Motivation for alcohol use in the context of commercial sex work and its influence on sexual risk: A qualitative study in Ugandan fishing communities

Introduction

In the fishing communities surrounding Lake Victoria, HIV prevalence is estimated to be as high as 28%, compared to 7.3% in the general Ugandan population. Commercial sex work and heavy alcohol use have been identified as major contributing factors to the elevated HIV risk, but little is known about the factors that influence alcohol use during sex, especially in the context of commercial sex work.

Methods

A total of 50 individuals (23 male, 27 female) participated in one of eight focus group discussions conducted in Gerenge, Uganda: one group of CSWs (n=6), two groups of fishermen (n=13), two groups of fishmongers (n=13), two groups of alcohol sellers (n=12), and one group of restaurant owners (n=6). Focus group data was analyzed using a content analysis approach.

Results

The main motivation for alcohol use during sex and engaging in commerical sex among fishermen was for leisure. CSWs were motivated to use alcohol during sex to become more sexually forward with clients, to gain control over clients, and to cope with the stressors of their work. Alcohol use was said to increase the likelihood of unprotected sex through several pathways, including impaired judgment, reduced perceived vulnerability to HIV, and increased aggression from male clients.

Conclusion

These findings highlight the need to focus on alcohol reduction as a strategy toward HIV/AIDS prevention among Ugandan fishermen and CSWs. Interventions that alter sex-related alcohol outcome expectancies and teach alternative strategies to cope with stress among CSWs may be especially impactful.