Metrics details. HIV and risky alcohol use are intertwined public health issues in sub-Saharan Africa. Research supports the association between alcohol and unprotected sex, but there is limited data using event-level analysis to examine this relationship. Partner type, HIV test results, and the other variables were evaluated as effect modifiers of this relationship. Drunkenness at last sex had a negative effect on the likelihood of condom use among men AOR 0.
However, for men in Southern Africa, this effect was primarily observed with steady partners. Contrary to predictions, in both Southern and Eastern Africa, for men, drunkenness during sex with casual partners increased the odds of condom use. These data indicate a need to implement HIV prevention efforts that consider the role of alcohol use in precipitating unprotected sex and how it varies based upon partner type.
Peer Review reports. The relationship between alcohol consumption and HIV has spawned a growing body of literature, with mounting support suggesting not only that the two are related [ 1 — 5 ] but that they should be treated as intertwined public health issues. Risky drinking is a predictor of sexual risk behavior in sub-Saharan Africa [ 5 , 8 ] and is common throughout the region. Several mechanisms have been theorized to explain this association, including the physiological effects of alcohol on decision making [ 11 , 12 ], expectations regarding alcohol intake and condom use [ 13 , 14 ], as well as certain personality types being more likely to engage in risky behaviors [ 15 — 17 ].
The vast majority of evidence supporting an association between alcohol consumption and unprotected sex is based on either global associations, which correlate self-reports of overall frequency of alcohol consumption or situational-overlap associations , which analyze the frequency of drinking during sex with self-reported frequency of unprotected sex [ 1 , 18 ].
These methodologies do not permit the researcher to determine if drinking during a specific sexual intercourse event is specifically associated with failure to use a condom during that sexual event. This limitation can be addressed by using event-level analysis , which requires pairing alcohol consumption during a specific instance of sexual intercourse and whether or not a condom was used.
