| BackgroundSince the middle1980s, the global literatures suggest that alcohol consumption is associated with a number of sexual risk behaviors including premarital intercourse, multiple sexual partners, unprotected sex, sexual violence, as well as outcomes such as unwanted pregnancy, HIV/AIDS and other sexually transmitted infections (STIs). Furthermore, alcohol use plays an crucial role in HIV disease progression, antiretroviral therapy (ART) effectiveness, adherence to ART and drug resistance. Nevertheless, data on the association between alcohol use and above behaviors or outcomes in China is limited, and the existing literatures mainly focused on specific sub-population such as drug users, migrants, female sex workers (FSWs) and men having sex with men (MSM) in metropolitan and coastal areas. Little is known about alcohol use and its association with sexual risk practice among general population and people living with HIV/AIDS (PLWHA) in China.Due to culture, custom, faith and belief, drinking is socially accepted and plays a significant role in daily life in ethnic minority area in Yunnan Province. It has the largest number of reported HIV/AIDS cases among all Chinese provinces, while sexual transmission replaced injection drug use (IDU) as the dominant mode of HIV transmission in Yunnan Province since2006. Previous studies conducted in this area had shown that residents and HIV-infected patients had exhibited high risky behaviors in some occasion, but little is known that alcohol as a causal consideration. ObjectivesThe study was conducted in Dehong Prefecture, Yunnan Province with specific aims:(1) to examine the prevalence and correlates of alcohol use and subsequent sexual activity among adult males in rural ethnic minority community;(2) to investigate the prevalence and correlates of alcohol use and subsequent HIV risky behaviors among a sample of predominately ethnic minority PLWHA in rural community;(3) to evaluate the prevalence and correlates of alcohol use, nonadherence to ART, and therapeutic effect among HIV-infected patients on ART, and (4) to assess alcohol use, CD4cell counts and viral load (VL) among ART-naive HIV-infected patients.Methods(1) Alcohol use and subsequent sexual activity among adult malesThe study among adult males was conducted in a rural ethnic minority community cluster with10villages geographically continued. All permanent male residents aged16to55years who were able to provide informed consent were recruited for this study. All participants completed a face-to-face, paper-pencil interview administered by trained local public health workers in a separate or private setting (e.g., the clinic consulting room or the participant’s home) designated by themselves. Five-part questionnaire covering social-demographic characteristics, cigarette use, alcohol use, drug use and sexual activity was used to measure the primarily interested variables. After interview, the participants were required to provide blood sample in according to personal intention to test for HIV.(2) Alcohol use and subsequent sexual activity, adherence to ART and therapeutic effect among PLWHAThe study among HIV-infected patients was conducted in a rural ethnic minority community cluster with2towns geographically continued. All registered HIV-infected patients aged16years or older who were able to provide informed consent were recruited for this study. All participants completed a face-to-face, paper-pencil interview administered by trained local public health workers in a separate or private setting (e.g., the clinic consulting room or the participant’s home) designated by themselves. Six-part questionnaire covering social-demographic characteristics, cigarette use, alcohol use, drug use, adherence to ART and sexual activity was used to measure the primarily interested variables. After interview, the participants were required to provide blood sample in according to personal intention to test for CD4cell count, viral load, and the blood sample that viral load>31og10IU/ml were test for drug resistance. Meanwhile, the data on date of ART initiation, CD4cell count, and therapy regime were extracted from the system of information management for HIV/AIDS of Longchuan CDC.Results(1) Alcohol use and subsequent sexual activity among adult malesIn total,382out of497eligible adult males were enrolled in this study,70%were ethnic minorities;74.1%were currently married;27.5%had used drugs;95.5%were sexually experienced; and6.0%were HIV-infected. Over81%were current drinkers;55.7%started drinking before the age of18years. Among current drinkers,44.5%drank daily and31.9%had drunk heavily in the past30days. Chinese white wine (with an ethanol content of at least40%) was the preferred choice. About13.5%of current drinkers reported having a custom of drinking in the morning. Those who were aged46to55years (OR=34.38,95%CI:3.34-353.99), being high/very high risky level drinkers (OR=3.74,95%CI:1.64-8.56), or had ever used drugs (OR=3.75,95%CI:1.53-9.22) were more likely to drink in the morning. Higher level of alcohol use was associated with being Jingpo ethnic minorities (OR=1.96,95%CI:1.29-2.97), being smokers (OR=2.09,95%CI:1.28-3.40), and having lifetime multiple sexual partners (OR=1.55,95%CI:0.99-2.42). Over21%reported having ever engaged in sex after drinking. Those who were aged26to35years (OR=3.80,95%CI:1.38-10.52), started drinking before age18(OR=2.14,95%CI:1.08-4.22), being high/very high risk level drinkers (OR=1.99,95%CI:1.05-3.76), or had ever used drugs (OR=2.00,95%CI:1.00-4.01) were more likely to have ever engaged in sex after drinking.(2) Alcohol use and subsequent sexual activity among PLWHAIn total,455(69.3%) out of657eligible HIV patients participated in the study. Of them,66.2%were males;82.6%were ethnic minorities;15.4%were never married;96.5%were sexually experienced;55.4%had used drugs,67.5%were receiving antiretroviral therapy (ART). Over65%were ever drinkers, of whom61.5%were current drinkers. Among current drinkers,32.4%drank daily and41.2%were hazardous drinkers. Chinese white wine was the preferred choice. Higher level of alcohol use among ever drinkers in the preceding month was positively associated with being males (OR=2.76,95%CI:1.03-7.43), ethnic minorities (OR jingpo=2.21,95%CI:1.06-4.59; OR other minorities=3.20,95%CI:1.34-7.62), higher education(ORi-6=1.98,95%CI:0.99-3.96; OR≥7=2.35,95%CI:1.09-5.06) and being ART-naive (OR=2.69,95%CI:1.67-4.32). Nearly26.5%of ever drinkers reported drinking prior to the first sex performance. Those who were males (OR=15.08,95%CI:1.70-133.88), other ethnic minorities (OR=4.13,95%CI:1.33-12.83), and illiterate (OR=3.00,95%CI:1.15-7.83) were more likely to have drunk prior to the first sex performance. About39%of ever drinkers reported having engaged in sex after drinking since HIV diagnosis. Those who were younger than46years (OR16-=7.77,95%CI:1.22-49.60, OR26-=2.79,95%CI:1.06-7.35, OR36-=2.96,95%CI:1.57-7.58), hazardous drinkers (OR=1.99,95%CI:1.00-3.97) and drug users (OR=3.01,95%CI:1.19-7.58) were more likely to have had sex after drinking. Approximately56%of drug users had used drugs after drinking.(3) Alcohol use, adherence to ART and therapeutic effect among PLWHA with ARTOut of the337potential participants who were receiving ART,307(91.1%) patients agreed to participate in this study. Of these patients,61.9%were males,82.7%were ethnic minorities,73.6%were currently married, and74.2%received education less than6years. Roughly56.0%were current smokers,32.6%were current drinkers,30.0%ever used illicit drugs under the HIV-infected status, and86.3%were receiving the first-line regime. Among the participants,10.4%were defined as nonadherence to ART in the previous month and it was associated with education level (OR illiterate=5.90,95%CI:1.39-24.96), alcohol use (OR moderate level=4.18;95%CI:1.37-12.77; OR hazardous level=14.19,95%CI:3.85-52.25) and the duration of ART (OR≤6months=5.27,95%CI:1.78-15.57). Among the current drinkers,18.0%ever missed dose for drinking in the previous month, and those who were singles, divorced or widows (OR=27.16,95%CI:4.16-177.25) and hazardous drinkers (OR=9.37,95%CI:1.93-45.66) were more likely to miss dose for drinking. Among the participants, there were14.5%patients with CD4cell counts of less than200/μl,35.7%with CD4cell counts of200/μl to350/μl. CD4cell counts of greater than350/μl associated with age, current smoking, current drinking, drug use under HIV infection and cell counts of therapy initiate. Those who aged16-years (HR=4.80,95%CI:2.14-10.79), were current smokers (HR=2.44,95%CI:1.15-5.19), current non-drinkers (HR=1.86,95%CI:1.19-2.92), never used drugs under HIV infection (HR=1.72,95%CI:1.06-2.78) and had the CD4cell counts of therapy initiate upper than200/μl (HR=3.11,95%CI:2.12-4.57) were more likely to with the CD4cell counts greater than350/μl. There were13.5%patients with VL of greater than31og10IU/ml. Those with the CD4cell counts of therapy initiate upper than200/μl (HR=1.42,95%CI:1.07-1.87) were more likely to with the VL lower than50IU/ml. Over11.9%reached virological failure, and it was associated with nonadherence to ART in the previous month (OR=9.90,95%CI:2.74-35.77) and longer duration of ART (OR7-12months=3.07,95%CI:1.00-9.48). The drug resistance rate was60.7%among those who had received ART more than6months and with the VL upper than31og10IU/ml.(4) Alcohol use and disease progression among PLWHA without ARTAmong the320eligible participants,148(46.3%) HIV patients were enrolled in this study. Of these patients,75.0%were males,82.4%were ethnic minorities,54.7%were currently married, and71.6%received education less than6years. Roughly73.6%were current smokers,55.4%were current drinkers, and39.2%ever used illicit drugs under the HIV-infected status. There were27.2%patients with CD4cell counts of less than200/μl,26.4%with counts of200/μl to350/μl Those who had the CD4cell counts of therapy initiate upper than200/μl (HR200-350=0.22,95%CI:0.07-0.69; HR≥351=0.11,95%CI:0.05-0.28) were not more likely to with the CD4cell counts less than200/μl. There were24.8%patients with VL of greater than51og10IU/ml. The drug resistance rate was4.7%among those with the VL upper than31og10IU/ml.Conclusions(1) Higher level of alcohol use is associated with HIV risks among these ethnic minority males. Health education programs for alcohol abuse and unwanted outcomes are urgently needed.(2) High prevalence of alcohol use and subsequent risky behaviors including sexual engagement and drug use among HIV patients in rural Yunnan require tremendous and integrated efforts for prevention and control of alcohol and drug abuse and HIV spreading.(3) High prevalence of alcohol use and subsequent decreased adherence to ART and therapeutic effect among HIV patients on ART in rural Yunnan require tremendous and integrated efforts for prevention and control of alcohol abuse and ART failure.(4) High prevalence of alcohol use among ART-naive patients in rural Yunnan underscores comprehensive health education programs for control of alcohol abuse are urgently needed. |
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