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Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs

An Event-Level Analysis

Zule, William A., DrPH*; Speizer, Ilene S., PhD; Browne, Felicia A., ScD, MPH*; Howard, Brittni N., BA*; Wechsberg, Wendee M., PhD*†‡§

doi: 10.1097/OLQ.0000000000000881
Original Studies

Background High rates of alcohol and other drug use contribute to the ongoing generalized human immunodeficiency virus epidemic in South Africa. Despite the general link between alcohol use and condomless sex, findings from event-level studies of the relationship between alcohol use and condomless sex during the same encounter have been inconsistent.

Methods We conducted event-level analyses of the most recent sexual encounter reported by 636 women who use substances in Pretoria. Data were collected via a questionnaire that included questions about the number of rounds of vaginal and anal sex and condom use during each round. We used multiple logistic regression analyses to model the associations between alcohol use by both partners and having multiple rounds of sex, and alcohol use and condom use during all rounds of sex.

Results Over 50% of encounters involved multiple rounds of vaginal or anal sex. Encounters that involved multiple rounds of sex were associated with inconsistent condom use. Encounters in which both partners drank alcohol were more likely to involve condomless sex, as compared with encounters in which one or neither partner drank alcohol.

Conclusions These findings raise the possibility that prior event-level studies, which do not ask about multiple rounds of sex, may underestimate the prevalence of condomless sex. The association between alcohol use by both partners and condomless sex may partially explain inconsistent associations between alcohol use and condom use in event-level studies that did not assess the number of partners drinking.

In a study of women who use drugs and alcohol, 54% engaged in multiple rounds of sex during their last sexual encounter. Condom use was lower when both partners drank.

From the *RTI International, 3040 East Cornwallis Road, Research Triangle Park, Durham;

Gillings School of Global Public Health, University of North Carolina, Chapel Hill;

Psychology in the Public Interest, North Carolina State University, Raleigh; and

§Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC

Sources of Support: Research reported in this publication was supported by the National Institutes of Health, National Institute on Drug Abuse under award R01DA032061.

Conflict of Interest: None declared.

Correspondence: William A. Zule, PhD, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709. E-mail:

Received for publication March 29, 2018, and accepted June 20, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association