title: Risky Sex and HIV Acquisition Among HIV Serodiscordant Couples in Zambia, 2002-2012: What Does Alcohol Have To Do With It?
abstract: In this paper we evaluate the effects of heavy alcohol consumption on sexual behavior, HIV acquisition, and antiretroviral treatment (ART) initiation in a longitudinal open cohort of 1929 serodiscordant couples in Lusaka, Zambia from 2002 to 2012. We evaluated factors associated with baseline heavy alcohol consumption and its association with condomless sex with the study partner, sex outside of the partnership, and ART initiation using multivariable logistic regression. We estimated the effect of alcohol consumption on HIV acquisition using multivariable Cox models. Baseline factors significantly associated with women's heavy drinking (drunk weekly or more in 12-months before enrollment) included woman's older age (adjusted prevalence odds ratio [aPOR] = 1.04), partner heavy drinking (aPOR = 3.93), and being HIV-infected (aPOR = 2.03). Heavy drinking among men was associated with less age disparity with partner (aPOR per year disparity = 0.97) and partner heavy drinking (aPOR = 1.63). Men's being drunk daily (aOR = 1.18), women's being drunk less than monthly (aOR = 1.39) vs. never drunk and being in a male HIV-negative and female HIV-positive union (aOR = 1.45) were associated with condomless sex. Heavy alcohol use was associated with having 1 or more outside sex partners among men (aOR drunk daily = 1.91, drunk weekly = 1.32, drunk monthly = 2.03 vs. never), and women (aOR drunk monthly = 2.75 vs. never). Being drunk weekly or more increased men's risk of HIV acquisition (adjusted hazard ratio [aHR] = 1.72). Men and women being drunk weekly or more was associated (p < 0.1) with women's seroconversion (aHR = 1.42 and aHR = 3.71 respectively). HIV-positive women who were drunk monthly or more had lower odds of initiating ART (aOR = 0.83; 95% CI = 0.70-0.99) adjusting for age, months since baseline and previous pregnancies. Individuals in HIV-serodiscordant couples who reported heavy drinking had more outside sex partnerships and condomless sex with their study partner and were more likely to acquire HIV. HIV-positive women had lower odds of initiating ART if they were heavy drinkers.
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA. dvoradavey@ucla.edu.|Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA. dvoradavey@ucla.edu.|Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa. dvoradavey@ucla.edu.
authors.forename: Dvora
authors.initials: D
authors.lastname: Joseph Davey
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.|Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Naw Htee
authors.initials: NH
authors.lastname: Khu
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.|Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.|Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia.
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.affiliation: School of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.|Zambia National Blood Transfusion Service, Lusaka, Zambia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mulenga
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA.
authors.forename: Marjan
authors.initials: M
authors.lastname: Javanbakht
authors.affiliation: Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Comulada
authors.affiliation: Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.|Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA.
authors.forename: Pamina M
authors.initials: PM
authors.lastname: Gorbach
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology*; D000435:Alcoholic Intoxication / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
keywords: Alcohol use; HIV serodiscordant couples; HIV transmission; Sexual behavior; Zambia