Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

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

Research output: Contribution to journalArticle

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 cannabis 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 cannabis 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 cannabis 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.

Original languageEnglish (US)
JournalInternational Journal of Drug Policy
DOIs
StateAccepted/In press - Nov 16 2015
Externally publishedYes

Fingerprint

Malawi
Sex Workers
HIV Infections
HIV
Alcohols
Cannabis
Alcohol Drinking
History

Keywords

  • Alcohol
  • Cannabis
  • HIV testing
  • Sex work
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

Lancaster, K. E., Go, V. F., Lungu, T., Mmodzi, P., Hosseinipour, M. C., Chadwick, K., ... Miller, W. C. (Accepted/In press). Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi. International Journal of Drug Policy. https://doi.org/10.1016/j.drugpo.2016.02.020

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi. / Lancaster, Kathryn E.; Go, Vivian F.; Lungu, Thandie; Mmodzi, Pearson; Hosseinipour, Mina C.; Chadwick, Katy; Powers, Kimberly A.; Pence, Brian W.; Hoffman, Irving F.; Miller, William C.

In: International Journal of Drug Policy, 16.11.2015.

Research output: Contribution to journalArticle

Lancaster, KE, Go, VF, Lungu, T, Mmodzi, P, Hosseinipour, MC, Chadwick, K, Powers, KA, Pence, BW, Hoffman, IF & Miller, WC 2015, 'Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi', International Journal of Drug Policy. https://doi.org/10.1016/j.drugpo.2016.02.020
Lancaster, Kathryn E. ; Go, Vivian F. ; Lungu, Thandie ; Mmodzi, Pearson ; Hosseinipour, Mina C. ; Chadwick, Katy ; Powers, Kimberly A. ; Pence, Brian W. ; Hoffman, Irving F. ; Miller, William C. / Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi. In: International Journal of Drug Policy. 2015.
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AU - Lancaster, Kathryn E.

AU - Go, Vivian F.

AU - Lungu, Thandie

AU - Mmodzi, Pearson

AU - Hosseinipour, Mina C.

AU - Chadwick, Katy

AU - Powers, Kimberly A.

AU - Pence, Brian W.

AU - Hoffman, Irving F.

AU - Miller, William C.

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N2 - 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 cannabis 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 cannabis 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 cannabis 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.

AB - 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 cannabis 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 cannabis 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 cannabis 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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