Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students

BMC Public Health

Per-Olof Östergren¹  Martin Stafström¹  Anette Agardh²  Vikas Choudhry¹ 

[1] Department of Clinical Sciences, Social Medicine and Global Health, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, House 28, Floor 12, Malmö, Sweden;Department of Pediatrics, Centre for Adolescent Health, Royal Children’s Hospital and Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Victoria, Australia

关键词: Uganda;    HIV;    Alcohol use;    Risky sexual behavior;    University students;   

Others  :  1161254
DOI  :  10.1186/1471-2458-14-128

 received in 2013-11-20, accepted in 2014-01-16,  发布年份 2014

【 摘 要 】

Background

As reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience.

Methods

A cross-sectional survey was carried out in 2010 among 1954 students at Mbarara University of Science and Technology, Uganda, using a self-administered questionnaire. Alcohol use was measured as consumption over the previous 12 months, during situations related to sexual activity and on the most recent occasion of sexual intercourse. Risky sexual behavior was defined as having two or more sexual partners in the previous 12 months or inconsistent condom use with new partners. Bivariate and multivariate logistic regression was performed to analyze the association between alcohol use and risky sexual behavior separately for males and females.

Results

Even after adjusting for confounders, the odds ratio (OR) of having two or more sexual partners in the past year indicated a statistically significant association with alcohol use on all levels (global, situational, and event) for both males and females. The ORs of inconsistent condom use with a new partner were significant for males who often consumed alcohol in relation to sexual activity—even after adjusting for potential confounders (OR, 1.75; confidence interval, 1.01–3.08). The risk of inconsistent condom use with a new partner was twice as high for females who often consumed alcohol in relation to sexual activity, although this association was not statistically significant.

Conclusions

The study supports previous research that alcohol consumption is associated with having multiple sexual partners. Inconsistent condom use was associated with the situational use of alcohol in relation to sexual activity and was similar for both genders. Interventions to reduce alcohol-related risky sexual behavior should target both male and female drinkers, particularly subgroups of students, who often consume alcohol in relation to sexual activity.

【 授权许可】

   
2014 Choudhry et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Uganda Ministry of Health and ICF International: 2011 Uganda AIDS Indicator Survey: Key Findings. Calverton, Maryland, USA: MOH and ICF International; 2012.
• [2]Doyle AM, Mavedzenge SN, Plummer ML, Ross DA: The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys. Revisión: El comportamiento sexual de adolescentes en África subsahariana: Patrones y tendencias en censos nacionales 2012, 17(7):796-807.
• [3]Uganda Bureau of Statistics: Uganda Demographic and Health Survey 2006. Calverton, Maryland, USA: Uganda Bureau of Statistics (UBOS) and Macro International; 2007.
• [4]Uganda Aids Commission: Young people, Health, HIV, AIDS and Development. Kampala: Uganda Aids Commission; 2007.
• [5]Kaaya SF, Flisher AJ, Mbwambo JK, Schaalma H, Aaro LE, Klepp KI: A review of studies of sexual behaviour of school students in sub-Saharan Africa. Scand J Public Health 2002, 30(2):148-160.
• [6]Darabi LBA, Serumaga K, Neema S, Kidombo R, Ahemd H, Banoba P: Protecting the Next Generation in Uganda: New Evidence on Adolescent Sexual and Reproductive Health Needs. New York: Guttmacher Institute; 2008.
• [7]EAC/EALP: HIV Sero-Behavioural Study in 6 Universities in Uganda, Study Report. Kampala, Uganda: ; 2010.
• [8]Agardh A, Odberg-Pettersson K, Ostergren PO: Experience of sexual coercion and risky sexual behavior among Ugandan university students. BMC Public Health 2011., 11
• [9]World Health Organisation: Alcohol, gender and drinking problems: perspectives from low and middle income countries. Geneva: WHO; 2005.
• [10]Cook RL, Clark DB: Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis 2005, 32(3):156-164.
• [11]Fisher JC, Cook PA, Kapiga SH: Alcohol use before sex and HIV risk: situational characteristics of protected and unprotected encounters among high-risk African women. Sex Transm Dis 2010, 37(9):571-578.
• [12]Baliunas D, Rehm J, Irving H, Shuper P: Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health 2010, 55(3):159-166.
• [13]Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S: Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci 2007, 8(2):141-151.
• [14]Fisher JC, Bang H, Kapiga SH: The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis 2007, 34(11):856-863.
• [15]World Health Organisation: Global Status Report on Alcohol and Health. Geneva: WHO; 2011.
• [16]Stafström M, Agardh A: Socio-economic determinants for alcohol consumption and heavy episodic drinking in a Ugandan student population. Int J Alcohol Drug Res 2012, Vol 1(No 1):2013.
• [17]State of Alcohol Abuse in Uganda “Young people drinking deeper into poverty” [http://www.uydel.org/downloads/State%20of%20Alcohol%20Abuse%20in%20Uganda-20110706-161512.pdf webcite]
• [18]Steele CM, Josephs RA: Alcohol myopia: its prized and dangerous effects. Am Psychol 1990, 45(8):921-933.
• [19]Lang AR: The Social-Psychology of Drinking and Human-Sexuality. J Drug Issues 1985, 15(2):273-289.
• [20]Bryan A, Rocheleau CA, Robbins RN, Hutchinson KE: Condom use among high-risk adolescents: testing the influence of alcohol use on the relationship of cognitive correlates of behavior. Health Psychol 2005, 24(2):133-142.
• [21]Kalichman SC, Cain D: The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. J Sex Res Suppl 2004, 41(3):235-241.
• [22]Kalichman SC, Weinhardt L, DiFonzo K, Austin J, Luke W: Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men. Ann Behav Med 2002, 24(3):229-235.
• [23]Weinhardt LS, Carey MP: Does alcohol lead to sexual risk behavior? Findings from event-level research. Annu Rev Sex Res 2000, 11:125-157.
• [24]Halpern-Felsher BL, Millstein SG, Ellen JM: Relationship of alcohol use and risky sexual behavior: a review and analysis of findings. J Adolesc Health 1996, 19(5):331-336.
• [25]Cooper ML: Does drinking promote risky sexual behavior? A complex answer to a simple question. Curr Dir Psychol Sci 2006, 15(1):19-23.
• [26]Brown JL, Vanable PA: Alcohol use, partner type, and risky sexual behavior among college students: Findings from an event-level study. Addict Behav 2007, 32(12):2940-2952.
• [27]Cooper ML: Alcohol use and risky sexual Behavior among college students and youth: Evaluating the evidence. J Stud Alcohol 2002, 14:101-117.
• [28]Leigh BC, Stall R: Substance use and risky sexual behavior for exposure to HIV: issues in methodology, interpretation, and prevention. Am Psychol 1993, 48(10):1035-1045.
• [29]Agardh A, Emmelin M, Muriisa R, Ostergren PO: Social capital and sexual behavior among Ugandan university students. Global Health Action 2010., 3
• [30]Agardh A, Ostergren P, Liljestrand J: Sexual patterns among youth in Mbarara district, Uganda with a special focus on coercion and power relations. Bangkok, Thailand: The XV International AIDS Conference; 2004.
• [31]Agardh A, Tumwine G, Ostergren PO: The impact of socio-demographic and religious factors upon sexual behavior among Ugandan university students. PLoS One 2011, 6(8):e23670.
• [32]Tumwesigye NM, Kasirye R, Nansubuga E: Is social interaction associated with alcohol consumption in Uganda? Drug Alcohol Depend 2009, 103(1–2):9-15.
• [33]UNAIDS, UNICEF, WHO: GLOBAL AIDS RESPONSE PROGRESS REPORTING 2013: Construction of Core indicators for monitoring the 2011 UN Political declaration on HIV/AIDS. UNAIDS: Geneva, Switzerland; 2013.
• [34]Simbayi LC, Kalichman SC, Jooste S, Cherry C, Mfecane S, Cain D: Risk factors for HIV-AIDS among youth in Cape Town, South Africa. AIDS Behav 2005, 9(1):53-61.
• [35]Simbayi LC, Kalichman SC, Jooste S, Mathiti V, Cain D, Cherry C: Alcohol use and sexual risks for HIV infection among men and women receiving sexually transmitted infection clinic services in Cape Town, South Africa. J Stud Alcohol 2004, 65(4):434-442.
• [36]Klein W, Geaghan T, Macdonald T: Unplanned sexual activity as a consequence of alcohol use: a prospective study of risk perceptions and alcohol use among college freshmen. J Am Coll Health 2007, 56(3):317-323.
• [37]Anderson PB, Mathieu DA: College students’ high-risk sexual behavior following alcohol consumption. J Sex Marital Ther 1996, 22(4):259-264.
• [38]Sadgrove J: ‘Keeping Up Appearances’: Sex and Religion amongst University Students in Uganda. J Relig Afr 2007, 37(1):116-144.
• [39]Luke N, Kurz KM: Cross-generational and Transactional Sexual Relations in Sub-Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual Practices. Washington DC: International Centre for Research on Women and Population Services International; 2002.
• [40]Morojele NK, Kachieng’a MA, Mokoko E, Nkoko MA, Parry CD, Nkowane AM, Moshia KM, Saxena S: Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. Soc Sci Med 2006, 62(1):217-227.
• [41]George WH, Stoner SA, Norris J, Lopez PA, Lehman GL: Alcohol expectancies and sexuality: a self-fulfilling prophecy analysis of dyadic perceptions and behavior. J Stud Alcohol 2000, 61(1):168-176.
• [42]Morris AB, Albery IP: Alcohol consumption and hiv risk behaviors: integrating the theories of alcohol myopia and outcome-expectancies. Addict Res Theory 2001, 9(1):73-86.
• [43]Kalichman SC, Simbayi LC, Jooste S, Cain D, Cherry C: Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa. Psychol Addict Behav 2006, 20(3):298-304.
• [44]Fritz K, Woelk G, Bassett M, McFarland W, Routh J, Tobaiwa O, Stall R: The Association Between Alcohol Use, Sexual Risk Behavior, and HIV Infection Among Men Attending Beerhalls in Harare, Zimbabwe. AIDS Behav 2002, 6(3):221-228.
• [45]Midanik LT: Validity of self-reported alcohol use: a literature review and assessment. Br J Addict 1988, 83(9):1019-1030.
• [46]Dingle GA, Oei TP: Is alcohol a cofactor of HIV and AIDS? Evidence from immunological and behavioral studies. Psychol Bull 1997, 122(1):56-71.