title: Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda.
abstract: BACKGROUND
  Although the association between alcohol consumption and HIV risk is well documented, few studies have examined the magnitude of new HIV infections that could be prevented by controlling alcohol use. We report the population attributable fraction (PAF) of incident HIV infections due to alcohol consumption among the HIV high-risk population of fishing communities along Lake Victoria, Uganda.
  
  
  METHODS
  In a community-based cohort study, 1607 HIV sero-negative participants aged 18-49 years were enrolled from eight fishing communities along Lake Victoria, Uganda. At follow up 12 months later, 1288 (80.1%) were seen and interviewed. At baseline and follow-up visits, participants completed interviewer-administered questionnaires on alcohol consumption, demographics, and sexual risk behavior, and were tested for HIV infection. HIV incidence and adjusted incident rate ratios (adjusted IRRs) were estimated using Poisson regression models; the crude and adjusted PAFs of incident HIV infections associated with alcohol consumption were calculated using the Greenland and Drescher method for cohort studies.
  
  
  RESULTS
  Among the 1288 participants seen at follow up, 53.5% reported drinking alcohol of whom 24.4% drank occasionally (2 days a week or less) and 29.1% drank regularly (3-7 days a week). Forty eight incident HIV infections occurred giving an incidence rate of 3.39/100 person years at-risk (pyar) (95% CI, 2.55-4.49). Compared to non-drinkers, the adjusted IRR of HIV was 3.09 (1.13-8.46) among occasional drinkers and 5.34 (2.04-13.97) among regular drinkers. The overall adjusted PAF of incident HIV infections due alcohol was 64.1 (95% CI; 23.5-83.1); ranging from 52.3 (11.9-74.2) among Muslims to 71.2 (32.6-87.7) for participants who reported ≥ 2 sexual partners in the past 12 months.
  
  
  CONCLUSIONS
  In fishing communities along Lake Victoria, Uganda, 64% of new HIV infections can be attributed to drinking alcohol. Interventions to reduce alcohol consumption should be integrated in HIV/AIDS prevention activities for populations in whom both HIV and alcohol consumption are highly prevalent.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.|Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.affiliation: Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.
authors.forename: Ali
authors.initials: A
authors.lastname: Ssetaala
authors.affiliation: Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ssekandi
authors.affiliation: Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.
authors.forename: Annet
authors.initials: A
authors.lastname: Nalutaaya
authors.affiliation: Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.
authors.forename: Paul Kato
authors.initials: PK
authors.lastname: Kitandwe
authors.affiliation: Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Ssempiira
authors.affiliation: Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda.|Department of Medical Microbiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda.
authors.forename: Bernard Ssentalo
authors.initials: BS
authors.lastname: Bagaya
authors.affiliation: International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America.
authors.forename: Apolo
authors.initials: A
authors.lastname: Balyegisawa
authors.affiliation: Medical Research Council/Uganda Virus Research Insitute, Uganda Research Unit on AIDS, Entebbe, Uganda.|Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Pontiano
authors.initials: P
authors.lastname: Kaleebu
authors.affiliation: Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Judith
authors.initials: J
authors.lastname: Hahn
authors.affiliation: Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Christina
authors.initials: C
authors.lastname: Lindan
authors.affiliation: Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda.
authors.forename: Nelson Kaulukusi
authors.initials: NK
authors.lastname: Sewankambo
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D005398:Fisheries; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D015994:Incidence; D060106:Lakes; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult