title: Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya.
abstract: Studies of alcohol use and sexual behavior in African populations have primarily been cross-sectional, used nonvalidated measures of alcohol use, or relied on self-reported sexual risk endpoints. Few have focused on human immunodeficiency virus (HIV)-positive women.
  
  
  
  Longitudinal data were collected from a cohort of HIV-positive Kenyan female sex workers. At enrollment and annual visits, participants were asked about past-year alcohol use using the Alcohol Use Disorders Identification Test (AUDIT). The primary endpoint was detection of prostate-specific antigen (PSA) in vaginal secretions at quarterly examinations. Associations between hazardous/harmful alcohol use (AUDIT score ≥7), PSA detection, and secondary measures of sexual risk were evaluated using generalized estimating equations with a log binomial regression model.
  
  
  
  A total of 405 women contributed 2750 vaginal samples over 606 person-years of follow-up. Hazardous/harmful alcohol use was reported at 16.6% of AUDIT assessments and was associated with higher risk of PSA detection (relative risk 1.50; 95% confidence interval, 1.11-2.01) relative to no alcohol use. This association was attenuated and no longer statistically significant, after adjusting for age, work venue, intimate partner violence, depression, and partnership status (adjusted relative risk, 1.13; 95% confidence interval, 0.82-1.56). In exploratory analyses, alcohol use was associated with self-report of unprotected sex and with sexually transmitted infection acquisition.
  
  
  
  Although hazardous/harmful alcohol use was not associated with detection of PSA in adjusted analysis, associations with secondary outcomes suggest that alcohol use is at least a marker of sexual risk behavior.
authors.affiliation: From the *Department of Epidemiology, †Department of Global Health, ‡Department of Medicine, University of Washington, Seattle, WA; §University of Washington-Kenya Non-Governmental Organization, Nairobi, Kenya; ¶Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya; ‖Department of Biostatistics, University of Washington, Seattle, WA; **Division of Public Health Sciences, ††Division of Vaccine and Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, WA; ‡‡Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya; §§Department of Psychology, University of Washington, Seattle, WA; ¶¶Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
authors.forename: Darcy
authors.initials: D
authors.lastname: White
authors.forename: Kate S
authors.initials: KS
authors.lastname: Wilson
authors.forename: Linnet N
authors.initials: LN
authors.lastname: Masese
authors.forename: George
authors.initials: G
authors.lastname: Wanje
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: John
authors.initials: J
authors.lastname: Kinuthia
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D000438:Alcohols; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000276:immunology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006679:HIV Seropositivity; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000032:analysis; D012309:Risk-Taking; D057566:Self Report; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology*; D047568:Unsafe Sex; D055815:Young Adult
chemical_list: D000438:Alcohols; D017430:Prostate-Specific Antigen