Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town, South Africa

ObjectiveThis study examined the association between alcohol use and sexual behaviors among South African adults who reported current drinking.MethodStreet-intercept surveys were administered to adults residing in neighborhoods in a South African township.ResultsAnalyses were restricted to participants reporting current drinking (N = 1285; mean age = 32; 27% women; 98% Black). Most participants (60%) reported heavy episodic drinking (i.e., 5 or more drinks on a single occasion) at least once per week in the past 30 days. Compared to non-heavy episodic drinkers, participants who reported heavy episodic drinking were more likely to drink before sex (79% vs. 66%) and have sex with a partner who had been drinking (59% vs. 44%). Overall, drinking before sex (self or partner) and heavy episodic drinking was associated with multiple sexual partners, discussing condom use with sexual partner(s), and proportion of protected sex. The frequency of condom use varied among participants with steady, casual, or both steady and casual sexual partners.ConclusionsAlcohol use among South African adults is associated with sexual risk behaviors, but this association differs by partner type. Findings suggest the need to strengthen alcohol use components in sexual risk reduction interventions especially for participants with both steady and casual sex partners.

► Alcohol use is associated with sexual risk behaviors among South Africans.
► The alcohol-risky behavior association varies by individual and contextual factors.
► Findings suggests the need to include alcohol content in HIV prevention programs.