This paper fills a knowledge gap on relationship between alcohol consumption and risky sexual behaviour, namely number and type of sex partners, use of condoms, and engagement in transactional sex, among subpopulation living and working in fish landing environments. It has addressed key research questions on the level of alcohol consumption and risky sexual behaviour, nature and strength of relationship between alcohol consumption and risky sexual behaviour in this setting, and provided clues on possible areas of intervention.
The levels of harmful use of alcohol and risky sexual behaviour at the fish landing sites are higher than what has been found in previous studies. For example, according to the 2001 demographic and health survey, a half of male and a quarter of female drinkers got drunk within the previous 30 days
. This is much lower than 62% of male and 52% of female drinkers that got drunk in the same period in this study.
The high level of risky sexual behaviour fits the categorization of most at risk population (MARPS). The prevalence of risky sexual behaviour at the landing sites is much higher than that found in the general population. According to the 2004/5 national HIV sero-prevalence behavioural survey the proportion of sexually active respondents that had had 2 or more partners in previous 12 months was 29% among men and 4% among women
, but in this study it was 50% among men and 33% among women. In the same survey, 0.5% of women and 1% of men said they engaged in transactional sex, but in this study shows that 28% of men and 25% of women were engaged in transactional sex.
Higher odds of engaging in risky sexual behaviour with higher frequency of alcohol consumption is consistent with many general population studies in different countries including those carried out in the USA, Finland and sub-Saharan Africa
[16–19]. The correlations between alcohol consumption and risky sexual behaviour show that reduced alcohol consumption may reduce risky sexual behaviour. The correlations between the AUDIT score and risky sexual behaviour suggest that reduced odds of risky sexual behaviour may not only be realized with reduced frequency of alcohol consumption but also with control of all alcohol use disorders.
The experience of intoxication is a proxy measure for amount drunk. Its strong relationship with risky sexual behaviour in this study, reflects what has already been established in a population based study in Uganda
. This finding relates closely with the previous results on correlations between risky sexual behaviour and both AUDIT score and frequency of alcohol consumption.
A literature search shows that few studies have investigated the correlation between risky behaviour and length of time, day of the week and time of the day of drinking in the region and Africa as a whole. This is one area in which this study makes a major contribution to this field of knowledge. Evidence of reduced odds of risky sexual behaviour among those who drink for a short time, drink on a specific day of the week and specific time of the day calls for disciplined alcohol consumption and increased control of access to alcohol as strategies for promoting safer sexual behaviour.
Results on non-significant correlation between inconsistent/non-use of condom with alcohol consumption patterns are in agreement with several other studies. A meta analysis carried out in 2002 found that drinking is not necessarily linked to unprotected intercourse; the relationship between alcohol use and unprotected sex depends on sexual experience of the partners
. Given that the respondents were adults with long time exposure to both sexual activity and alcohol consumption the relationship may not be significant as results of the 2002 meta analysis showed. Other studies carried out in 2000 and 2002 showed less support for increased risk behaviour as a result of alcohol consumption
[31, 32]. However, there are still many studies that support the relationship between alcohol use and inconsistent or non-use of condom use
The results have further shown that, for each occupation there is a unique set of modifiable alcohol consumption indicators that are correlated to particular risky sexual behaviour indicators. For example, among the fishermen frequent alcohol consumption, higher AUDIT score, getting drunk, longer time of drinking, days of drinking and time for drinking are all strongly correlated to engagement in transactional sex but not with other sexual behaviour indicators. Among traders, it is five of the six alcohol consumption indicators that are correlated with engagement in transactional sex while three of the factors are correlated with having more than one sexual partner. Among service providers four of the alcohol factors are correlated with having more than one sexual partner while five of the factors are correlated with having had transactional sex.
This study is subject to several limitations. First, the findings from two landing sites on Lake Victoria in Uganda may have limited generalizability to landing sites in other settings, such as those less close to an urban centre such as Kampala city. Second, due to the cross-sectional nature of this study, causal relationships for alcohol consumption and risky sexual behaviour cannot be established. Third, alcohol consumption and sexual risk behaviour may have been underreported since they were measured by self-reporting in a single survey and may also be subject to socially desirable responses; alternative methods, such as the Bogus Pipeline Method could potentially have increased the validity of self-report of alcohol consumption
. In this method, the person whose attitude or emotion is being measured is told that they are being monitored by a machine or a polygraph (lie detector), resulting in more truthful answers
Having got drunk in previous 30 days was taken to be a proxy measure of having got drunk in previous 12 months but this may not be a right measure for people who drink occasionally. Some people may not have got drunk in previous 30 days because there was no event that could expose them to alcohol consumption but they drank in a month preceding the previous one.