title: The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women: A Cross-Sectional Study.
abstract: BACKGROUND
  Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk.
  
  
  METHODS
  In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption.
  
  
  RESULTS
  Visiting alcohol outlets was associated with having more sex partners [adjusted odds ratio (aOR), one versus zero partners (95% confidence interval (CI)): 1.51 (1.21, 1.88)], more unprotected sex acts [aOR, one versus zero acts (95% CI): 2.28 (1.52, 3.42)], higher levels of transactional sex [aOR (95% CI): 1.63 (1.03, 2.59)], and HSV-2 infection [aOR (95% CI): 1.30 (0.88, 1.91)]. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex.
  
  
  CONCLUSIONS
  Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2.
  
  
  BACKGROUND
  HIV Prevention Trials Network HPTN 068.
authors.affiliation: Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America; Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Molly
authors.initials: M
authors.lastname: Rosenberg
authors.affiliation: Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; 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.
authors.forename: Audrey
authors.initials: A
authors.lastname: Pettifor
authors.affiliation: Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.affiliation: Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
authors.affiliation: Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: 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; INDEPTH Network, Accra, Ghana.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.affiliation: 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.
authors.forename: Rhian
authors.initials: R
authors.lastname: Twine
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.affiliation: Laboratory of Immunoregulation, NIAID, NIH, Baltimore, Maryland, United States of America; Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.affiliation: Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Amanda
authors.initials: A
authors.lastname: Selin
authors.affiliation: 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; Centre for Global Health Research, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects*; D044383:Black People; D005260:Female; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D018258:Herpesvirus 2, Human / Q000472:pathogenicity; D006801:Humans; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000523:psychology / Q000821:virology; D013019:South Africa; D047568:Unsafe Sex / Q000523:psychology; D055815:Young Adult