Alcohol Use and Sex Risk Behaviors Among HIV-Infected Female Sex Workers (FSWs) and HIV-Infected Male Clients of FSWs in India
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.
KeywordsAlcohol Transactional sex HIV Female sex workers
- 1.UNAIDS. Report on the global AIDS epidemic. 2008. http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp. Accessed 15 Dec 2009.
- 2.National AIDS Control Organisation. National Behavioural Surveillance Survey (BSS): Female Sex Workers (FSWs) and their Clients. 2006. http://www.nacoonline.org/upload/NACO%20PDF/Female_Sex_Workers_%28FSWs%29_and_Their_Clients.pdf. Accessed 13 Aug 2009.
- 8.International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3): India. Mumbai: IHS. 2005–2006. http://www.nfhsindia.org/NFHS-3%20Data/VOL-1/India_volume_I_corrected_17oct08.pdf. Accessed 9 Mar 2009.
- 13.Population Council. Assessing the patterns and drivers of migration/mobility of sex workers and male workers and examining the links with HIV risk. http://www.popcouncil.org/projects/HIV_IndiaMigrationHIV.html. Accessed 30 Dec 2009.
- 15.Ware JE Jr, Kosinski M, Keller SD. SF-36 physical and mental health summary scales: a user’s manual. Boston, MA: The Health Inst; 1994.Google Scholar
- 17.Sobell LC, Sobell MB. Alcohol Timeline Followback (TLFB) users’ manual. Toronto, Canada: Addiction Research Foundation; 1995.Google Scholar
- 18.National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide: updated 2005 edition. Bethesda, MD: National Institutes of Health. 2007. http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf. Accessed 27 Oct 2009.
- 21.McCullagh P, Nelder JA. Generalized linear models. 2nd ed. New York: Chapman and Hall/CRC; 1989.Google Scholar
- 25.National Institute on Alcohol Abuse and Alcoholism. National epidemiologic survey on alcohol and related conditions: alcohol alert. 2006. http://pubs.niaaa.nih.gov/publications/AA70/AA70.htm. Accessed 12 Oct 2009.
- 32.National Institute on Alcohol Abuse and Alcoholism. The genetics of alcoholism: alcohol alert. 2003. http://pubs.niaaa.nih.gov/publications/aa60.htm. Accessed 20 May 2010.
- 36.Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009 [epub ahead of print].Google Scholar
- 41.World Health Organization. A rapid situation assessment of sexual risk behaviour and substance use among sex workers and their clients in Chennai (Madras), South India. http://www.who.int/mental_health/evidence/sexual_behaviour_assessment_chennai.pdf. Accessed 20 May 2010.