Alcohol use and extramarital sex among men in Cameroon.
Alcohol use and extramarital sex among men in Cameroon.
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DOI：
10.1186/1472-698x-7-6
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发表时间：
2007-08-03
影响因子：
3
通讯作者：
Wiysonge CS
中科院分区：
文献类型：
--
作者：
Kongnyuy EJ;Wiysonge CS
艾滋病毒在撒哈拉以南非洲的传播被认为是由不安全的性行为造成的，需要确定后者的可改变的风险因素，以便在该区域制定全面的艾滋病毒预防方案。先前的一些研究表明，酗酒与不安全的性行为之间存在关联，例如同时存在多个性伴侣关系以及与非配偶非同居伴侣发生性关系时不一致地使用避孕套。然而，这些研究大多数是在发达国家进行的，在非洲进行的少数研究是在明确界定的社会群体中进行的，如参加啤酒霍尔斯或性传播感染诊所的男子。因此，我们在喀麦隆进行了一项基于人口的调查，研究了酒精与婚外性行为（多重并发性伴侣的标志）之间的关联;这是撒哈拉以南非洲的一个低收入国家，酒精滥用率很高，艾滋病毒流行普遍。我们分析了2678正式结婚或同居的男性，年龄在15至59岁，谁参加了2004年喀麦隆人口与健康调查，使用多元回归模型的数据。四分之一的男子（25.8%）声称在最后一次性交前饮酒，21%的男子表示最后一次性交是与妻子或同居伴侣以外的妇女进行的。在控制了其他社会人口学特征可能的混杂因素后，饮酒与婚外性行为显著相关：调整后的比值比（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和45-59岁：OR 4.10，95%CI 2.16-4.27），高等教育（OR 1.25，95%CI 1.10-1.45）和财富（OR 1.71，95%CI 1.50-1.98）也与婚外性行为的高几率显著相关。如果是婚外性行为，男性在最近一次性行为中使用安全套的可能性更大（OR 10.50，95%CI 8.10-13.66）。初次性行为年龄较大（16-19岁：OR 0.81，95%CI 0.72-0.90和> 19岁：OR 0.74，95%CI 0.65-0.87）和身为户主（OR 0.17，95%CI 0.14-0.22）显著降低了婚外性行为的几率。宗教和居住地（无论是城市还是农村）与婚外性行为没有显着相关。在喀麦隆，饮酒与已婚男子同时拥有多个非配偶性伙伴关系有关。我们不能从这项横断面研究中推断出酗酒和不安全性行为之间的因果关系，因为酗酒和不安全性行为可能有一套共同的个人和社会因素。然而，考虑到与其他环境中的研究结果的一致性以及酒精摄入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喀麦隆和其他具有类似社会背景的非洲国家需要将酗酒和艾滋病毒预防工作结合起来。
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.