A population-based study on alcohol and high-risk sexual behaviors in Botswana

Sheri D. Weiser, Karen Leiter, Michele Heisler, Willi McFarland, Fiona Percy-De Korte, Sonya M. DeMonner, Sheila Tlou, Nthabiseng Phaladze, Vincent Iacopino, David Bangsberg

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Background: In Botswana, an estimated 24% of adults ages 15-49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors. Methods and Findings: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers. Conclusions: Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.

Original languageEnglish (US)
Pages (from-to)1940-1948
Number of pages9
JournalPLoS Medicine
Volume3
Issue number10
DOIs
StatePublished - Oct 2006
Externally publishedYes

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Botswana
Risk-Taking
Sexual Behavior
Sexual Partners
Alcohols
Confidence Intervals
Unsafe Sex
Population
HIV
Alcohol Drinking
Drinking
Sampling Studies
Sales
Alcoholism
HIV Infections
Logistic Models
Education
Logistics

ASJC Scopus subject areas

  • Biotechnology
  • Biochemistry
  • Molecular Biology
  • Cell Biology

Cite this

Weiser, S. D., Leiter, K., Heisler, M., McFarland, W., Percy-De Korte, F., DeMonner, S. M., ... Bangsberg, D. (2006). A population-based study on alcohol and high-risk sexual behaviors in Botswana. PLoS Medicine, 3(10), 1940-1948. https://doi.org/10.1371/journal.pmed.0030392

A population-based study on alcohol and high-risk sexual behaviors in Botswana. / Weiser, Sheri D.; Leiter, Karen; Heisler, Michele; McFarland, Willi; Percy-De Korte, Fiona; DeMonner, Sonya M.; Tlou, Sheila; Phaladze, Nthabiseng; Iacopino, Vincent; Bangsberg, David.

In: PLoS Medicine, Vol. 3, No. 10, 10.2006, p. 1940-1948.

Research output: Contribution to journalArticle

Weiser, SD, Leiter, K, Heisler, M, McFarland, W, Percy-De Korte, F, DeMonner, SM, Tlou, S, Phaladze, N, Iacopino, V & Bangsberg, D 2006, 'A population-based study on alcohol and high-risk sexual behaviors in Botswana', PLoS Medicine, vol. 3, no. 10, pp. 1940-1948. https://doi.org/10.1371/journal.pmed.0030392
Weiser SD, Leiter K, Heisler M, McFarland W, Percy-De Korte F, DeMonner SM et al. A population-based study on alcohol and high-risk sexual behaviors in Botswana. PLoS Medicine. 2006 Oct;3(10):1940-1948. https://doi.org/10.1371/journal.pmed.0030392
Weiser, Sheri D. ; Leiter, Karen ; Heisler, Michele ; McFarland, Willi ; Percy-De Korte, Fiona ; DeMonner, Sonya M. ; Tlou, Sheila ; Phaladze, Nthabiseng ; Iacopino, Vincent ; Bangsberg, David. / A population-based study on alcohol and high-risk sexual behaviors in Botswana. In: PLoS Medicine. 2006 ; Vol. 3, No. 10. pp. 1940-1948.
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abstract = "Background: In Botswana, an estimated 24{\%} of adults ages 15-49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors. Methods and Findings: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31{\%} of men and 17{\%} of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95{\%} confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95{\%} CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95{\%} CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95{\%} CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95{\%} CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95{\%} CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers. Conclusions: Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.",
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N2 - Background: In Botswana, an estimated 24% of adults ages 15-49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors. Methods and Findings: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers. Conclusions: Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.

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