Sandfort, T.G.M., Knox, J.R., Alcala, C., et al. Journal of Acquired Immune Deficiency Syndromes (October 2017),76: e34-e46.
This systematic review of 68 studies examined associations between substance use and HIV among men who have sex with men (MSM) in sub-Saharan Africa. Only one of eight studies describing alcohol use found any link between alcohol use and HIV infection, though in one study alcohol consumption was marginally associated with lower pre-exposure prophylaxis adherence. One study found that alcohol consumption was associated with increased likelihood of numerous risky behaviors, including unprotected anal intercourse, multiple sexual partners, and lack of partner disclosure. The proportion of men reporting sex under the influence of alcohol ranged from 47.3 percent in South Africa to 77.5 percent in Kenya. Drug use and its association with HIV depended on the type of drug, whether/how it was injected, and HIV prevalence. The proportion of men reporting drug use ranged from 7 percent in the past year in Nigeria to 61.2 percent in the last three months in Zanzibar. Reported injection drug use ranged from 1.4 percent in Kenya to 13.9 percent in Tanzania, and was associated with having two or more male receptive partners, group sex, and symptoms of sexually transmitted infections. The authors concluded that future interventions for MSM should be contextually based on local alcohol and drug use practices and their link to risky sex.