Alcohol Use As Individual and Structural Drivers of Positive HIV Status Among Vulnerable Youth in Kampala, Uganda: Alcohol Use and Drinking Prior to Sexual Activity

Introduction: The purpose of this study was to determine the associations between alcohol use and HIV status among youth living in the slums of Kampala using a mixed-methods approach. Data from these youth remain scarce despite their high unmet needs for clinical and preventive services and fast population growth, but are needed to guide the design of interventions.

 Methods:  Nine focus groups (N=96) and a cross-sectional study (N=457) were conducted in 2011 to quantify and describe high-risk behaviors related to alcohol use in a convenience sample of urban youth living in the slums, 14-24 years of age, who participated in a Uganda Youth Development Link drop-in center for disadvantaged street youth. Logistic regression analyses were performed to determine statistical associations between alcohol use, other risk factors and positive HIV status. The focus groups were structured across three thematic areas and asked participants their thoughts about alcohol use, its effects, and involvement in risky behaviors more broadly. Data from the focus groups were coded to identify important themes related to perceptions and thoughts pertaining to the link between alcohol and HIV.      

 Results:  Overall, 8.3% of youth reported having been told by a doctor or nurse that they have HIV/AIDS. Bivariate analyses restricted to youth who were sexually active in the past year (n=318), indicated that drunkenness (OR=3:56; 95%CI:1.47-5.87) and sadness (OR=2.34; 95%CI:1.02-5.38) were significantly associated with positive HIV status. In multivariate analyses, drunkenness remained statistically associated with positive HIV status. Drinking alcohol prior to engaging in sex, either by the participant or their sexual partner, was also associated with positive HIV status.

 Conclusions: High-risk youth living in the slums of Kampala report a high prevalence of HIV and HIV-related sexual risk practices as well as sexual victimization. Alcohol use, specifically drunkenness and use of alcohol prior to engaging in sexual activity, appears to be significant correlates of HIV infection and was also recognized as an important concern throughout the focus groups. These results indicate that increased attention is needed to address early alcohol use and alcohol-related risky sexual behaviors as individual and structural drivers of HIV in this vulnerable population.