Men’s heavy alcohol use and risk of HIV acquisition and transmission to sexual partners within marriage in India

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Article (peer-reviewed)

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Background: Heavy episodic drinking by men in India and elsewhere is associated with their sexual risk behaviors, thereby increasing the risk for HIV. This paper assesses whether heavy episodic drinking is associated with acquisition of HIV among married men and its transmission to their spouses in India. Methods: A case-control study was conducted from March-August 2010 among 595 cases (HIV positives) and 611 controls (HIV negatives) aged 18 years and above, recruited from HIV testing and treatment centers in seven districts of eastern and northern India. Logistic regression analyses were used to assess the associations between heavy episodic drinking (defined based on frequency and quantity) in the past 7 days and the following outcome variables: extramarital sex, men’s HIV status and their spouse’s HIV status. Results: No significant difference was observed in the HIV status of men reporting heavy episodic drinking and those reporting light drinking (41% vs. 50%, adjusted odds ratio [AOR] = 0.7, 95% confidence interval [CI] = 0.5-1.0, p=0.083). However, men reporting heavy episodic drinking were more likely to have had sex with a paid partner (past 12 months) than light drinkers (25% vs. 12%, AOR = 3.0; 95% CI = 1.9-4.7, p < 0.001). A higher proportion of men who were heavy episodic drinkers reported having an HIV positive wife than light drinkers (53% vs. 42%, AOR = 4.1; 95% CI = 1.8-9.2, p < 0.001). Conclusions: Men’s heavy episodic drinking is associated with higher prevalence of HIV infection among their spouses. Prevention of heavy episodic drinking and associated men’s risk behaviors may augment efforts to reduce the secondary transmission of HIV.