Alcohol and sexual risk: An event–level analysis in commercial sex setting

• We modeled on alcohol use and sexual behaviors with clients among sex workers.
• We examined the event–level associations between alcohol use and sexual risk.
• Alcohol use increases the likelihood of unprotected sex with clients.
• Effect size of alcohol use declines with an increase in the number of clients.
• A larger number of drinks were related to more unprotected sex.

ObjectiveTo assess the episodic relationship between alcohol and sexual risk in multiple-client occasions among female sex workers (FSWs).MethodsData on alcohol use and sexual episodes with clients from the past two days were collected among FSWs in Guangxi, China (N = 336 for yesterday, and N = 299 for the day before yesterday). Logistic regression using generalized estimating equations with robust variance estimation was used to assess the alcohol–sexual risk relationship, controlling for contextual variables salient in the setting of commercial sex.ResultsAlcohol use among FSWs was associated with a higher likelihood of unprotected sex with clients during both days. This relationship was modified by the number of clients received within a day. Additionally, having a larger number of drinks was associated with higher odds of unprotected sex, but the association was not consistent across the two days.ConclusionFindings from the study support an association between alcohol use and sexual risk among FSWs. The design of alcohol and sexual risk reduction intervention among FSWs in China may take advantage of the interaction between contextual factors and alcohol use on sexual risk.