GMV and problem drinking. Conversely, models where GMV resulted from problem drinking were not supported. These new findings reveal distinct psychological factors that dispose men and women to problem drinking. Although mediation analyses did not determine a causal link, GMV reduction in the insula and thalamus may represent neural phenotype of these risk processes rather than the consequence of alcohol consumption in non-dependent social drinkers. The results add to the alcohol imaging literature which has largely focused on dependent individuals and help elucidate alterations in brain structures that may contribute to the transition from social to habitual drinking. Alcohol expectancy (AE) and impulsivity are risk factors for problem drinking. AE mediates the correlation between right insula GMV and problem drinking in women. AE and impulsivity interacts to mediate left thalamus GMV and problem drinking in all. Models where changes in GMV as a result of problem drinking are not supported.
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Affiliation(s)
- Jaime S Ide
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States
| | - Sien Hu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States.,Department of Psychology, State University of New York at Oswego, Oswego, NY 13126, United States
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, United States.,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, United States.,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06520, United States
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