Safer sex behavior and alcohol consumption. Research Group of the Swiss HIV Prevention Study

Determinants of alcohol consumption in HIV-uninfected injection drug users

We assess the association between time fixed and time varying participant characteristics and subsequent alcohol consumption in 1968 injection drug users (median age 37 years, 28% female, 90% African-American) followed semi-annually from 1988 to 2008. Median alcohol consumption was seven drinks per week at study entry (first and third quartile: 1, 26) with 36% reporting binge drinking. Alcohol consumption and binge drinking decreased over follow-up. Older individuals and women reported consuming fewer drinks per week. Higher typical alcohol consumption was reported by those participants who reported in the prior 6 months: non-injection cocaine use, injection drug use, having one or more sex partners, or among men, a same sex partner. Associations were generally similar for drinks per week and binge drinking. This study demonstrates that in a large urban cohort of persons with a history of injection drug use, risky drug use and sexual risk behavior are associated with subsequent alcohol consumption.

Risk factors for syphilis and prevalence of HIV, hepatitis B and C among men who have sex with men in Beijing, China: implications for HIV prevention

To examine the correlates for syphilis and the prevalence for HIV, hepatitis B, hepatitis C among men-who-have-sex-with-men (MSM) in Beijing, China. A total of 541 MSM was recruited using peer-referral, community outreach, and Internet. Questionnaire-based interviews provided information including, demographics, sexual and other risk behaviors. HIV prevalence was 4.8%, syphilis 19.8%, HCV 0.4% and HBsAg 6.5%. The median number of lifetime male sex partners was ten. In the past 3 months, 20.7% drank alcohol > or =1 times per week. In the past month, 21.3 and 14.6% had unprotected anal intercourse with regular and casual male sex partners, respectively. Syphilis infection was associated with less education, alcohol use, finding male sex partners through bathhouses/public washrooms/parks, and diagnoses of sexual transmitted diseases (STDs). Syphilis is now epidemic among Beijing's MSM. Prevention efforts are urgent as HIV prevalence is already near 5%. Education, condom promotion, STD control, and alcohol-related intervention are needed urgently.

Sexual behaviour and lifestyles of young men in Finland, 1998-2005. Cross-sectional survey of military conscripts

OBJECTIVE

To reveal sexual risk behaviour over time and to explore the associations of sexual risk behaviour, HIV-testing and socio-demographic and lifestyle characteristics, including alcohol and drug use among young men.

METHODS

Cross-sectional, structured health and lifestyle survey carried out during the beginning of the mandatory military service. Data were collected from 10,446 randomized conscripts in 1998-2005, with a response rate of 95%.

RESULTS

There was a minor increase in the prevalence of those reporting early sexual intercourse and multiple lifetime partners between 1998 and 2005 (age adjusted odds ratios [ORs] 0.68 [95% confidence interval (CI) 0.54-0.87] and 0.83 [0.70-0.99]), and a minor decrease in multiple partners over the past 12 months or engaging in high risk sex between 2000 and 2005 (ORs: 1.20 [95% CI: 1.08-1.41] and 1.45 [1.13-1.86]). No significant differences were observed in non-condom use and HIV-testing over the study period. Alcohol consumption had an independent, strong dose-contingent relationship with sexual risk behaviour. Illegal drug use showed a trend for similar but weaker association with risky sex as alcohol use.

CONCLUSIONS

This study shows minor change in the risk indicators over time, yet the prevalence of sexually transmitted infections has risen. More in-depth research to identify groups with risky sexual behaviour and multiple risk factors related to sex, alcohol and drugs is a matter of public health importance.

A low-cost, sustainable intervention for drinking reduction in the HIV primary care setting

Excess drinking poses multiple substantial health risks to HIV-infected individuals. However, no published intervention studies have focused on drinking reduction as the main outcome in HIV primary care patients. An intervention in this setting must place minimal demands on pressured staff and resources. This pilot study tested such an intervention, which consisted of brief Motivational Interviewing (MI) and HealthCall, an automated daily telephone self-monitoring system based on Interactive Voice Response (IVR), designed to extend and enhance the effects of brief MI. Thirty-one patients entered the study, received a 30-minute MI and were instructed in daily use of the IVR system. They received graphical feedback on their daily drinking from the HealthCall database after 30 days. A statistically significant decrease in drinking was found over time, both as reported in daily IVR calls (beta = - 0.01, se 0.01, p=.03) and in follow-up interviews (beta = - 0.04, se 0.12, p=.02) at 60 days. The proportion of daily calls made supported the feasibility of the intervention. The results indicate that HealthCall is acceptable to a disadvantaged HIV patient population, and preliminary data support the efficacy of this intervention in reducing harmful drinking among HIV primary care patients.

Women who fall by the roadside: gender, sexual risk and alcohol in rural Uganda

AIMS

To investigate community perceptions about the different relationship between alcohol consumption and sexual risk-taking for men and women in a high HIV prevalence African setting.

DESIGN AND SETTING

Participatory learning and action (PLA) activities were conducted in five rural villages in south-western Uganda in 2002. For each village, discussions and visualization activities over the course of 5 days explored local concepts of fun, drinking alcohol and HIV-related behavioural risks. Twelve focus group discussions (FGDs) investigated emerging themes. Analysis is based on visual outputs, observation notes and focus group transcripts.

PARTICIPANTS

Attendance at sex-segregated PLA sessions was open to all village residents. FGDs were purposively sampled from drinkers and general population groups.

FINDINGS

For men, drinking is conducted invariably outside the home, usually at night in bars, emphasizing independence, masculinity and freedom from domestic responsibilities. For women, drinking outside male supervision challenges feminine ideals of domesticity and signifies potential sexual vulnerability. Accepting drinks from men was viewed as signifying assent to sex and refusal could justify men resorting to sexual coercion. Even though drinking is seen to promote sexual risk, HIV prevention campaigns were considered unwelcome in bars. Communities preferred seminars involving drinkers and non-drinkers alike.

CONCLUSIONS

Public drinking in this community serves as a marker for men willing to exercise privileges of independence (sexual and otherwise) and women willing to defy gender norms (and risk the sexual consequences). The social and symbolic context of drinking suggests why effective HIV prevention around alcohol should not be limited to drinking environments alone.

The relationship between alcohol use and risk-taking sexual behaviors in a large behavioral study

BACKGROUND

Sexually transmitted infections (STIs) present a continuing challenge to the efforts to prevent disease in the military. Since the degree of high-risk sexual behavior is a primary determinant for acquiring STIs, the identification of personality traits or situations associated with such behavior is of special interest.

METHODS

Data for this study were obtained from the 1998 Department of Defense Survey of Health Related Behaviors Among Military Personnel. The survey instrument was a self-administered questionnaire that was conducted using a stratified, two-stage, two-phase probability design to obtain representative samples of U.S. active duty personnel worldwide.

RESULTS

More frequent episodes of alcohol intoxication were associated in a dose-dependent manner with an increased risk of having more sexual partners in the previous 12 months. Men and women who experienced intoxication more than 3 days per week were, respectively, 4.55 and 6.18 times more likely to have more than one sexual partner in the previous year.

CONCLUSIONS

This study is based on retrospective self-report and may be subject to recall bias as well as information bias due to the sensitive nature of the subject matter. However, the results are compatible with a personality-based hypothesis, in which individuals with certain sensation-seeking tendencies may incur an increased risk for sexually transmitted infections.

Teenage pregnancies and abortions in Finland in the 1990s

AIMS

This study analyses trends and regional variation in teenage pregnancy, abortion, and fertility rates in Finland in the 1990s, by single-year age group.

METHODS

Individual-level data from Finnish abortion and birth registers maintained by the National Research and Development Centre for Welfare and Health (STAKES) were used to calculate the rates and the abortion ratio. The abortion ratio was also calculated using conception as the time reference.

RESULTS

Teenage pregnancy rates and abortion rates reverted from decrease to increase in the mid-1990s. This was accompanied by an increase in the share of teenage pregnancies that ended in an abortion. The increase in abortions started first among older teenagers, and spread gradually to younger girls. Regional variation in the rates remained the same throughout the study period.

CONCLUSIONS

The observed trends reflect a change towards less effective use of contraceptive methods among teenagers. There is also evidence of the earlier start of teenage sexual activity at the end of the 1990s. The possible explanations for less effective contraceptive use include cutbacks in healthcare and family planning services in the first half of the 1990s and the reduction of sex education in schools.

Alcohol-exposed pregnancy: characteristics associated with risk

BACKGROUND

Prenatal alcohol exposure is a leading cause of neurodevelopmental deficits in children. Women who are fertile, drink alcohol, and have unprotected intercourse are at risk for an alcohol-exposed pregnancy, but little is known about this population.

METHODS

A survey was administered to 2672 English-speaking women aged 18 to 44 years from six settings, including an urban jail, a drug/alcohol treatment facility, a gynecology clinic, two primary care clinics, and respondents to a media solicitation. Bivariate and multivariate analyses were conducted to explore variables that were correlated with membership in the at-risk group.

RESULTS

Most respondents (70%) reported a household income of <$20,000; 68% had a high school or equivalent education; and 62% were African American. A total of 333 women (12.5%) met the a priori definition of "at risk" for an alcohol-exposed pregnancy. Stepwise logistic regression showed that recent drug use (odds ratio [OR]=3.1; 95% confidence interval [CI]=2.1-4.4); having smoked more than 100 cigarettes (OR=1.9, 95% CI=1.3-2.7); a history of inpatient treatment for drugs or alcohol (OR=1.8, 95% CI=1.3-2.4) or inpatient mental health treatment (OR=1.6, 95% CI=1.1-2.3); having multiple sex partners (OR=1.7, 95% CI=1.2-2.2); and recent physical abuse (OR=1.5, 95% CI=1.1-2.0) were significantly correlated with being at risk.

CONCLUSIONS

It was possible to identify diverse settings with an increased prevalence of women at risk for an alcohol-exposed pregnancy. Within these settings, women at risk were characterized by an increased frequency of selected behaviors. This information may help clinicians develop and target interventions prior to conception.

Defining alcohol-related fatal medical conditions for social-cost studies in western societies: an update of the epidemiological evidence

OBJECTIVES

To elaborate a state-of-the-art list of alcohol-related fatal medical conditions for future social-cost studies in Western societies.

METHODS

Three major social-cost studies were compared with regard to their respective section on fatal health effects attributable to long-term as well as short-term use of alcohol. On discordant conditions, a systematic literature search was conducted in the Medline and ETOH databases.

RESULTS

There is no consensus between social-cost studies with respect to alcohol-related causes of mortality. Based on the recent epidemiological evidence on alcohol and health, this paper suggests an up-to-date list of fatal medical conditions for which the causal relationship has been established with sufficient scientific evidence. A further investigation is needed, however, to reestimate relative risks by meta-analysis.

CONCLUSIONS

Evaluating new epidemiological evidence regularly is necessary for the purpose of up-to-date social-cost studies.

Drug and alcohol consumption and sexual risk behaviour among young adults: results from a national survey

To study the association of the consumption of alcohol and other psychoactive drugs with sexual risk behaviour for HIV infection, data from a representative sample of the Spanish population aged 18-39 years were analysed. A national household survey was carried out in 1996 using a combination of face-to-face interviews and self-administered questionnaires. The survey included 5253 subjects aged 18-39 years who provided information on alcohol and drug consumption, number of sexual partners and condom use with the steady partner and with casual partners in the 12 months before the survey. Of those surveyed, 27.4% had been drunk at least once and 20.5% had consumed drugs. Both behaviours were associated with male sex, younger age, higher educational level, being single and having had more than one sexual partner. In the logistic regression analysis adjusting for the sociodemographic variables, the greater frequency of drunkenness and cannabis use were associated with having more than one sexual partner. Regular condom use was significantly less frequent among cocaine users and more frequent among opiate users, but was not associated with the use of other drugs. Sexual risk behaviour (i.e. more than one partner and failure to use a condom regularly) was more frequent among persons who had been drunk or used cannabis or cocaine. Excessive consumption of alcohol, and cannabis and cocaine use are independently associated with sexual behaviour involving greater risk of HIV infection or transmission.

Risk factors for incident and recurrent condylomata acuminata among women. A population-based study

BACKGROUND

Condylomata acuminata is one of the most common sexually transmitted diseases (STDs) diagnosed in the United States, yet relatively little research has been conducted on the determinants of this disease in well-defined populations.

GOAL

To determine the exposures that predispose a woman to the development of condylomata acuminata or genital warts.

STUDY DESIGN

A population-based case-control study was conducted among enrollees of Group Health Cooperative of Puget Sound. Patients (94 women with incident and 55 women with recurrent condyloma) were diagnosed between April 1, 1987 and September 30, 1991. Control subjects were 133 women without a history of genital warts. An in-person interview was conducted to collect information on subject characteristics, exposures, and on all episodes of genital warts.

RESULTS

Women with five or more partners within the 5 years before reference date were over seven times more likely to have incident condyloma (relative risk [RR], 7.5; 95% confidence interval [CI], 3.1-18.1) and over 12 times more likely to have recurrent condyloma (RR, 12.8; 95% CI, 4.2-38.9) compared with women with only one sexual partner during this time period. An increased risk of incident condyloma was also associated with a history of any STD (RR, 2.6; 95% CI, 1.1-5.8), a history of oral herpes (RR, 2.2; 95% CI, 1.1-4.4), and a history of allergies (RR, 2.0 95% CI, 1.0-3.8). Our data did not support a strong association between risk of condyloma and smoking or recent use of oral contraceptives.

CONCLUSION

Our results suggest that risk of condyloma is primarily related to sexual behavior. We did not observe a strong association between risk of condyloma and many of the exposures considered to be potential cofactors for anogenital cancers associated with other types of human papillomaviruses.