Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Frederick Altice

Subject Area(s)

Medicine

Abstract

CORRELATION BETWEEN ALCOHOL USE DISORDERS AND RISKY SEX IN PERUVIAN MEN WHO HAVE SEX WITH MEN.

Kaysia Ludford and Frederick L. Altice MD. Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

Goals: To evaluate the prevalence of alcohol use disorders; to assess their correlation with sexual risk behaviors and to determine the correlation between sexual risk behaviors and being unaware of being HIV-infected.

Methods: Between June and October 2011, 5,148 MSM were recruited using convenience sampling in five cities to participate in a cross-sectional bio-behavioral survey. Five high-risk sexual criteria associated with incident HIV infection were selected a priori as the dependent outcomes. Screening for AUDs used the validated Alcohol Use Disorders Identification Test (AUDIT). Adjusted odds ratios (AOR) were computed to establish the independent correlates of the five dependent outcomes. Additionally all participants were screened for HIV.

Results: 62.8% of participants met screening criteria for having an AUD; AUDs were independently correlated with: 1) >5 sexual partners [AOR=1.76; (1.54-2.02)]; 2) sex with an HIV-infected partner [AOR=1.29; (1.03-1.62)]; 3) having a sexually transmitted infection [AOR=1.38; (1.13-1.68)]; 4) being a sex worker [AOR=1.61; (1.40-1.87)] during the previous 6 months and 5) unprotected sex during last encounter [AOR=1.22; (1.09-1.38)]. 8% of participants tested seropositive. Of these, 90% were unaware of their HIV-infected status. Compared to those participants who were previously aware of being HIV-infected, these individuals had higher odds of engaging in unprotected intercourse during their last sexual encounter [AOR = 2.84 (95 % CI 1.09-7.40)] and of having an alcohol use disorder (AUD) [AOR = 2.14 (95 %CI 1.01-5.54)].

Conclusions: AUDs are highly prevalent among MSM in Peru and are associated with increased HIV risk-taking behaviors that are associated with HIV transmission. Likewise, being unaware of being HIV-infected is associated with high-risk sexual behaviors. Strategies that target problematic drinking and HIV testing could potentially reduce risky behaviors and ultimately reduce HIV transmission among MSM in Peru.

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