The Role of Alcohol Expectancies in Sexual Risk Behaviors Among Adolescents and Young Adults in the Democratic Republic of the Congo.
Considering the increased risk of HIV among alcohol users, we explored the role of individual alcohol expectancies in risk behaviors among youth in the Democratic Republic of the Congo.



We surveyed 1,396 adolescents (ages 15-19) and young adults (ages 20-24) on alcohol and sexual behaviors in May, 2010. We assessed expectancies of alcohol use (1) leading to sex or positive sexual experiences; (2) diminishing one's ability to resist unwanted sex; and (3) diminishing one's ability to use or negotiate use of condoms. Adjusted logistic regression models assessed the association between alcohol use and alcohol expectancies with unprotected sex and multiple sex partners (MSP).



Participants reporting alcohol use (36.8%) were more likely to have engaged in unprotected sex and MSP than nondrinkers (adjusted odds ratio [AOR]: 2.87, 95% confidence interval [CI]: 2.29-3.60; AOR: 3.73 95% CI: 2.94-4.72, respectively). Among alcohol users, after adjusting for drinking quantity, moderate expectancies of alcohol leading to positive sexual experiences were significantly associated with MSP among adolescent boys (AOR: 4.20, 95% CI: 1.49-11.86) and girls (AOR: 3.97, 95% CI: 1.36-11.60), whereas high expectancies were significant among young adult men (AOR: 2.70, 95% CI: 1.19-6.10). Among adolescent girls who used alcohol, adjusted odds of unprotected sex were elevated among those with expectancies of diminished ability to refuse unwanted sex (AOR: 5.13, 95% CI: 1.41-16.64) or to negotiate condom use (AOR: 16.22; 2.08-126.8).



HIV prevention efforts for youth should acknowledge the role of alcohol expectancies in sexual risk behaviors and tailor programs to address different roles of expectancies in males and females.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: eahurley@jhu.edu.
Emily A
EA
Hurley
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Heena
H
Brahmbhatt
Department of Epidemiology, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Patrick K
PK
Kayembe
Department of Epidemiology, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Michelle-Alphonsine Fatuma
MF
Busangu
Department of Epidemiology, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Ma-Umba
MU
Mabiala
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Deanna
D
Kerrigan
D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000187:drug effects* / Q000706:statistics & numerical data; D000066608:Underage Drinking / Q000706:statistics & numerical data; D047568:Unsafe Sex / Q000187:drug effects / Q000706:statistics & numerical data; D055815:Young Adult
Adolescents; Alcohol expectations; Alcohol use; HIV; Sexual behaviors; Sub-Saharan Africa; Young adults