Alcohol Use and Transactional Sex among Women in South Africa: Results from a Nationally Representative Survey

Transactional sex and risky sexual practices in Jamaica

BACKGROUND

Transactional sex relationships (TSRs) create financial and emotional support for men and women, as well as an increased sexual risk. Studies have reported high HIV and STI transmission rates among young women in transactional sex relationships. However, little is known about TSR prevalence in Jamaica and risky sexual practices among participants. This study investigates the sexual behaviour of Jamaicans in TSR.

METHODS

Secondary data analysis of a national survey revealed that 586 participants (38%) self-reported being in at least one TSR in the last 12 months. We also identified a third category called "Benefluids", who play both roles of benefactor and beneficiary in transactional sex relationships.

RESULTS

59 percent of male Benefluids had two to five transactional sex relationship partners in the last 12 months, compared to 40% of female Benefluids. Twenty-eight percent of female Benefluids reported sexually transmitted infection symptoms in the last 12 months compared to 13.5% of male Benefluids. While females reported more sexually transmitted infection symptoms, young men had the highest sexual risk precursors.

CONCLUSIONS

People in transactional sex relationships often play the role of beneficiaries and benefactors to meet material and sexual needs but this increases the risk of STI symptoms.

Pathways to transactional sex among peri-urban South African women: the role of relationship control, food insecurity and alcohol misuse

Transactional sex increases sub-Saharan African women's risk of HIV acquisition. We quantitatively explored the pathways contributing towards women's future engagement in transactional sex with casual partners and khwapheni (secret concurrent sex partners). We conducted secondary data analysis from a cluster randomised controlled trial in urban informal settlements in eThekwini Municipality., South Africa. Data were collected at enrolment (t0) and 24 months' later (t2) using self-completed questionnaires. Structural equation modelling (SEM) assessed pathways leading to transactional sex over two years. 677 women 18-35 years were enrolled and 80.5% (n = 545) were followed up. At t2, 44.6% of respondents reported transactional sex with a casual partner or khwapheni. The SEM demonstrated a small effect (d = 0.23) between transactional sex at t0 and at t2. Controlling for past transactional sex, main partner relationship control had a large effect size on future transactional sex (d = 0.60). Hazardous drinking had a medium effect size (d = 0.45) and food insecurity a small effect (d = 0.24), (RMSEA 0.03, 90%CI 0.02-0.04; CFI 0.97; TLI 0.96). HIV prevention programming should highlight current transactional sex but also address structural issues predicting future transactional sex, including food insecurity and alcohol misuse. Gender transformative interventions to reduce controlling behaviours in main relationships are worth investigating.

Prevalence of substance and hazardous alcohol use and their association with risky sexual behaviour among youth: findings from a population-based survey in Zimbabwe

OBJECTIVES

Hazardous drinking (HD) and substance use (SU) can lead to disinhibited behaviour and are both growing public health problems among Southern African youths. We investigated the prevalence of SU and HD and their association with risky sexual behaviour among youth in Zimbabwe.

DESIGN

Data analysis from a population-based survey conducted between October 2021 and June 2022 to ascertain the outcomes of a cluster randomised trial (CHIEDZA: Trial registration number:NCT03719521). Trial Stage: Post-results.

SETTING

24 communities in three provinces in Zimbabwe.

PARTICIPANTS

Youth aged 18-24 years living in randomly selected households.

OUTCOME MEASURES

HD was defined as an Alcohol Use Disorders Identification Test score ≥8, SU was defined as ever use of ≥1 commonly used substances in the local setting.

RESULTS

Of 17 585 participants eligible for this analysis, 61% were women and the median age was 20 (IQR: 19-22) years. Overall, 4.5% and 7.0% of participants reported HD and SU, respectively. Men had a substantially higher prevalence than women of HD (8.2% vs 1.9%) and SU (15.1% vs 1.5%). Among men, after adjusting for socio-demographic factors, we found increased odds of having >1 sexual partner in those who engaged in SU (adjusted OR (aOR)=2.67, 95% CI: 2.21 to 3.22), HD (aOR=3.40, 95% CI: 2.71 to 4.26) and concurrent HD and SU (aOR=4.57,95% CI: 3.59 to 5.81) compared with those who did not engage in HD or SU. Similarly, there were increased odds of receiving/providing transactional sex among men who engaged in SU (aOR=2.51, 95% CI: 1.68 to 3.74), HD (aOR=3.60, 95% CI: 2.24 to 5.79), and concurrent HD and SU (aOR=7.74, 95% CI: 5.44 to 11.0). SU was associated with 22% increased odds of inconsistent condom use in men (aOR=1.22, 95% CI: 1.03 to 1.47). In women, the odds of having >1 sexual partner and having transactional sex were also increased among those who engaged in SU and HD.

CONCLUSION

SU and HD are associated with sexual behaviours that increase the risk of HIV acquisition in youth. Sexual and reproductive health interventions must consider HD and SU as potential drivers of risky sexual behaviour in youths.

Epidemiology of alcohol use and alcohol use disorder among female sex workers in Mbeya City, Tanzania

Alcohol misuse is a global concern, contributing to 5.3% of total deaths and 132.6 million disability-adjusted life years worldwide. In Sub-Saharan African countries, the prevalence of Alcohol Use Disorder (AUD) has risen, especially among female sex workers, due to increased availability and advertising. However, there are limited studies on alcohol use and AUD among female sex workers in Tanzania. This study aimed to determine the prevalence, patterns, and factors associated with alcohol use and AUD among sex workers in Mbeya city, Tanzania. In this cross-sectional study, 212 female sex workers in Mbeya city, Tanzania, seeking enrolment in the National Institute for Medical Research Mbeya Medical Research Centre's registration cohort from July to November 2022. Structured interviews covered socio-demographics, alcohol screening (AUDIT-C and Timeline Follow Back Calendar), and sexual behaviours data. Data were analysed using Stata version 17. Descriptive analysis assessed alcohol consumption and AUD prevalence. Factors associated with alcohol use and AUD at bivariate analysis were identified using Chi-square/Fisher's exact tests. All variables with p-value ≤ 0.20 were entered into a multivariable logistic regression model to identify factors associated with alcohol use and AUD. Among 212 participants, 86.6% reported alcohol use in the past 12 months, 85% in the past 30 days, and 98.5% met AUD criteria. Factors linked to recent alcohol consumption included primary education or higher, income above the median, and more than 10 sexual partners. Education level, marital status, income, and having dependents were significantly associated with heavy drinking episodes. The prevalence of AUD, alcohol use, and heavy episodic drinking were high among female sex workers in Mbeya city. Socio-demographic factors and risky sexual behaviours were associated with alcohol use and heavy episodic drinking highlighting the need for targeted interventions to combat alcohol abuse among female sex workers within the HIV program.

Exploring ecosocial contexts of alcohol use and misuse during the COVID-19 pandemic among urban refugee youth in Kampala, Uganda: Multi-method findings

Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth in Kampala, Uganda. We conducted a cross-sectional survey (n = 335), in-depth individual interviews (IDI) (n = 24), and focus groups (n = 4) with urban refugee youth in Kampala. We also conducted key informant interviews (n = 15) with a range of stakeholders in Kampala. We conducted multivariable logistic regression analyses with survey data to examine socio-demographic and ecosocial (structural, community, interpersonal) factors associated with ever using alcohol and alcohol misuse. We applied thematic analyses across qualitative data to explore lived experiences, and perceived impacts, of alcohol use. Among survey participants (n = 335, mean age= 20.8, standard deviation: 3.01), half of men and one-fifth of women reported ever using alcohol. Among those reporting any alcohol use, half (n = 66, 51.2 %) can be classified as alcohol misuse. In multivariable analyses, older age, gender (men vs. women), higher education, and perceived increased pandemic community violence against women and children were associated with significantly higher likelihood of ever using alcohol. In multivariable analyses, very low food security, relationship status, transactional sex, and lower social support were associated with increased likelihood of alcohol misuse. Qualitative findings revealed: (1) alcohol use as a coping mechanism for stressors (e.g., financial insecurity, refugee-related stigma); and (2) perceived impacts of alcohol use on refugee youth health (e.g., physical, mental). Together findings provide insight into multi-level contexts that shape vulnerability to alcohol mis/use among urban refugee youth in Kampala and signal the need for gender-tailored strategies to reduce socio-environmental stressors.

An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa

BACKGROUND

Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission.

METHODS

We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month.

RESULTS

Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000-2021 period 54% (95% CI: 34-74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0-32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0-68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0-2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8-7.2%) or by 7.3% (0.6-21.2%) if there was no waning of intervention impact.

CONCLUSIONS

Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.

Transactional sex among women in Sub-Saharan Africa: A systematic review and meta-analysis

INTRODUCTION

Transactional sex is casual sex between two people to receive material incentives in exchange for sexual favors. Transactional sex is associated with negative consequences, which increase the risk of sexually transmitted diseases, including HIV/AIDS, unintended pregnancy, unsafe abortion, and physiological trauma. In Sub-Saharan Africa, several primary studies have been conducted in various countries to examine the prevalence and associated factors of transactional sex among women. These studies had great discrepancies and inconsistent results. Hence, this systematic review and meta-analysis aimed to synthesize the pooled prevalence of the practice of transactional sex among women and its associated factors in Sub-Saharan Africa.

METHOD

Data source: PubMed, Google Scholar, HINARI, the Cochrane Library, and grey literature were searched from March 6 to April 24, 2022, and included studies conducted from 2000 to 2022. The pooled prevalence of transactional sex and associated factors was estimated using Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic, a funnel plot, and Egger's test were used to check for heterogeneity and publication bias, respectively. A subgroup analysis was done based on the study years, source of data, sample sizes, and geographical location.

RESULTS

The pooled prevalence of transactional sex among women in Sub-Saharan Africa was 12.55% (9.59%-15.52%). Early sexual debut (OR = 2.58, 95% CI: 1.56, 4.27), substance abuse (OR = 4.62, 95% CI: 2.62, 8.08), history of sexual experience (OR = 4.87, 95% CI: 2.37, 10.02), physical violence abuse (OR = 6.70, 95% CI: 3.32, 13.53), orphanhood (OR = 2.10, 95% CI: 1.27, 3.47), and sexual violence abuse (OR = 3.76, 95% CI: 1.08, 13.05) were significantly associated with transactional sex.

CONCLUSION

The prevalence of transactional sex among women in sub-Saharan Africa was high. Alcohol consumption, substance abuse, early sex debuts, having a history of sexual experiences, physical violence, and sexual violence increased the practice of transactional sex.

Race, place, and HIV: The legacies of apartheid and racist policy in South Africa

Black South Africans accounted for 6.2 out of 6.4 million people living with HIV in South Africa in 2012, highlighting extreme racial disparities in HIV infection. These racial disparities are the result of structural and historical factors, specifically, the racist policies which were facilitated by segregation before, during, and after Apartheid. First, we describe the theoretical context of how racist policies and segregation are linked to HIV prevalence. Next, using data from a 2012 national survey of South Africans (SABSSM IV) and Statistics South Africa (StatsSA), we describe the race-specific geospatial distribution of HIV in South Africa, provide empirical evidence for the impact of Apartheid on important risk factors for HIV infection, and describe the relationship between these risk factors and HIV within racial groups. Using multilevel logistic regression, we find that segregation increases the odds of HIV infection among Black South Africans, even after adjusting for many covariates which are sometimes blamed, in place of structural factors, for a higher HIV prevalence in Black South Africans. We found that the estimated odds of infection in the most segregated municipality was 1.95 (95% CI: 1.15, 3.32) times the odds of infection in the least segregated municipality for Black South Africans. In addition to segregation, we also find other covariates to be differentially associated with HIV infection depending on race, such as gender, age, and sexual behavior. We also find that the HIV infection odds ratio comparing Black and Coloured (i.e., multiple ethnic groups with mixed ancestries from Africa, Asia, and Europe) South Africans varies over space. These results continue to build evidence for the influence of structural and historical factors on the modern geospatial and demographic distribution of HIV.

Transactional sex among young people in Switzerland: a cross-sectional study

Background The aim of this research was to determine the prevalence and characteristics of youths having ever exchanged sex and to assess if there were differences depending on whether they had done it once or several times. We also investigated what they exchanged sex for and their relationship with the last person they did it with. Methods A cross-sectional national survey was carried out in Switzerland in 2017 among young adults. The 5175 participants (51% males, mean age 26.3years) who answered the question 'Have you ever received something or obtained an advantage in exchange for a sexual act?' were divided into three groups: Never (96.8%), Once (1.5%) and Several (1.7%). Results In the multivariate analysis, compared to the Never group, those in the Once group were significantly more likely to be males, to have a poor mental health, to be non-exclusively heterosexual and to have had 10+ lifetime sexual partners. Those in the Several group reported the same characteristics, but were also more likely to be younger at first sexual contact, to have their parents not living together, to report a lower socioeconomic status and a history of sexual abuse, and to have ever sent sexual images/videos of themselves. They were also less satisfied with their financial situation. Conclusions Results indicate that transactional sex is a reality for some youths in Switzerland, and health professionals dealing with them should include this question in their sexual anamnesis. From a public health perspective, sexual education and prevention campaigns should include this phenomenon.

Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.

Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD

BACKGROUND

Research suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Structural vulnerabilities reflect societal level factors (e.g., sexism, homophobia, racism) that constrain an individual's agency, particularly related to health outcomes. This study examines the association between SM status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based FSW.

METHODS

The current study utilizes baseline data from the SAPPHIRE study, a prospective cohort of cis gender and transgender FSW in Baltimore, MD, recruited through targeted time-location sampling from April 2016 to January 2017. The current analysis focuses on cisgender women. The baseline survey ascertained demographics, substance use, intimate partner violence (IPV), and sex work characteristics. Multivariable models were constructed using self-identity and behaviorally defined SM status as independent variables with vulnerability outcomes (e.g., injection drug use, injection speedball, binge drinking, homelessness, physical IPV, ever had a pimp, and being a minor at sex work entry (age < 18)) as dependent variables.

RESULTS

Of the participants (n = 247), 25.5% (n = 63) self-identified as a SM by identity (e.g., gay or bisexual), and 8.5% (n = 21) reported SM behavior (e.g., same-gender sexual behavior) in the past 3 months. In multivariable logistic regression models, SM status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical IPV, and being a minor at sex work entry. SM status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry.

CONCLUSION

The study indicates disproportionate structural vulnerability and heightened HIV risk among SM-FSW, as compared to their heterosexual counterparts, with differences in their profile by sexual identity and behavior. Findings suggest a need for nuanced interventions tailored to these populations.

Alcohol Misuse and Illicit Drug Use Among Occupational Groups at High Risk of HIV in Sub-Saharan Africa: A Systematic Review

Key occupational groups in sub-Saharan Africa (SSA) are at increased risk of HIV, and may be at increased risk of substance use. In January 2018, we systematically searched for studies reporting prevalence of, and risk factors for alcohol misuse or illicit drug use and their association with HIV incidence or prevalence among fisherfolk, uniformed personnel, truckers, miners, motorcycle taxi riders and sex workers in SSA. Seventy-one studies published between 1983 and 2017 were included: 35 reported on alcohol misuse (19 using AUDIT, 5 using CAGE) and 44 on illicit drug use (eight reported both). Median prevalence of alcohol misuse based on AUDIT/CAGE was 32.8% (IQR 20.8-48.5%). Prevalence of illicit drug use ranged from 0.1% (95% CI: 0.0-0.2%) for injection drug use to 97.1% (95% CI: 85.1-99.9%) for khat (among uniformed personnel). Among papers examining associations between substance use and HIV incidence (n = 3) or prevalence (n = 14), nine papers (53%) reported a significant positive association (2 with incidence, 7 with prevalence). Harm reduction interventions in occupational settings are urgently required to prevent new HIV infections.

Gender Differences and Psychosocial Factors Associated with Problem Drinking Among Adults Enrolling in HIV Care in Tanzania

Problem drinking is commonly reported among people living with HIV (PLWH), associated with suboptimal HIV care outcomes and differs by gender. Psychosocial factors associated with problem drinking among PLWH remain poorly understood, including whether they differ by gender. This analysis examines the relationship between psychosocial factors and problem drinking separately by gender among PLWH in Tanzania. Cross-sectional data were collected from 812 men and non-pregnant women living with HIV aged 18 or older enrolling in HIV care at four health facilities in Tanzania. Problem drinking was assessed with the CAGE Questionnaire and defined as responding yes to two or more items. Sex-stratified multivariable logistic regression modeled the association of social support, HIV-related stigma, and physical or sexual violence on problem drinking, controlling for age, relationship status, employment, having been away from home for more than  one month, and timing of first HIV-positive diagnosis. Thirteen percent of the sample reported problem drinking, with problem drinking significantly more commonly reported among men than non-pregnant women (17.6% vs. 9.5%). Among men and non-pregnant women, in multivariable analyses, enacted and internalized HIV-related stigma were significantly positively associated with problem drinking. Screening and treatment of problem drinking should be integrated into HIV care. Evidence-based substance abuse interventions should be adapted to address HIV-related stigma. Future research should longitudinally investigate the interrelationships between stigma, violence, and problem drinking among PLWH.

Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon

Introduction

The purpose of this study was to examine the relationship between socio-demographic characteristics, risky sexual behaviour, alcohol use and transactional sex among female bar workers in Yaounde, Cameroon.

Materials and methods

A cross-sectional survey was conducted among a representative sample of 410 female bar workers, recruited through a modified version of venue-based cluster sampling technique from May to June 2017. Transactional sex was defined as having received money/gifts in exchange for sex with any sexual partner in the past 12 months. Logistic regression models were performed to identify the factors associated with transactional sex. The level of statistical significance was set at p< = 0.05.

Results

About 14.9% (n = 61) of respondents reported to have engaged in transactional sex, 83.7% (n = 338) had multiple sexual partners at the time of the study, 14.4% (n = 55) had sex with one or more of their male customers in the past 6 months. Almost 73.4% (n = 301) reported alcohol use. Of these, 37.2% (n = 112) were frequent alcohol consumers. About 17.6% (n = 72) reported to have had unprotected sex under the influence of alcohol in the past 6 months. Multivariate logistic regression analysis showed that those who engaged in transactional sex were more likely to have had sex with a male customer in the past 6 months (aOR = 7.34; 95% CI, 3.63–16.98), had sex under the influence of alcohol in the past 6 months (aOR = 2.42; 95% CI, 1.18–4.96) and frequent alcohol consumers (aOR = 2.06; 95%CI, 1.04–4.10). Respondents who had their last sexual intercourse 4 weeks or more prior to the study (aOR = 0.26; 95% CI, 0.08–0.84) were less likely to have engaged in transactional sex.

Conclusions

Our study concludes that female bar workers are exposed to male customers and engage in risky sexual practices including transaction sex. Most of them also consume alcohol which increases their risk of HIV and STI acquisition. They are a high-risk group that need to be targeted with HIV prevention interventions.

Engagement in sex work does not increase HIV risk for women who inject drugs in Ukraine

Background

We studied the association between sex in exchange for money, drugs or goods and HIV for women who inject drugs (WWID) in Ukraine, as previous data on this association from the post-USSR region are contradictory.

Methods

Data come from the Integrated Bio-Behavioral Survey of Ukrainian people who inject drugs collected in 2011 using respondent-driven sampling. Participants were interviewed and tested with rapid HIV tests.

Results

The sample included 2465 WWID (24% HIV positive); 214 (8.7%) of which reported having had exchange sex during the last 90 days. Crude analysis showed no association between exchange sex and HIV (OR = 0.644; 95% CI 0.385–1.077). No confounders were found to alter this result in a multivariable analysis. Further modeling showed that exchange sex modifies association between HIV and alcohol use: no association between HIV and daily alcohol use was found for those women who exchanged sex (OR = 1.699, 95% CI 0.737–3.956); while not engaging in sex work and daily using alcohol reduced odds to be HIV infected (OR = 0.586, 95% CI 0.389–0.885).

Conclusions

Exchange sex may have less impact on the HIV status of WWID who are exposed to injecting risks. The finding that daily alcohol use appears protective against HIV among WWID who do not exchange sex requires more research.

HIV/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status

OBJECTIVES

To quantify HIV/AIDS mortality attributable to alcohol use in the adult general population of South Africa in 2012 by socioeconomic status (SES).

DESIGN

Comparative risk assessment based on secondary individual data, aggregate data and risk relations reported in the literature.

SETTING

South African adult general population.

PARTICIPANTS

For metrics of alcohol use by SES, sex and age: 27 070 adults that participated in a nationally representative survey in 2012. For HRs of dying from HIV/AIDS by SES: 87 029 adults that participated in a cohort study (years 2000 to 2014) based out of the Umkhanyakude district, KwaZulu-Natal.

MAIN OUTCOME MEASURES

Alcohol-attributable fractions for HIV/AIDS mortality by SES, age and sex were calculated based on the risk of engaging in condom-unprotected sex under the influence of alcohol and interactions between SES and alcohol use. Age-standardised HIV/AIDS mortality rates attributable to alcohol by SES and sex were estimated using alcohol-attributable fractions and SES-specific and sex-specific death counts. Rate ratios were calculated comparing age-standardised rates in low versus high SES by sex.

RESULTS

The age-standardised HIV/AIDS mortality rate attributable to alcohol was 31.0 (95% uncertainty interval (UI) 21.6 to 41.3) and 229.6 (95% UI 108.8 to 351.6) deaths per 100 000 adults for men of high and low SES, respectively. For women the respective rates were 10.8 (95% UI 5.5 to 16.1) and 75.5 (95% UI 31.2 to 144.9). The rate ratio was 7.4 (95% UI 3.4 to 13.2) for men and 7.0 (95% UI 2.8 to 18.2) for women. Sensitivity analyses corroborated marked differences in alcohol-attributable HIV/AIDS mortality, with rate ratios between 2.7 (95% UI 0.8 to 7.6; women) and 15.1 (95% UI 6.8 to 27.7; men).

CONCLUSIONS

The present study showed that alcohol use contributed considerably to the socioeconomic differences in HIV/AIDS mortality. Targeting HIV infection under the influence of alcohol is a promising strategy for interventions to reduce the HIV/AIDS burden and related socioeconomic differences in South Africa.

HIV/AIDS workplace policy addressing epidemic drivers through workplace programs

BACKGROUND

HIV workplace policies have become an important tool in addressing the HIV Pandemic in Sub-Saharan Africa. In Zambia, the National AIDS Council has been advocating for establishing of HIV/AIDS workplace policies to interested companies, however no formal evaluation has been done to assess uptake and implementation. The study aimed to establish the existence of HIV/AIDS policies and programs in the private sector and to understand implementation factors and experiences in addressing HIV epidemic drivers through these programs.

METHODS

A mixed method assessment of the availability of policies was conducted in 128 randomly selected member companies of Zambia Federation of Employers in Lusaka. Categorized variables were analysed on Policy and programs using Stata version 12.0 for associations: Concurrently, 28 in-depth interviews were conducted on purposively sampled implementers. Qualitative results were analysed thematically before integrating them with qualitative findings.

RESULTS

Policies were found in 47/128 (36.72%) workplaces and the private sector accounted for 34/47 (72.34%) of all workplaces with a policy. Programs were available in 56/128 (43.75%) workplaces. The availability of policy was 2.7 times more likely to occur with increased size of a workplace, P value = 0.0001, (P < 0.05). Management support was 0.253 times more likely to occur in workplaces with policy, P value = 0.013, (P < 0.05) compared to those without. Having a specific budget for programs was 0.23 times more likely to occur in workplaces with a policy (P < 0.05) than those without a policy. Implementation was hindered by reduced funding, lack of time, sensitisation and lack of monitoring/evaluation systems. HIV awareness (56/56, 100%) and HIV/AIDS/Stigma (47/56, 83.93%) were the most addressed epidemic drivers through programs while Mother to Child Transmission (30/56 53.57%) and Males having sex with males were the least addressed (18/56, 32.14%).

CONCLUSION

HIV/AIDS policies exist in the private sector at a very low proportion but policy translation was very high suggesting that workplaces with polices are likely to implement programs. The eradication of HIV/AIDS by 2030, requires addressing epidemic drivers with a focus on marginalised populations, gender integration, a wellness and rights based approach within the context of the legal framework.

Alcohol Use, Socioeconomic Status and Risk of HIV Infections

The present study investigated the associations among alcohol use, socioeconomic status (SES), and human immunodeficiency virus (HIV) status, in the South African context. It was hypothesized that SES (predictor; measured as median split asset score) and alcohol use in the past 12 months (predictor) would interact such that current drinkers of low SES would be at an increased risk of testing HIV-positive (outcome). Nationally representative, cross-sectional survey data from 2005 (N = 16,110), 2008 (N = 13,055), and 2012 (N = 25,979) were analyzed using multinomial regression models. Current drinkers of low SES had an elevated risk of HIV infection in all survey years, ranging from a relative risk ratio (RRR) of 1.94 (95% confidence interval (CI) 1.29-3.00, t = 2.93, p = 0.002) in 2012 to RRR of 3.51 (95% CI 2.02-6.08, t = 4.47, p < 0.001) in 2008. Targeting preventive strategies to alcohol users of low SES could help reduce HIV burden and associated socioeconomic differences.