Alcohol and Condom Use among HIV+ Ugandan Adults: a Prospective Event-Level Study
Alcohol consumption in sub-Saharan Africa is a major public health concern that has received insufficient attention. The World Health Organization (WHO) estimates that although 70% of adults in sub- Saharan Africa are self-reported abstainers, the 30% who report consuming alcohol have among the highest levels of per capita consumption in the world. The heavy, episodic pattern of consumption that characterizes alcohol use in this region is associated with many negative HIV-related consequences including an increased likelihood of engaging in high risk behavior and a higher cumulative risk of onward transmission among sero-discordant partnerships. The intersection of these two epidemics underscores the urgency of increased research attention and intervention development. Research aimed at understanding how, and in what contexts, alcohol is most likely to result in high risk behavior in sub-Saharan Africa has been dominated by cross-sectional study designs that fail to capture the temporal relationship between alcohol consumption and its subsequent effect on risky behavior. Recent reviews of the literature indicate that alcohol is "adding fuel to the fire" of the HIV epidemic in sub- Saharan Africa due to its association with higher frequency of unprotected sex, lower adherence to antiretroviral treatment (ART), and consequently increased cumulative risk of onward transmission among HIV- positives. Uganda has one of the highest levels of per capita alcohol consumption in the world combined with a generalized HIV epidemic that affects approximately 6.5% of the adult population. The research proposed in this application examines the co-occurrence of alcohol use and unprotected sex among HIV+ Ugandan adults in order to develop a behavioral HIV prevention intervention targeting alcohol use that has the potential to ameliorate these co-occurring public health burdens.