title: Alcohol use disorder, contexts of alcohol use, and the risk of HIV transmission among South African male patrons of shebeens.
abstract: BACKGROUND
  Shebeens in South Africa are settings in which alcohol use and sexual behavior often co-occur. The prevalence of alcohol use disorder (AUD), and the association between AUD, situations and settings, and sexual risk behavior, in shebeens remains unknown.
  
  
  METHODS
  Men (n=763; mean age=30; 98% Black African) were recruited from townships in Cape Town, South Africa and completed a self-administered survey that assessed alcohol use, sexual risk behaviors, and situations and settings of alcohol use. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSV-IV Version (AUDADIS-IV) was used to identify the likelihood of AUD. Bivariate regression analyses assessed whether screening for AUD predicted sexual risk behaviors. Multivariate regression analyses examined whether AUD and/or situations/settings predicted risk behaviors.
  
  
  RESULTS
  Nearly two-thirds of men (62%) endorsed sufficient criteria for AUD; 25%, 17%, and 20% were classified as having a mild, moderate, or severe AUD, respectively. AUD was associated with HIV risk such that men with AUD reported more unprotected sex than men without AUD. Analyses indicated that (a) individual (i.e., AUD) and (b) settings (i.e., frequency of having sex with a partner in a shebeen, tavern, or bottle store) interacted to predict unprotected sex.
  
  
  CONCLUSIONS
  The prevalence of AUD among shebeen patrons was high and was associated with unprotected sex. Findings suggest the need to integrate both individual and situational/setting factors to prevent HIV among patrons of shebeens.
authors.affiliation: Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02912, United States. Electronic address: lori_scott-sheldon@brown.edu.
authors.forename: Lori A J
authors.initials: LA
authors.lastname: Scott-Sheldon
authors.affiliation: Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, United States.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Carey
authors.affiliation: Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02912, United States.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carey
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, United States.
authors.forename: Demetria
authors.initials: D
authors.lastname: Cain
authors.affiliation: HIV/AIDS, STIs, and TB (HAST), Human Sciences Research Council, Cape Town 8000, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa.
authors.forename: Leickness C
authors.initials: LC
authors.lastname: Simbayi
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, United States.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D044383:Black People; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012931:Social Environment; D013019:South Africa / Q000453:epidemiology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Alcohol use disorder; HIV; Risky sex; Shebeens; South Africa; Unprotected sex