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HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention

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Abstract

Alcohol use is associated with increased HIV-risk behaviors, including unprotected sex and number of sex partners. Alcohol-serving venues can be places to engage in HIV-related sexual risk behaviors, but are also important sites of social support for patrons, which may mitigate risks. We sought to examine the relationship between alcohol-serving venue attendance, social support, and HIV-related sexual risk behavior, by gender, in South Africa. Adult patrons (n = 496) were recruited from six alcohol-serving venues and completed surveys assessing frequency of venue attendance, venue-based social support, and recent sexual behaviors. Generalized estimating equations tested associations between daily venue attendance, social support, and sexual behaviors, separately by gender. Interaction effects between daily attendance and social support were assessed. Models were adjusted for venue, age, education, and ethnicity. Daily attendance at venues was similar across genders and was associated with HIV-related risk behaviors, but the strength and direction of associations differed by gender. Among women, daily attendance was associated with greater number of partners and higher proportion of unprotected sex. Social support was a significant moderator, with more support decreasing the strength of the relationship between attendance and risk. Among men, daily attendance was associated with a lower proportion of unprotected sex; no interaction effects were found for attendance and social support. Frequent venue attendance is associated with additional HIV-related risks for women, but this risk is mitigated by social support in venues. These results were not seen for men. Successful HIV interventions in alcohol-serving venues should address the gendered context of social support and sexual risk behavior.

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Acknowledgements

This project was funded by the National Institute of Alcohol Abuse and Alcoholism (R01 AA018074). We also appreciate the support from the Duke Center for AIDS Research (NIAID P30 AI064518) and would like to acknowledge the South African research team that collected the data, specifically Desiree Pieterse, Simphiwe Dekeda, Albert Africa, Judia Adams, Bulelwa Nyamza and Jabulile Mantantana. We are grateful to the participants for their contributions to the study.

Author Contributions

KJ.S. and S.C.K. conceived the study and acquired funding. K.J.S., S.C.K., M.H.W., and D.S. designed the study protocols and data collection instruments, and managed data collection. J.V., M.H.W, L.A., D.S., and A.C.D. participated in the design of this analysis and the interpretation of statistical results. The final manuscript was written by J.V. with substantive input and approval from all authors.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Jennifer Velloza, Melissa H. Watt, Laurie Abler, Alexis C. Dennis & Kathleen J. Sikkema

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Jennifer Velloza

  3. Unit for Research on Health and Society, Stellenbosch University, Cape Town, South Africa

    Donald Skinner

  4. Department of Psychology, University of Connecticut, Storrs, CT, USA

    Seth C. Kalichman

  5. Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Box 90086, Durham, NC, 27708-0086, USA

    Kathleen J. Sikkema

  6. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Kathleen J. Sikkema

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  1. Jennifer Velloza
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Correspondence to Kathleen J. Sikkema.

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The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the University of Connecticut, Stellenbosch University, and Duke University institutional review boards, national research ethics committees for the study sites, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Velloza, J., Watt, M.H., Abler, L. et al. HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention. AIDS Behav 21 (Suppl 2), 144–154 (2017). https://doi.org/10.1007/s10461-017-1853-z

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