Substance use and HIV
Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in Sub-Saharan Africa: systematic review of empirical findings. Prev Sci 2007 Jan 31; [Epub ahead of print]
Alcohol consumption is associated with risks for sexually transmitted infections, including HIV. In this paper, Kalichman and colleagues systematically review the literature on alcohol use and sexual risk behaviour in southern Africa, the region of the world with the greatest HIV burden. Studies show a consistent association between alcohol use and sexual risks for HIV infection. Among people who drink, greater quantities of alcohol consumption predict greater sexual risks than does frequency of drinking. In addition, there are clear gender differences in alcohol use and sexual risks; men are more likely to drink and engage in higher risk behaviour whereas women's risks are often associated with their male sex partners' drinking. Factors that are most closely related to alcohol and sexual risks include drinking venues and alcohol serving establishments, sexual coercion, and poverty. Research conducted in southern Africa therefore confirms an association between alcohol use and sexual risks for HIV. The authors conclude that sexual risk reduction interventions are needed for men and women who drink and interventions should be targeted to alcohol serving establishments.
Editors’ note: This article highlights the relevance of venue-based HIV prevention programmes to reach drinking men and women at risk for HIV.
Wood E, Lloyd-Smith E, Li K, Strathdee SA, Small W, Tyndall MW, Montaner JS, Kerr T. Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med 2007;120:172-9.
Opposition to needle exchange programs has been fuelled by a Vancouver study showing an association between frequent program use and elevated rates of human immunodeficiency virus (HIV) infection among injection drug users. Wood and colleagues evaluated possible explanations for the observed association between elevated HIV rates and frequent needle exchange attendance using a prospective observational cohort study of injection drug users in Vancouver, BC, Canada. HIV incidence rates were examined using stratified Kaplan-Meier methods and Cox proportional hazards regression. Between May 1996 and December 2004, 1035 individuals were recruited. At 48 months after recruitment, the cumulative HIV incidence rate was 18.1% among those reporting daily needle exchange use at baseline, compared with 10.7% among those who did not report this behaviour (P <.001). However, comparing HIV incidence among daily versus nondaily exchange users, while stratifying the cohort into those who did (23.2% vs 16.8%; P=.157) and did not (11.4% vs 9.0%; P=.232) report daily cocaine injection at baseline, the association between daily exchange use and HIV incidence was no longer significant. In an adjusted Cox model, daily exchange use was not associated with the time to HIV seroconversion (relative hazard=1.41 [95% confidence interval, 0.95-2.09]). The authors concluded that the differential HIV incidence rates between frequent and nonfrequent needle exchange attendees can be explained by the higher risk profile of daily attendees. Causal factors, including the high rates of cocaine injection and other local injection drug user characteristics, explain the Vancouver HIV outbreak.
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