Abler, L., Sikkema, K. J., Watt, M. H., et al. Journal of Acquired Immune Deficiency Syndromes (March 2015), Vol. 68, Issue 3, pp. 322–328.
Following a secondary analysis of data from a 2009–2012 study of 560 women patrons of 12 alcohol serving venues in Cape Town, South Africa, the authors developed a model estimating the effects of and interrelationships among traumatic stress, alcohol use, and unprotected sex. Eighty percent of participants reported elevated levels of traumatic stress, and 88 percent reported hazardous alcohol use. The authors' analysis showed that alcohol use was a significant behavioral facilitator that influenced the effect of traumatic stress on sexual risk behavior. Also, women with significant symptoms of traumatic stress (independent of alcohol use) were 82 percent more likely to have unprotected sex than women without traumatic stress. Similarly, high alcohol use was associated with higher rates of unprotected sex, regardless of traumatic stress levels. The authors concluded that women who had both traumatic stress and alcohol abuse were at higher risk for HIV, and that problem drinking exacerbated the relationship between trauma experiences and sexual risk behavior. They recommended that interventions to reduce the impact of alcohol use on HIV risk should be adapted to address both traumatic stress and alcohol use.