Substance Use and HIV Infection Awareness among HIV-Infected Female Sex Workers in Lilongwe, Malawi

Highlights

• Over half of HIV-infected FSW reported hazardous, harmful, or dependent alcohol use
• Increased alcohol use was associated with lack of HIV infection awareness
• Marijuana use was uncommon among HIV-infected FSW

Abstract

Background

HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and marijuana use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi.

Methods

From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and marijuana use and lack of HIV infection awareness.

Results

Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current marijuana use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5).

Conclusion

Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.

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By:  Kathryn E. Lancaster, Vivian F. Go, Thandie Lungu, Pearson Mmodzi, Mina C. Hosseinipour, Katy Chadwick, Kimberly A. Powers, Brian W. Pence, Irving F. Hoffman, William C. Miller

Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America

Correspondence

Corresponding author. University of North Carolina Institute of Global Health and Infectious Diseases 130 Mason Farm Rd Chapel Hill, NC 27599 USA. Tel.: +919 966 2536; fax: +919 966 6714.

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