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Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It?

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Abstract

This study examines baseline associations between alcohol use and HIV sexual risk among a cohort of HIV-uninfected pregnant women (n = 1201) residing in a high HIV burdened community in Cape Town, South Africa. Alcohol use was measured using a modified version of the Alcohol Use Disorder Identification Test (AUDIT). HIV sexual risk was measured through a composite variable of four risk factors: diagnosis with a STI, self-report of > 1 recent sex partners, partner HIV serostatus (unknown or HIV+) and condomless sex at last sex. Any past year alcohol use prior to pregnancy was reported by half of participants (50%); 6.0% reported alcohol use during pregnancy. Alcohol use prior to pregnancy was associated with increased odds of being at high risk of HIV (aOR = 1.33, 95% CI 1.05–1.68, for 2 risks and aOR = 1.47, 95% CI 0.95–2.27 for 3 risks). In addition to reducing alcohol use, several other strategies to address HIV sexual risk were identified. Evidence-based interventions to address alcohol use and other HIV sexual risk behaviors during pregnancy in South Africa are desperately needed. Qualitative work exploring individual and community level drivers of alcohol use among pregnant and breastfeeding women in this setting could support development of a culturally tailored intervention to address these issues in this population.

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Acknowledgements

The authors would like to thank the Pre-exposure prophylaxis in Pregnancy and Post-partum study staff as well as the study participants for their time.

Funding

This project was supported by National Institute of Mental Health grants T32MH080634 (PI: Gorbach) and R01MH116771 (PI: Joseph Davey) and Fogarty International Center grant K01TW011187 (PI: Joseph Davey).

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Authors and Affiliations

  1. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA

    Amanda P. Miller, Pamina M. Gorbach & Dvora L. Joseph Davey

  2. Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Steven Shoptaw

  3. Department of Psychiatry, University of Cape Town, Cape Town, South Africa

    Steven Shoptaw

  4. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa

    Rufaro Mvududu, Nyiko Mashele, Landon Myer & Dvora L. Joseph Davey

  5. Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Thomas J. Coates & Dvora L. Joseph Davey

  6. The Desmond Tutu HIV Centre, Faculty of Health Science, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa

    Linda-Gail Bekker & Dvora L. Joseph Davey

  7. Centre for Community-Based Research, Human Sciences Research Council, Pretoria, South Africa

    Zaynab Essack & Candice Groenewald

  8. Psychology Department, Rhodes University, Makhanda, South Africa

    Candice Groenewald

  9. Impact and Research Development, Human Sciences Research Council, Pretoria, South Africa

    Zaino Petersen

  10. Department of Epidemiology, Fielding School of Public Health, 650 Charles E. Young Drive South, Room #41-295CHS, Los Angeles, CA, 90095-1772, USA

    Amanda P. Miller

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Correspondence to Amanda P. Miller.

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Written informed consent was obtained from all study participants; unassisted self-consent was obtained from adolescents (participants 16 and 17 years of age). Each woman received R100, (~ USD$7) in compensation for her time.

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Miller, A.P., Shoptaw, S., Mvududu, R. et al. Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It?. AIDS Behav 27, 37–50 (2023). https://doi.org/10.1007/s10461-022-03742-1

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