Alcohol-Associated Unprotected Sexual Intercourse Among a Cohort of Newly Diagnosed HIV+ Adults in Mbarara, Uganda: A Pilot Study

Uganda has one of the highest per capita rates of alcohol consumption in the world coupled with a generalized HIV epidemic that affects 5-7% of the adult population. A growing body of research has shown that alcohol use is strongly correlated with sexual risk behavior, but the strength of this association among HIV+ adults remains unclear. Understanding the mechanisms by which alcohol use is related to unprotected sexual intercourse among HIV+ individuals is essential for developing effective secondary HIV prevention interventions. The primary goal of this project is to obtain a preliminary understanding of the relationship between alcohol use and high-risk sexual behavior of newly diagnosed HIV+ adults in Uganda. Two measures of sexual risk behavior will be added to the baseline questionnaire of an existing cohort study of persons infected with HIV initiating clinical care in Mbarara, Uganda. We will augment these self-report questionnaires with a biomarker of recent semen exposure as an additional aim of the study. Finally, a qualitative sub-study that uses semi-structured interviews to gain a more in-depth understanding of the contextual variables that characterize unprotected sexual events is also proposed. Logistic regression will be used to analyze the hypothesis that alcohol use during a sexual event, high levels of intoxication, and endorsement of sex-related alcohol expectancies are associated with an increased likelihood of unprotected sex at a most recent sexual event. The qualitative data will be analyzed to identify and describe recurrent themes related to event-level sexual decision making. This project will be conducted over a 12 month period beginning in February 2012. The long term goal of this research proposal is to inform the development of interventions that target the co-occurring risks of alcohol use and unprotected sexual intercourse among individuals living with HIV.