Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
Alcohol Research Center on HIV, Brown University School of Public Health, Providence, RI, USA.
AIDS Behav. 2019 Sep;23(9):2347-2360. doi: 10.1007/s10461-019-02475-y.
Fishing communities are a most-at-risk population for HIV in Uganda. Alcohol use and abuse and economic vulnerability fuel risky sexual practices and lead to increased risk of HIV infection in these communities. Economic strengthening is an emerging intervention approach and interventions promoting saving money via mechanisms with a "soft commitment" in the form of restricting or charging small fees for withdrawals, may serve to reduce spending on alcohol and spending that leads to HIV risk behaviors in cash-based economies. However, little research has been conducted to explore the potential for commitment savings-led economic strengthening interventions to address alcohol use and sexual risk behavior among fisherfolk. This cross-sectional study explored the associations between commitment savings, HIV sexual risk behavior, and problematic alcohol among fisherfolk. We also determined whether commitment savings moderated the associations between problematic alcohol use and risky sexual behaviors. 300 (132 male, 168 female) residents of fishing communities on Lake Victoria, Uganda completed a structured interviewer-assisted interview. Over half (55.3%) used commitment savings by saving money in a bank or savings cooperative or via mobile money. Having problematic alcohol use increased the rate of risky unprotected sex with: all partners (adjIRR 6.08, 95% CI 4.30-8.60) and with casual partners and CSWs/clients (adjIRR 4.90, 95% CI 3.09-7.78), and increased the odds of having met a sex partner at an alcohol venue (adjOR 2.84, 95% CI 1.46-5.51) compared to those without problematic alcohol use. Commitment savings was associated with lower odds of: problematic alcohol use (adjOR 0.50, 95% CI 0.26-0.96), meeting a sex partner at an alcohol venue (adjOR 0.43, 95% CI 0.24-0.78), as well as lower rates of risky unprotected sex with all partners (adjIRR 0.68, 95% CI 0.48-0.96), and with causal partners, CSWs/clients (adjIRR 0.38, 95% CI 0.17-0.85). Use of commitment savings moderated the associations between problematic alcohol use and unprotected sex. However, the moderating effects of commitment savings varied by gender. These findings suggest that promoting saving money in savings mechanisms which involve a commitment may be a potentially viable avenue for HIV prevention among fishing communities and may be particularly helpful for those who have problematic alcohol use.
渔业社区是乌干达艾滋病毒的高危人群。酗酒和滥用以及经济脆弱性助长了高危性行为，并导致这些社区的艾滋病毒感染风险增加。经济加强是一种新兴的干预方法，通过在提款时设置“软性承诺”机制来促进存钱，例如限制或收取小额提款费，可能有助于减少现金经济中用于酗酒和导致艾滋病毒风险行为的支出。然而，几乎没有研究探索承诺储蓄主导的经济加强干预措施在解决渔民酗酒和性风险行为方面的潜力。本横断面研究探讨了承诺储蓄与艾滋病毒性风险行为和渔民酗酒之间的关系。我们还确定了承诺储蓄是否调节了酗酒与高危性行为之间的关联。300 名（132 名男性，168 名女性）维多利亚湖渔业社区居民完成了结构化访谈者协助的访谈。超过一半（55.3%）通过在银行或储蓄合作社存钱或通过移动货币进行承诺储蓄。酗酒会增加与所有性伴侣发生高危无保护性行为的风险：（调整后的 IRR6.08，95%CI4.30-8.60）和与偶然伴侣和性工作者/客户（调整后的 IRR4.90，95%CI3.09-7.78），并增加在饮酒场所遇到性伴侣的几率（调整后的 OR2.84，95%CI1.46-5.51）与不酗酒者相比。承诺储蓄与以下因素的几率降低有关：酗酒（调整后的 OR0.50，95%CI0.26-0.96），在饮酒场所遇到性伴侣（调整后的 OR0.43，95%CI0.24-0.78），以及与所有性伴侣发生高危无保护性行为的比率降低（调整后的 IRR0.68，95%CI0.48-0.96），以及与偶然伴侣、性工作者/客户（调整后的 IRR0.38，95%CI0.17-0.85）。承诺储蓄的使用调节了酗酒与无保护性行为之间的关联。然而，承诺储蓄的调节作用因性别而异。这些发现表明，在渔业社区促进在涉及承诺的储蓄机制中存钱可能是预防艾滋病毒的一种可行途径，对于酗酒者尤其有帮助。
