In this paper we evaluate the effects of heavy alcohol consumption on sexual behavior, HIV acquisition, and antiretroviral treatment (ART) initiation in a longitudinal open cohort of 1929 serodiscordant couples in Lusaka, Zambia from 2002 to 2012. We evaluated factors associated with baseline heavy alcohol consumption and its association with condomless sex with the study partner, sex outside of the partnership, and ART initiation using multivariable logistic regression. We estimated the effect of alcohol consumption on HIV acquisition using multivariable Cox models. Baseline factors significantly associated with women's heavy drinking (drunk weekly or more in 12-months before enrollment) included woman's older age (adjusted prevalence odds ratio [aPOR] = 1.04), partner heavy drinking (aPOR = 3.93), and being HIV-infected (aPOR = 2.03). Heavy drinking among men was associated with less age disparity with partner (aPOR per year disparity = 0.97) and partner heavy drinking (aPOR = 1.63). Men's being drunk daily (aOR = 1.18), women's being drunk less than monthly (aOR = 1.39) vs. never drunk and being in a male HIV-negative and female HIV-positive union (aOR = 1.45) were associated with condomless sex. Heavy alcohol use was associated with having 1 or more outside sex partners among men (aOR drunk daily = 1.91, drunk weekly = 1.32, drunk monthly = 2.03 vs. never), and women (aOR drunk monthly = 2.75 vs. never). Being drunk weekly or more increased men's risk of HIV acquisition (adjusted hazard ratio [aHR] = 1.72). Men and women being drunk weekly or more was associated (p < 0.1) with women's seroconversion (aHR = 1.42 and aHR = 3.71 respectively). HIV-positive women who were drunk monthly or more had lower odds of initiating ART (aOR = 0.83; 95% CI = 0.70-0.99) adjusting for age, months since baseline and previous pregnancies. Individuals in HIV-serodiscordant couples who reported heavy drinking had more outside sex partnerships and condomless sex with their study partner and were more likely to acquire HIV. HIV-positive women had lower odds of initiating ART if they were heavy drinkers.
Nuestro estudio evaluó los efectos del consumo de alcohol en el comportamiento sexual, la adquisición del VIH y la iniciación del tratamiento antirretroviral (TARV) en una cohorte de 1929 parejas serodiscordantes en Zambia. Los factores asociados con el consumo intensivo de alcohol de las mujeres (bebido semanalmente o más de 12 meses antes de la inscripción) incluyeron la edad avanzada, el consumo excesivo de alcohol de pareja y la infección por el VIH. El consumo excesivo de alcohol entre los hombres también se asoció con el consumo excesivo de alcohol de las mujeres. Los hombres que se emborrachan diariamente, las mujeres se emborrachan menos de una vez al mes vs. nunca se asocian con sexo sin condón. El consumo excesivo de bebidas alcohólicas se asoció con tener más de 1 pareja entre hombres y mujeres. Estar ebrio semanalmente o aumentar el riesgo de los hombres de la adquisición de VIH (aHR = 1.72). Los hombres y las mujeres que se emborrachaban semanalmente o más se asociaron (p < 0.1) con la seroconversión de las mujeres (aHR = 1.42 y aHR = 3.71 respectivamente). Las mujeres infectadas por el VIH bebían mensualmente o más tenían probabilidades más bajas de iniciar el TARV (aOR = 0.83; 95% CI = 0.70–0.99) ajustándose a los confounders. Los individuos de parejas serodiscordantes con VIH que reportaron tener un consumo excesivo de alcohol tuvieron más asociaciones externas y sexo sin condón y fueron más propensos a contraer el VIH. Las mujeres que reportaron tener un consumo excesivo de alcohol iniciación menos el TARV.
Keywords: Alcohol use; HIV serodiscordant couples; HIV transmission; Sexual behavior; Zambia.