Alcohol use by men is a risk factor for the acquisition of sexually transmitted infections and human immunodeficiency virus from female sex workers in Mumbai, India

Abstract

Objective: We investigated whether men who were under the influence of alcohol when visiting female sex workers (FSW) were at greater risk for sexually transmitted infections (STI) and human immunodeficiency virus (HIV).

Study: A cross-sectional analysis using baseline data from a randomized controlled trial of an HIV prevention intervention for high-risk men in Mumbai, India.

Results: The overall HIV prevalence among 1741 men sampled was 14%; 64% had either a confirmed STI or HIV; 92% reported sex with an FSW, of whom 66% reported having sex while under the influence of alcohol (SUI). SUI was associated with unprotected sex (odds ratio [OR]: 3.1; 95% confidence interval [CI], 2.3-4.1), anal sex (OR: 1.5; 1.1-2.0), and more than10 FSW partners (OR: 2.2; 1.8-2.7). SUI was independently associated with having either an STI or HIV (OR: 1.5; 1.2-1.9).

Conclusion: Men who drink alcohol when visiting FSWs engage in riskier behavior and are more likely to have HIV and STIs. Prevention programs in India need to raise awareness of this relationship.

Fig. 1

Mediation model of the association of sex under the influence of alcohol (SUI) with an FSW and STI/HIV. Note: a, b, c, d are the unadjusted odds ratios for SUI, with FSW predicting STI/HIV, unprotected sex, anal sex, and >10 partners, respectively. The adjusted odds ratios of SUI conditional on all the 3 risk behaviors is shown as a′. The rest of the adjusted odds ratios e′, f′, g′ are showing the relationship of each of the risk behavior, unprotected sex, anal sex, and >10 partners, respectively, predicting STI/HIV conditional on SUI. The unadjusted and adjusted odds ratio and 95% CI for each of these relations are: OR (95% confidence interval), a, 1.5 (1.2–1.9); a′, 1.4 (1.2–1.8); b, 3.1 (2.3–4.1); c, 1.5 (1.1–2.0); d, 2.2 (1.7–2.7); e′, 1.7 (1.2–2.4); f′, 0.8 (0.6–1.2); g′, 1.1 (0.9–1.4).