Alcohol Use and Sexual Behaviour among Men who have Sex with Men in Kampala, Uganda

Aim: The aim of this study was to investigate alcohol use among men who have sex with men (MSM) in the Kampala Metropolitan District, and determine how alcohol use may relate to sexual behavior.

Study Design: A cross sectional study was conducted among MSM aged 18 years and above.

Place and Duration of Study: The study was conducted in Uganda’s Kampala Metropolitan District (including the neighboring suburbs of Mukono and Wakiso). Data collection was undertaken between June and September 2016.

Methods: A mixed-methods study which used Respondent-driven sampling (RDS) to recruit MSM ≥18 years who reported anal sex with another man in the previous six months. MSM were interviewed in over 6 waves. Quantitative data was collected using semi-structured questionnaires and analyzed using SPSS and STATA while qualitative data was collected using focus group discussions, key informant guides and analyzed thematically.

Results: A total of 129 MSM participated in the study with a median age of 25 years (inter quartile range, 21–29 years). The prevalence of alcohol use was 84% [CI (76%-91%)] while knowledge on national laws restricting alcohol use was 66%. Taking alcohol before sex had a significant relationship (p=0.011) as did membership in a Community-based Organisation (CBO) - MSM in CBOs were 8 times more likely to be involved in sex work (p=0.005) with alcohol use. Bivariate analysis indicated that higher education level reduced the chances of engaging in sex work by 78%. However alcohol use did not influence unprotected Insertive Anal Intercourse (IAI) (p = 0.517), Receptive Anal Intercourse (RAI) (p = 0.768) or coercion into sex (p= 0.058).

Conclusion: Majority of MSM use alcohol to enhance confidence and pleasure while knowledge of the laws restricting its usage and dangers does not determine use. It is therefore essential to address mostly the behavioral issues associated with alcohol use in order to achieve reduction of alcohol-related problems and sexual illnesses including HIV among high-risk populations.