Alcohol use among people who inject drugs living with HIV in Kenya is associated with needle sharing, more new sex partners, and lower engagement in HIV care.

We assessed the prevalence and correlates of alcohol use among 870 people who inject drugs living with HIV in Kenya, with attention toward (1) sexual and injecting risk behaviors for HIV transmission and (2) HIV care engagement. We defined heavy alcohol use as > 14 drinks/week for men and > 7 drinks/week for women, moderate alcohol use as any lesser but non-zero amount, and any alcohol use as either moderate or heavy use. Approximately 39% of participants reported any alcohol use and 15% heavy use. In multivariate analysis, any alcohol use compared to no use was associated with needle sharing, > 3 new sex partners in the past 3 months, being unaware of HIV status, never enrolling in HIV care, and not being on ART (all p < 0.05). Heavy alcohol use as compared to no use was associated with needle sharing (aOR = 2.72; 95% CI 1.43, 5.13), injection equipment sharing (aOR = 1.80; 95% CI 1.00, 3.16), > 3 new sex partners in the past 3 months (aOR = 1.99; 95% CI 1.12, 3.49), and being unaware of HIV status (aOR = 2.77; 95% CI 1.46, 5.19). There was no association between any measure of alcohol use and unsuppressed viral load. Alcohol use among people who inject drugs living with HIV may carry elevated risk of HIV transmission mediated by sexual and injecting practices and is associated with lower engagement in multiple stages of the HIV care cascade.

HIV risk behaviors and the context of sexual coercion in young adults' sexual interactions: results from a diary study in rural South Africa.

BACKGROUND: Gender inequalities in relationship power may promote unprotected sexual intercourse. GOALS: The goal of this study was to gain insight into the specific gender dynamics in the intimate relationships of rural South African young adults that contribute to risk for HIV infection. STUDY: Using diary methods, 25 female and 25 male secondary school students in rural South Africa provided daily reports (N = 1000) over a 3-week timeframe, including details regarding 466 sexual interactions. RESULTS: Inconsistent condom use was more likely in relationships in which the male partner had ever used threat or force to engage in sex during this period (unadjusted odds ratio, 13.4; 95% confidence interval, 1.57-114.26). Male sexual coercion was more likely in relationships in which alcohol was ever used in conjunction with sex and when a man's desire to engage in sex was perceived as greater than the woman's. CONCLUSION: This study adds to the growing evidence that sexual relationships characterized by gender inequality and sexual coercion are contexts of sexual risk.