title: Alcohol Consumption among HIV-Infected Persons in a Large Urban HIV Clinic in Kampala Uganda: A Constellation of Harmful Behaviors.
abstract: BACKGROUND
  Alcohol use by persons living with HIV/AIDS (PLWHA) negatively impacts the public health benefits of antiretroviral therapy (ART). Using a standardized alcohol assessment tool, we estimate the prevalence of alcohol use, identify associated factors, and test the association of alcohol misuse with sexual risk behaviors among PLWHA in Uganda.
  
  
  METHODS
  A cross-section of PLWHA in Kampala were interviewed regarding their sexual behavior and self-reported alcohol consumption in the previous 6 months. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). Gender-stratified log binomial regression analyses were used to identify independent factors associated with alcohol misuse and to test whether alcohol misuse was associated with risky sexual behaviors.
  
  
  RESULTS
  Of the 725 subjects enrolled, 235 (33%) reported any alcohol use and 135 (18.6%) reported alcohol misuse, while 38 (5.2%) drank hazardous levels of alcohol. Alcohol misuse was more likely among subjects not yet on ART (adjusted prevalence ratio [aPR] was 1.65 p=0.043 for males and 1.79, p=0.019 for females) and those with self-reported poor adherence (aPR for males=1.56, p=0.052, and for females=1.93, p=0.0189). Belonging to Pentecostal or Muslim religious denominations was protective against alcohol misuse compared to belonging to Anglican and Catholic denominations in both sexes (aPR=0.11 for men, p<0.001, and aPR=0.32 for women, p=0.003). Alcohol misuse was independently associated with reporting risky sexual behaviors (aPR=1.67; 95% CI: 1.07-2.60, p=0.023) among males, but not significant among females (aPR=1.29; 95% CI: 0.95-1.74, p=0.098). Non-disclosure of HIV positive status to sexual partner was significantly associated with risky sex in both males (aPR=1.69; p=0.014) and females (aPR 2.45; p<0.001).
  
  
  CONCLUSIONS
  Alcohol use among PLWHA was high, and was associated with self-reported medication non-adherence, non-disclosure of HIV positive status to sexual partner(s), and risky sexual behaviors among male subjects. Interventions targeting alcohol use and the associated negative behaviors should be tested in this setting.
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wandera
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Nazarius Mbona
authors.initials: NM
authors.lastname: Tumwesigye
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Joaniter Immaculate
authors.initials: JI
authors.lastname: Nankabirwa
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Andrew Ddungu
authors.initials: AD
authors.lastname: Kambugu
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Parkes-Ratanshi
authors.affiliation: Department of Social Work and Social administration, Makerere University College of Humanities and Social Sciences, Kampala, Uganda.
authors.forename: David Kaawa
authors.initials: DK
authors.lastname: Mafigiri
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine and Mwanza Interventional Trials Unit, Mwanza, Tanzania.
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors; D012725:Sexual Behavior; D014454:Uganda / Q000453:epidemiology; D014505:Urban Population