High alcohol consumption rates occurring within the context of high HIV prevalence pose a significant public health challenge in South Africa. In their design of the current study, the authors set out to answer three questions regarding these coexisting health challenges: "(a) Are problem drinkers more likely to have multiple concurrent partners than those who are not? (b) Are condoms applied less effectively and less consistently by problem drinkers compared to those who are not? (c) Are the female sexual partners of problem drinkers different from those who are not?"
In two peri-urban settings on the outskirts of Cape Town, the researchers conducted two cross-sectional HIV bio-behavioral surveillance surveys using Respondent-Driven Sampling. The recruited participants were 848 men ages 25 to 55 who had multiple concurrent female sex partners. Men who scored three or higher on the CAGE questionnaire were classified as problem drinkers. Significant associations between outcome variables and problem drinking were assessed using multivariate logistic regression models.
Among the men, 58 percent were rated as problem drinkers. In comparison to other participants, the problem drinkers were significantly more likely to report:
- having any STD symptom
- non-use of condoms due to drinking
- inconsistent use of condoms with all partner types
- having had a "once-off" sexual relationship, and that their most recent such partner was unemployed
- that they met their most recent partner at a venue where alcohol is served.
"Alcohol may fuel once-off sexual encounters, often characterized by transactional sex and women's limited authority to negotiate sex and condom use; factors that can facilitate transmission of HIV," the authors concluded. "HIV prevention interventions specifically targeting drinkers, the contexts in which problem drinking occurs, and multiple sexual partnering are urgently needed."