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Relationship Between Community-Level Alcohol Outlet Accessibility and Individual-Level Herpes Simplex Virus Type 2 Infection Among Young Women in South Africa

Rosenberg, Molly PhD*†‡; Pettifor, Audrey PhD†‡§; Lippman, Sheri A. PhD§¶; Thirumurthy, Harsha PhD‡∥; Emch, Michael PhD†‡**; Miller, William C. MD, PhD†††; Selin, Amanda MHS; Gómez-Olivé, Francesc Xavier MD, PhD§‡‡; Hughes, James P. PhD§§; Laeyendecker, Oliver PhD¶¶∥∥; Tollman, Stephen MMed, PhD§‡‡***; Kahn, Kathleen MBBCh, PhD§‡‡***

Sexually Transmitted Diseases: May 2015 - Volume 42 - Issue 5 - p 259–265
doi: 10.1097/OLQ.0000000000000263
Original Study

Background Exposure to alcohol outlets may influence sexual health outcomes at the individual and community levels. Visiting alcohol outlets facilitates alcohol consumption and exposes patrons to a risky environment and network of potential partners, whereas the presence of alcohol outlets in the community may shift social acceptance of riskier behavior. We hypothesize that living in communities with more alcohol outlets is associated with increased sexual risk.

Methods We performed a cross-sectional analysis in a sample of 2174 South African schoolgirls (ages 13–21 years) living across 24 villages in the rural Agincourt subdistrict, underpinned by long-term health and sociodemographic surveillance. To examine the association between number of alcohol outlets in village of residence and individual-level prevalent herpes simplex virus type 2 (HSV-2) infection, we used generalized estimating equations with logit links, adjusting for individual- and village-level covariates.

Results The median number of alcohol outlets per village was 3 (range, 0–7). Herpes simplex virus type 2 prevalence increased from villages with no outlets (1.4% [95% confidence interval, 0.2–12.1]), to villages with 1 to 4 outlets (4.5% [3.7–5.5]), and to villages with more than 4 outlets (6.3% [5.6, 7.1]). An increase of 1 alcohol outlet per village was associated with an 11% increase in the odds of HSV-2 infection (adjusted odds ratio [95% confidence interval], 1.11 [0.98–1.25]).

Conclusions Living in villages with more alcohol outlets was associated with increased prevalence of HSV-2 infection in young women. Structural interventions and sexual health screenings targeting villages with extensive alcohol outlet environments could help prevent the spread of sexually transmitted infections.

A study of young women in rural South Africa found that living in communities with more alcohol outlets was associated with increased likelihood of herpes simplex virus type 2 infection.

From the *Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA; †Department of Epidemiology, Gillings School of Global Public Health, and ‡Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; §MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ¶Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA; ∥Department of Health Policy and Management, Gillings School of Global Public Health, **Department of Geography, and ††Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡‡INDEPTH Network, Accra, Ghana; §§Department of Biostatistics, University of Washington, Seattle, WA; ¶¶Laboratory of Immunoregulation, NIAID, NIH, Baltimore, MD; ∥∥Department of Medicine, Johns Hopkins University, Baltimore MD; and ***Centre for Global Health Research, Umeå University, Umeå, Sweden.

Acknowledgments: The authors would like to acknowledge the time and effort of those involved in the collection of data used in this study, especially the field staff and the study participants themselves.

Funding: This research was funded by the National Institutes of Health through Grant Nos. T32 HD007168 and R24 HD050924 to the Carolina Population Center. The parent study described was supported by Award Nos. 5R01MH087118-02, 5U01AI069423-04, and UM1 AI068619 from the National Institute of Allergy and Infectious Diseases, and the community mapping data were supported by 1R21MH090887-01 from the National Institute of Mental Health. The Agincourt Health and Socio-demographic Surveillance System is supported by the University of the Witwatersrand, Johannesburg; the South African Medical Research Council; and the Wellcome Trust, UK (Grant Nos. 058893/Z/99/A, 069683/Z/02/Z, and 085477/Z/08/Z). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health.

Correspondence: Molly Rosenberg, PhD, Center for Population and Development Studies, Harvard University, 9 Bow St, Cambridge, MA 02138. E-mail:

Received for publication November 4, 2014, and accepted February 11, 2015.

© Copyright 2015 American Sexually Transmitted Diseases Association