title: Relationship between community-level alcohol outlet accessibility and individual-level herpes simplex virus type 2 infection among young women in South Africa.
abstract: BACKGROUND
  Exposure to alcohol outlets may influence sexual health outcomes at the individual and community levels. Visiting alcohol outlets facilitates alcohol consumption and exposes patrons to a risky environment and network of potential partners, whereas the presence of alcohol outlets in the community may shift social acceptance of riskier behavior. We hypothesize that living in communities with more alcohol outlets is associated with increased sexual risk.
  
  
  METHODS
  We performed a cross-sectional analysis in a sample of 2174 South African schoolgirls (ages 13-21 years) living across 24 villages in the rural Agincourt subdistrict, underpinned by long-term health and sociodemographic surveillance. To examine the association between number of alcohol outlets in village of residence and individual-level prevalent herpes simplex virus type 2 (HSV-2) infection, we used generalized estimating equations with logit links, adjusting for individual- and village-level covariates.
  
  
  RESULTS
  The median number of alcohol outlets per village was 3 (range, 0-7). Herpes simplex virus type 2 prevalence increased from villages with no outlets (1.4% [95% confidence interval, 0.2-12.1]), to villages with 1 to 4 outlets (4.5% [3.7-5.5]), and to villages with more than 4 outlets (6.3% [5.6, 7.1]). An increase of 1 alcohol outlet per village was associated with an 11% increase in the odds of HSV-2 infection (adjusted odds ratio [95% confidence interval], 1.11 [0.98-1.25]).
  
  
  CONCLUSIONS
  Living in villages with more alcohol outlets was associated with increased prevalence of HSV-2 infection in young women. Structural interventions and sexual health screenings targeting villages with extensive alcohol outlet environments could help prevent the spread of sexually transmitted infections.
authors: From the *Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA; †Department of Epidemiology, Gillings School of Global Public Health, and ‡Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; §MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ¶Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA; ∥Department of Health Policy and Management, Gillings School of Global Public Health, **Department of Geography, and ††Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡‡INDEPTH Network, Accra, Ghana; §§Department of Biostatistics, University of Washington, Seattle, WA; ¶¶Laboratory of Immunoregulation, NIAID, NIH, Baltimore, MD; ∥∥Department of Medicine, Johns Hopkins University, Baltimore MD; and ***Centre for Global Health Research, Umeå University, Umeå, Sweden.
authors: Molly
authors: M
authors: Rosenberg
authors: Audrey
authors: A
authors: Pettifor
authors: Sheri A
authors: SA
authors: Lippman
authors: Harsha
authors: H
authors: Thirumurthy
authors: Michael
authors: M
authors: Emch
authors: William C
authors: WC
authors: Miller
authors: Amanda
authors: A
authors: Selin
authors: Francesc Xavier
authors: FX
authors: Gómez-Olivé
authors: James P
authors: JP
authors: Hughes
authors: Oliver
authors: O
authors: Laeyendecker
authors: Stephen
authors: S
authors: Tollman
authors: Kathleen
authors: K
authors: Kahn
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000517:prevention & control / Q000523:psychology; D003132:Commerce; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006558:Herpes Genitalis / Q000517:prevention & control / Q000523:psychology / Q000635:transmission*; D018258:Herpesvirus 2, Human / Q000472:pathogenicity*; D006801:Humans; D015995:Prevalence; D012111:Residence Characteristics; D012424:Rural Population; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult