Kongnyuy Eugene J, Wiysonge Charles Shey
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
BMC Int Health Hum Rights. 2007 Aug 3;7:6. doi: 10.1186/1472-698X-7-6.
The spread of HIV in sub-Saharan Africa is believed to be driven by unsafe sex, and identification of modifiable risk factors of the latter is needed for comprehensive HIV prevention programming in the region. Some previous studies suggest an association between alcohol abuse and unsafe sexual behaviour, such as multiple concurrent sexual partnerships and inconsistent condom use in sex with non-spousal non-cohabiting partners. However, most of these studies were conducted in developed countries and the few studies in Africa were conducted among well-defined social groups such as men attending beer halls or sexually transmitted infection clinics. We therefore examined the association between alcohol and extramarital sex (a sign of multiple concurrent sexual partnerships) among men in a population-based survey in Cameroon; a low-income country in sub-Saharan Africa with a high rate of alcohol abuse and a generalised HIV epidemic.
We analyzed data from 2678 formally married or cohabiting men aged 15 to 59 years, who participated in the 2004 Cameroon Demographic and Health Survey, using a multivariate regression model.
A quarter of the men (25.8%) declared having taken alcohol before their last sexual intercourse and 21% indicated that the last sex was with a woman other than their wife or cohabiting partner. After controlling for possible confounding by other socio-demographic characteristics, alcohol use was significantly associated with having extramarital sex: adjusted odds ratio (OR) 1.70, 95% confidence intervals (CI) 1.40 to 2.05. Older age (30-44 years: OR 3.06, 95%CI 2.16-4.27 and 45-59 years: OR 4.10, 95%CI 2.16-4.27), higher education (OR 1.25, 95%CI 1.10-1.45), and wealth (OR 1.71, 95%CI 1.50-1.98) were also significantly associated with higher odds of having extramarital sex. The men were more likely to have used a condom in their last sex if it was extramarital (OR 10.50, 95%CI 8.10-13.66). Older age at first sex (16-19 years: OR 0.81, 95%CI 0.72-0.90 and > 19 years: OR 0.74, 95% CI 0.65-0.87) and being the head of a household (OR 0.17, 95%CI 0.14-0.22) significantly decreased the odds of having sex outside of marriage. Religion and place of residence (whether urban or rural) were not significantly associated with extramarital sex.
Alcohol use is associated with having multiple concurrent non-spousal sexual partnerships among married men in Cameroon. We cannot infer a causal relationship between alcohol abuse and unsafe sex from this cross-sectional study, as both alcohol use and unsafe sexual behaviour may have a common set of causal personal and social factors. However, given the consistency with results of studies in other settings and the biologic plausibility of the link between alcohol intake and unsafe sex, our findings underscore the need for integrating alcohol abuse and HIV prevention efforts in Cameroon and other African countries with similar social profiles.
据信，撒哈拉以南非洲地区的艾滋病毒传播是由不安全的性行为推动的，该地区全面的艾滋病毒预防规划需要确定不安全性行为的可改变风险因素。此前的一些研究表明，酗酒与不安全的性行为之间存在关联，比如多个性伴侣同时存在以及与非配偶、非同居伴侣发生性行为时不坚持使用避孕套。然而，这些研究大多在发达国家进行，而在非洲进行的少数研究是在特定的社会群体中开展的，例如光顾啤酒馆的男性或性传播感染诊所的患者。因此，我们在喀麦隆开展了一项基于人群的调查，研究男性饮酒与婚外性行为（多个性伴侣同时存在的一种表现）之间的关联；喀麦隆是撒哈拉以南非洲的一个低收入国家，酗酒率高，艾滋病毒疫情普遍。
我们使用多元回归模型分析了2678名年龄在15至59岁之间、正式结婚或同居的男性的数据，这些男性参与了2004年喀麦隆人口与健康调查。
四分之一的男性（25.8%）宣称在最后一次性交前饮酒，21%的男性表示最后一次性行为的对象不是其妻子或同居伴侣。在控制了其他社会人口学特征可能造成的混杂因素后，饮酒与婚外性行为显著相关：调整后的优势比（OR）为1.70，95%置信区间（CI）为1.40至2.05。年龄较大（30 - 44岁：OR 3.06，95%CI 2.16 - 4.27；45 - 59岁：OR 4.10，95%CI 2.16 - 4.27）、受教育程度较高（OR 1.25，95%CI 1.10 - 1.45）以及财富水平较高（OR 1.71，95%CI 1.50 - 1.98）也与婚外性行为的较高几率显著相关。如果是婚外性行为，男性在最后一次性行为中更有可能使用避孕套（OR 10.50，95%CI 8.10 - 13.66）。首次性行为的年龄较大（16 - 19岁：OR 0.81，95%CI 0.72 - 0.90；大于19岁：OR 0.74，95%CI 0.65 - 0.87）以及作为户主（OR 0.17，95%CI 0.14 - 0.22）会显著降低婚外性行为的几率。宗教信仰和居住地点（城市或农村）与婚外性行为无显著关联。
在喀麦隆，已婚男性饮酒与多个非配偶性伴侣同时存在有关。由于饮酒和不安全的性行为可能有共同的因果个人和社会因素，我们无法从这项横断面研究中推断出酗酒与不安全性行为之间的因果关系。然而，鉴于与其他研究结果的一致性以及饮酒与不安全性行为之间联系的生物学合理性，我们的研究结果强调在喀麦隆和其他具有类似社会概况的非洲国家，有必要将酗酒问题与艾滋病毒预防工作结合起来。
