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Alcohol as a Correlate of Unprotected Sexual Behavior Among People Living with HIV/AIDS: Review and Meta-Analysis

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Abstract

The present investigation attempted to quantify the relationship between alcohol consumption and unprotected sexual behavior among people living with HIV/AIDS (PLWHA). A comprehensive search of the literature was performed to identify key studies on alcohol and sexual risk behavior among PLWHA, and three separate meta-analyses were conducted to examine associations between unprotected sex and (1) any alcohol consumption, (2) problematic drinking, and (3) alcohol use in sexual contexts. Based on 27 relevant studies, meta-analyses demonstrated that any alcohol consumption (OR = 1.63, CI = 1.39–1.91), problematic drinking (OR = 1.69, CI = 1.45–1.97), and alcohol use in sexual contexts (OR = 1.98, CI = 1.63–2.39) were all found to be significantly associated with unprotected sex among PLWHA. Taken together, these results suggest that there is a significant link between PLWHA’s use of alcohol and their engagement in high-risk sexual behavior. These findings have implications for the development of interventions to reduce HIV transmission risk behavior in this population.

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Notes

  1. In addition to the event-level investigation by Kiene et al. [40], a study by Barta et al. [71] employed telephone-based daily diary assessments and found a significant event-level association between PLWHA’s alcohol consumption prior to sex and the occurrence of unprotected sexual intercourse. Problematic drinking (i.e., alcohol dependence) was negatively related to unprotected sex. Due to the nature of the data analytic procedures and statistical outcomes presented by Barta et al. results from the study were not included in our meta-analyses.

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Acknowledgments

The research was funded by the South African Medical Research Council (MRC) through a grant received from the US President’s Emergency Fund for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. We would also like to thank Dr. Charles Parry at the MRC for his comments on this manuscript, and we are grateful to delegates of the MRC/CDC Alcohol and Infectious Diseases Technical Meeting (July 2008, Cape Town, South Africa) for their feedback regarding this project.

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  1. Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada

    Paul A. Shuper, Narges Joharchi, Hyacinth Irving & Jürgen Rehm

  2. Department of Psychology, University of Toronto, Toronto, ON, Canada

    Paul A. Shuper

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Jürgen Rehm

  4. Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany

    Jürgen Rehm

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  1. Paul A. Shuper
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Shuper, P.A., Joharchi, N., Irving, H. et al. Alcohol as a Correlate of Unprotected Sexual Behavior Among People Living with HIV/AIDS: Review and Meta-Analysis. AIDS Behav 13, 1021–1036 (2009). https://doi.org/10.1007/s10461-009-9589-z

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