Abstract
Background: Alcohol consumption is associated with risky sex, which increases the risk of acquiring and transmitting HIV.
Objective: To examine the prevalence of, and associations among alcohol, risky sex, and HIV, in Nigeria.
Methods: We searched electronic databases and reviewed reference sections of relevant papers to locate studies that sampled people living in Nigeria and assessed both alcohol and sexual risk behavior. We calculated effect sizes to determine (a) prevalence of alcohol and sex behaviors and (b) associations between alcohol consumption and risky sex, and examined moderators to determine if sample characteristics predicted behavioral or biological outcomes.
Results: Of the 696 unique records identified, 35 manuscripts reporting on 42 separate studies met the inclusion criteria. Participants in these studies (N = 83,350; M age = 26 years; 48% women; 10% HIV-infected) reported high rates of heavy drinking (63%) and low rates of consistent condom use (24%). One-third of participants (30%) also reported using alcohol before sexual activity. Participants who consumed alcohol were more likely to report sexual activity (OR = 3.66, 95% CI = 3.09, 4.33), multiple partners (OR = 3.22, 95% CI = 2.38, 4.36), and condomless sex or inconsistent use of condoms (OR = 2.30, 95% CI = 1.54, 3.43).
Conclusion: High rates of heavy drinking and low rates of condom use have been well-documented in Nigeria. Results from this meta-analysis can be used to inform critically needed alcohol-related HIV interventions.
Keywords: Nigeria, alcohol, sexual risk behaviors, HIV, meta-analysis, alcohol consumption.
Graphical Abstract
[1]
Joint United Nations Programme on HIV/AIDS. The Gap Report
2014 [January 23, 2018]. Available from. http: //www.unaids. Org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
[2]
World Health Organization. Global Status Report on Alcohol and
Health 2014 [December 31, 2017]. Available from. 2014.http: //www.who.int/substance_abuse/publications/global_alcohol_report/profiles/nga.pdf?Ua=1
[3]
Scott-Sheldon LAJ, Carey KB, Cunningham K, Johnson BT, Carey MP. Alcohol use predicts sexual decision-making: A systematic review and meta-analysis of the experimental literature. AIDS Behav 2016; 20: 19-39.
[4]
Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS, a systematic review. Alcohol Alcohol 2010; 45(2): 159-66.
[5]
Cook RT. Alcohol abuse, alcoholism, and damage to the immune system- A review. Alcohol Clin Exp Res 1998; 22(9): 1927-42.
[6]
Joint United Nations Programme on HIV/AIDS HIV and AIDS Estimates: Nigeria 2014 [January 23, 2018]. Available from. http: //www.unaids.org/en/regionscountries/countries/nigeria
[7]
National Agency for the Control of AIDS Federal Republic of Nigeria: Global AIDS Response. Country Progress Report. Abuja, Nigeria 2014 [January 23, 2018]. Available from. http: //www.unaids.org/sites/default/files/country/documents/NGA_narrative_report_2014.pdf
[8]
Federal Republic of Nigeria Global AIDS Response Country Progress Report Abuja, Nigeria: National Agency for the Control of AIDS; 2015 [August 15, 2017]. Available from. http: //www.unaids.org/sites/default/files/country/documents/NGA_narrative_report_2015.pdf
[9]
Orubuloye IO, Caldwell JC, Caldwell P. Perceived male sexual needs and male sexual behavior in southwest Nigeria. Soc Sci Med 1997; 44(8): 1195-207.
[10]
Obidoa CA, Cromley RG. A geographical analysis of HIV/AIDS infection in Nigeria, 1991-2001. J Soc Behav Health Sci 2012; 6(1): 13-29.
[11]
National Agency for the Control of AIDS. National HIV Strategy for Adolescents and Young People: 2016-2020 2016 [January 23, 2018]. Available from. http: //www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---ilo_aids/documents/legaldocument/ wcms _532857.pdf
[12]
Pierri Z, Barkindo A. Muslims in northern Nigeria: Between challenge and opportunity. In mason, editor. Muslim minority-state relations: Violence, integration, and policy. New York: Palgrave Macmillan US; 2016: p. 133-53.
[13]
Chikere EI, Mayowa MO. Prevalence and perceived health effect of alcohol use among male undergraduate students in Owerri, South-East Nigeria: A descriptive cross-sectional study. BMC Public Health 2011; 11(1): 118.
[14]
Abayomi O, Onifade PO, Adelufosi AO, Akinhanmi AO. Psychosocial correlates of hazardous alcohol use among undergraduates in southwestern Nigeria. Gen Hosp Psychiatry 2013; 35(3): 320-4.
[15]
World Health Organization. Global Status Report on Alcohol and Health 2018. Geneva, Switzerland: World Health Organization, Department of Mental Health and Substance Abuse 2018.
[16]
Dumbili EW. Changing patterns of alcohol consumption in Nigeria: An exploration of responsible factors and consequences. Medical Sociology Online 2013; 7(1): 20-33.
[17]
Dumbili EW. Patterns and determinants of alcohol use among Nigerian University students: An overview of recent developments. Afr J Drug Alcohol Stud 2013; 12(1): 29-51.
[18]
Central Intelligence Agency. The World Factbook: Central Intelligence Agency; [August 16, 2017]. Available from. https: //www.cia.gov/library/publications/the-world-factbook/geos/ni.html
[19]
Moss AC, Albery IP. A dual-process model of the alcohol-behavior link for social drinking. Psychol Bull 2009; 135(4): 516-30.
[20]
Steele CM, Josephs RA. Alcohol myopia: Its prized and dangerous effects. Am Psychol 1990; 45(8): 921-33.
[21]
Bryant KJ, Nelson S, Scott Braithwaite R, Roach D. Integrating hiv/aids and alcohol research. Alcohol Health Res World 2010; 33(3): 167.
[22]
Adamczyk A, Hayes BE. Religion and sexual behaviors: Understanding the influence of Islamic cultures and religious affiliation for explaining sex outside of marriage. Am Sociol Rev 2012; 77(5): 723-46.
[24]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement The PRISMA statement. Ann Intern Med 2009; 151(4): 264-9.
[25]
Cohen J. Statistical Power Analysis of the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum 1998.
[26]
Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 1979; 86(2): 420.
[28]
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327(7414): 557-60.
[29]
Ekong PS, Ducheyne E, Carpenter TE, et al. Spatio-temporal epidemiology of highly pathogenic avian influenza (H5N1) outbreaks in Nigeria, 2006-2008. Prev Vet Med 2012; 103(2): 170-7.
[30]
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996; 17(1): 1-12.
[31]
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52(6): 377-84.
[32]
Fowkes FG, Fulton PM. Critical appraisal of published research: Introductory guidelines. BMJ 1991; 302(6785): 1136-40.
[33]
Brahmbhatt H, Kågesten A, Emerson M, Decker MR, Olumide AO, Ojengbede O, et al. Prevalence and determinants of adolescent pregnancy in urban disadvantaged settings across five cities. J Adolesc Health 2014; 55: S48-57.
[34]
Imaledo JA, Peter-Kio OB, Asuquo EO. Pattern of risky sexual behavior and associated factors among undergraduate students of the University of Port Harcourt, Rivers State, Nigeria. Pan Afr Med J 2012; 12: 16.
[35]
Nigeria Federal Ministry of Health. National HIV/AIDS and Reproductive Health Survey. Nigeria. 2005.
[36]
Oye-Adeniran BA, Aina OF, Gbadegesin A, Ekanem EE. Substance use and sexual behaviour among female students in Nigerian universities. Int Q Community Health Educ 2014; 35(1): 73-83.
[37]
Sekoni AO, Onajole AT, Odeyemi KO, Otoh DO. The effects of health education on sexual behavior and uptake of HIV counseling and testing among out of school youths in a Nigerian border market. J Med Trop 2011; 2011: 13(1).
[38]
Bamidele JO, Asekun-Olarinmoye EO, Odu OO, Amusan OA, Egbewale BE. Sociodemographic characteristics and health risk behaviours among students of a tertiary institution in south western Nigeria. Afr J Med Med Sci 2007; 36(2): 129-36.
[39]
Owoaje ET, Uchendu OC. Sexual risk behaviour of street youths in south west Nigeria. East Afr J Public Health 2009; 6(3): 274-9.
[40]
Adoga MP, Banwat EB, Forbi JC, et al. Human immunodeficiency virus, hepatitis B virus and hepatitis C virus: Sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria. J Infect Dev Ctries 2009; 3: 539-47.
[41]
Etukumana EA, Thacher TD, Sagay AS. HIV risk factors among pregnant women in a rural Nigerian hospital. West Indian Med J 2010; 59(4): 424-8.
[42]
Ezugwu EC, Agu P, Ohayi SA, Okeke TC, Dim CC, Obi SN. HIV sero-prevalence among pregnant women in a resource constrained setting, South East Nigeria. Niger J Med 2012; 21(3): 338-42.
[43]
Adeyemi AO, Fakunle O, Adesola SO. HIV prevention strategy: Assessing predictors of HIV infection among female sex workers towards participation in HIV vaccine trial. AIDS Res Hum Retroviruses 2010; 26(10): A95.
[44]
Cheng Y, Li X, Lou C, et al. The association between social support and mental health among vulnerable adolescents in five cities: Findings from the study of the well-being of adolescents in vulnerable environments. J Adolesc Health 2014; 55(6)(Suppl.): S31-8.
[45]
Decker MR, Marshall BD, Emerson M, et al. Respondent-driven sampling for an adolescent health study in vulnerable urban settings: A multi-country study. J Adolesc Health 2014; 55(6)(Suppl.): S6-S12.
[46]
Decker MR, Peitzmeier S, Olumide A, et al. Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15-19 years in vulnerable urban environments: A Multi-country study. J Adolesc Health 2014; 55(6)(Suppl.): S58-67.
[47]
Marshall BD, Astone N, Blum RW, et al. Social capital and vulnerable urban youth in five global cities. J Adolesc Health 2014; 55(6)(Suppl.): S21-30.
[48]
Mmari K, Blum R, Sonenstein F, et al. Adolescents’ perceptions of health from disadvantaged urban communities: Findings from the WAVE study. Soc Sci Med 2014; 104: 124-32.
[49]
Mmari K, Lantos H, Blum RW, et al. A global study on the influence of neighborhood contextual factors on adolescent health. J Adolesc Health 2014; 55(6)(Suppl.): S13-20.
[50]
Mmari K, Lantos H, Brahmbhatt H, et al. How adolescents perceive their communities: A qualitative study that explores the relationship between health and the physical environment. BMC Public Health 2014; 14: 349.
[51]
Olumide AO, Robinson AC, Levy PA, et al. Predictors of substance use among vulnerable adolescents in five cities: Findings from the well-being of adolescents in vulnerable environments study. J Adolesc Health 2014; 55(6)(Suppl.): S39-47.
[52]
Sonenstein FL. Introducing the well-being of adolescents in vulnerable environments study: Methods and findings. J Adolesc Health 2014; 55(6)(Suppl.): S1-3.
[53]
Dada JO, Olaseha IO, Ajuwon AJ. Sexual behavior and knowledge of AIDS among female trade apprentices in a Yoruba town in south-western Nigeria. Int Q Community Health Educ 1998; 17(3): 255-70.
[54]
Eke AN. Socializing influences on HIV/AIDS-Related risk behaviors among adolescents in Nigeria [Dissertation]. Baltimore, Maryland: Johns Hopkins University 1997.
[55]
Essien EJ, Meshack A, Ekong E, et al. Effectiveness of a situationally-based HIV risk-reduction intervention for the Nigerian Uniformed Services on readiness to adopt condom use with casual partners. Counsell Psychother Health 2005; 1(1): 19-30.
[56]
Essien EJ, Ogungbade GO, Kamiru HN, Ekong E, Ward D, Holmes L. Emerging sociodemographic and lifestyle predictors of intention to use condom in human immunodeficiency virus intervention among uniformed services personnel. Mil Med 2006; 171(10): 1027-34.
[57]
Essien EJ, Ogungbade GO, Ward D, et al. Influence of educational status and other variables on human immunodeficiency virus risk perception among military personnel: A large cohort finding. Mil Med 2007; 172(11): 1177-81.
[58]
Ross MW, Essien EJ, Ekong E, et al. The impact of a situationally focused individual human immunodeficiency virus/sexually transmitted disease risk-reduction intervention on risk behavior in a 1-year cohort of Nigerian military personnel. Mil Med 2006; 171(10): 970-5.
[59]
Holmes L, Ogungbade G, Ward DD, Ross MW, Ekong E, Essien EJ. Epidemiologic and behavioral characterization of knowledge of condom use and modeling among military personnel. Afr J Reprod Health 2008; 12(2): 32-44.
[60]
Essien EJ, Mgbere O, Monjok E, Ekong E, Holstad MM, Kalichman SC. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel. Soc Sci Med 2011; 72(1): 63-71.
[61]
Mgbere O, Monjok E, Abughosh S, Ekong E, Holstad MM, Essien EJ. Modeling covariates of self-perceived and epidemiologic notions of risk for acquiring stis/HIV among military personnel: A comparative analysis. AIDS Behav 2013; 17(3): 1159-75.
[62]
Essien EJ, Monjok E, Chen H, et al. Correlates of HIV knowledge and sexual risk behaviors among female military personnel. AIDS Behav 2010; 14(6): 1401-14.
[63]
Essien EJ, Mgbere O, Monjok E, Ekong E, Abughosh S, Holstad MM. Predictors of frequency of condom use and attitudes among sexually active female military personnel in Nigeria. HIV AIDS (Auckl) 2010; 2: 77-88.
[64]
Ibigbami OI. The relationship between personality traits, alcohol use and risky sexual behavior in an undergraduate student population in south-western Nigeria. Lagos, Nigeria: The West African College of Physicians 2004.
[65]
Isiugo-Abanihe UC, Erinosho O, Ushie B, Aderinto A, Sunmola G, Joseph R. Age of sexual debut and patterns of sexual behaviour in two local government areas in southern Nigeria. Afr J Reprod Health 2012; 16(4): 81-94.
[66]
Research Alliance to Combat HIV and AIDS. Social dimensions of HIV and AIDS prevention: HIV/AIDS related risk behaviors and testing & counselling in Nigeria. Evanston, IL. 2010.
[67]
Iyaniwura CA, Mautin G. Sexual activity and other related practices among youth corpers in Nigeria. West Afr J Med 2008; 27(1): 13-9.
[68]
Lawal RA, Adeyemi JD, Akinhanmi AA, et al. A rapid situation assessment of sexual risk behaviour of alcohol users in Lagos, Nigeria. Niger Postgrad Med J 2007; 14(3): 180-9.
[69]
Lawal RA. A rapid situation assessment of alcohol in relation to sexual behaviour in lagos, nigeria geneva, world health organization 2002 [january 23, 2018]. Available from.http: //www.who.int/iris/handle/10665/70794
[70]
Mbakwem-Aniebo C, Ezekoye CC, Okonko IO. Knowledge about HIV/AIDS and reported risk behaviors among freshmen of the University of Port Harcourt, Port Harcourt, Southern Nigeria. World Appl Sci J 2012; 16(8): 1093-103.
[71]
Mboto CI, Etok CA, Akinjogunla OJ, Iniewe UU. Behavioural and occupational risk factors associated with hepatitis B surface antigen (hbsag) among healthcare workers in a tertiary teaching hospital, in South Nigeria. J Microbiol Biotechnol Res 2014; 4(5): 1-8.
[72]
National Population Commission, ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro; November. 2009.
[73]
Vu L, Tun W, Karlyn A, Adebajo S, Ahonsi B. Attitudinal and behavioral factors associated with extramarital sex among Nigerian men: Findings from a national survey. Int J Sex Health 2011; 23(4): 258-68.
[74]
Momodu J. Attitudes, religious beliefs, knowledge of HIV, and its association with sexual risk behaviors in urban and rural regions of Nigeria. Ann Arbor: Walden University 2014.
[75]
Fatusi AO, Blum RW. Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents. BMC Public Health 2008; 8: 136.
[76]
Okonofua FE. Female and male infertility in Nigeria: Studies on the epidemiology of infertility in Nigeria with special reference to the role of genital tract infections and sexual and reproductive risk factors. Stockholm, Sweden: Karolinska Institutet 2005.
[77]
Okonofua F, Menakaya U, Onemu SO, Omo-Aghoja LO, Bergstrom S. A case-control study of risk factors for male infertility in Nigeria. Asian J Androl 2005; 7(4): 351-61.
[78]
Okulate G, Olayinka MO. Trends in HIV high risk behaviours in the Nigerian Army. Rev Int Serv Sante Forces Armees 2007; 80(4): 252.
[79]
Okulate GT, Jones OB, Olorunda MB. Condom use and other HIV risk issues among Nigerian soldiers: Challenges for identifying peer educators. AIDS Care 2008; 20(8): 911-6.
[80]
Oladepo O, Fayemi MM. Perceptions about sexual abstinence and knowledge of HIV/AIDS prevention among in-school adolescents in a western Nigerian city. BMC Public Health 2011; 11: 304.
[81]
Olaleye OS, Ajuwon AJ. Prevalence and factors associated with perpetration of non-consensual sex among students of a tertiary institution in Ibadan, Nigeria. Afr J Reprod Health 2012; 16(4): 108-18.
[82]
Olaleye OS, Ajuwon AJ. Experience of non-consensual sex among students in a tertiary institution in Ibadan, Nigeria. Sierra Leone J Biomed Res 2011; 3(3): 175-83.
[83]
Olley BO. Social and health behaviors in youth of the streets of Ibadan, Nigeria. Child Abuse Negl 2006; 30(3): 271-82.
[84]
Olley BO. Child sexual abuse as a risk factor for sexual risk behaviours among socially disadvantaged adolescents in Ibadan, Nigeria. Vulnerable Child Youth Stud 2008; 3(3): 243-8.
[85]
Olley BO. Date fighting and sexual risk behaviors among adolescents attending public schools in Ibadan, Nigeria. Gend Behav 2015; 13(1): 6515-21.
[86]
Olley BO. Child sexual abuse, harmful alcohol use and age as determinants of sexual risk behaviours among freshmen in a Nigerian University. Afr J Reprod Health 2008; 12(2): 75-88.
[87]
Sekoni AO, Odukoya OO, Onajole AT, Odeyemi KA. Sexually transmitted infections: Prevalence, knowledge and treatment practices among female sex workers in a cosmopolitan city in Nigeria. Afr J Reprod Health 2013; 17(1): 94-102.
[88]
Odukoya O, Sekoni AO, Onajole AT, Upadhyay RP. Alcohol consumption and cigarette smoking pattern among brothel based female sex workers in two local government areas in Lagos state, Nigeria. Afr Health Sci 2013; 13(2): 490-7.
[89]
Sunmola AM, Adebayo D, Olapegba M, Alarape A. The experience of condom use and other sexual risk practices among male brewery employees who recently migrated in Nigeria. Health Educ J 2006; 65(3): 288-301.
[90]
Sunmola AM. Factors associated with consistent condom use by employees in the brewery industry in Nigeria. SAHARA J 2004; 1(1): 27-34.
[91]
Sunmola AM, Olley BO, Oso GE. Predictors of condom use among sexually active persons involved in compulsory national service in Ibadan, Nigeria. Health Educ Res 2007; 22(4): 459-72.
[92]
Tobin-West CI, Maduka O, Onyekwere VN, Tella AO. Awareness, acceptability, and use of female condoms among university students in Nigeria: Implications for STI/HIV prevention. Int J Adolesc Med Health 2014; 26(2): 259-65.
[93]
Van de Mortel TF. Faking it: Social desirability response bias in self-report research. Aust J Adv Nurs 2008; 25(4): 40.
[94]
A clickable map of Nigeria exhibiting its 36 states and the federal capital territory. https://uploadwikimediaorg/wikipedia/commons/ d/d2/Nigeria_politicalpng
[95]
Idoko J, Folayan MO, Dadem NY, Kolawole GO, Anenih J, Alhassan E. “Why should I take drugs for your infection?”: Outcomes of formative research on the use of HIV pre-exposure prophylaxis in Nigeria. BMC Public Health 2015; 15(1): 349.
[97]
Ucheaga DN, Hartwig KA. Religious leaders’ response to AIDS in Nigeria. Glob Public Health 2010; 5(6): 611-25.
[98]
Hasnain M. Cultural approach to HIV/AIDS harm reduction in Muslim countries. Harm Reduct J 2005; 2: 23.
[99]
Cooper ML. Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. J Stud Alcohol Suppl 2002; 14: 101-17.
[100]
Dir AL, Gilmore AK, Moreland AD, et al. What’s the harm? Alcohol and marijuana use and perceived risks of unprotected sex among adolescents and young adults. Addict Behav 2018; 76: 281-4.
[101]
Leigh BC. Alcohol and condom use: A meta-analysis of event-level studies. Sexually transmitted diseases 2002; 29(8): 476-82.
[102]
Alford S, Cheetham N, Hauser D. Science and success in developing
countries: Holistic programs that work to prevent teen pregnancy,
HIV, and sexually transmitted infections Washington, DC:
Advocates for Youth; 2005 [January 3, 2018] Available from http: //www.advocatesforyouth.org/storage/advfy/documents/sciencesuccess_developing.pdf
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