title: Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi.
abstract: BACKGROUND
  HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and cannabis use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi.
  
  
  METHODS
  From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and cannabis use and lack of HIV infection awareness.
  
  
  RESULTS
  Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current cannabis use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5).
  
  
  CONCLUSIONS
  Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: kathryn_lancaster@med.unc.edu.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Lancaster
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Vivian F
authors.initials: VF
authors.lastname: Go
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.
authors.forename: Thandie
authors.initials: T
authors.lastname: Lungu
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.
authors.forename: Pearson
authors.initials: P
authors.lastname: Mmodzi
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: Theatre for a Change, Lilongwe, Malawi.
authors.forename: Katy
authors.initials: K
authors.lastname: Chadwick
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D015995:Prevalence; D011477:Sex Work / Q000706:statistics & numerical data; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Alcohol; Cannabis; HIV testing; Sex work; Sub-Saharan Africa