Original Paper

AIDS and Behavior

, Volume 14, Issue 1, pp 74-83

Alcohol Use and Sex Risk Behaviors Among HIV-Infected Female Sex Workers (FSWs) and HIV-Infected Male Clients of FSWs in India

  • Jeffrey H. SametAffiliated withDepartment of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical CenterDepartment of Community Health Sciences, Boston University School of Public Health Email author 
  • , Christine A. PaceAffiliated withInternal Medicine Residency Program, Brigham and Women’s Hospital
  • , Debbie M. ChengAffiliated withDepartment of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical CenterDepartment of Biostatistics, Boston University School of Public Health
  • , Sharon ColemanAffiliated withData Coordinating Center, Boston University School of Public Health
  • , Carly BriddenAffiliated withDepartment of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center
  • , Manoj PardesiAffiliated withNetwork of Maharashtra by People Living with HIV & AIDS (NMP+)
  • , Niranjan SaggurtiAffiliated withPopulation Council
  • , Anita RajAffiliated withDepartment of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical CenterDepartment of Community Health Sciences, Boston University School of Public Health

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Abstract

Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Given alcohol’s association with risky sex in other populations and alcohol’s role in HIV disease progression, we investigated patterns of alcohol use in HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in Mumbai. Analyses identified factors associated with heavy alcohol use and evaluated the relationship between alcohol use and risky sex. We surveyed 211 female and 205 male individuals; 80/211 FSWs (38%) and 127/205 male clients (62%) drank alcohol in the last 30 days. Among females, 32 and 11% drank heavily and were alcohol-dependent, respectively; among males the respective proportions were 44 and 29%. Men’s heavy alcohol use was significantly associated with inconsistent condom use over the last year (AOR 2.40, 95% CI 1.21–4.77, P = 0.01); a comparable association was not seen in women. These findings suggest a need to address alcohol use both to avoid the medical complications of its heavy use in this population and to mitigate inconsistent condom use, the latter issue possibly requiring gender specific approaches. Such efforts to reduce drinking will be an important dimension to secondary HIV prevention in India.

Keywords

Alcohol Transactional sex HIV Female sex workers