Hazardous alcohol use associated with increased sexual risk behaviours among people who inject drugs

Background—Alcohol is associated with a multitude of severe health consequences. While risk behaviours related to illicit drug use are commonly studied among people who inject drugs (PWID), the role of alcohol use has received substantially less attention in this population. We explored whether drug and sexual risk behaviours as well as experiences of violence were associated with hazardous alcohol use in a cohort of PWID. Methods—Analyses were conducted using observational data from a prospective cohort of community-recruited HIV-negative PWID in Vancouver, Canada. We used the US National Institute on Alcohol Abuse and Alcoholism definition of hazardous alcohol use (i.e., > 14 drinks/week or > 4 drinks on one occasion for men, and > 7 drinks/week or > 3 drinks on one occasion for women.) We used multivariable generalized estimating equations to identify factors associated with hazardous alcohol use. Results—Between 2006 and 2012, 1114 HIV-negative individuals were recruited, and 186 (16.7%) reported hazardous alcohol use in the previous six months at baseline. In multivariable GEE analyses, having multiple sex partners (Adjusted Odds Ratio [AOR] = 1.25), history of sexually transmitted infection (AOR = 1.50), experiencing violence (AOR = 1.36) and incarceration (AOR = 1.29) were each independently associated with hazardous alcohol use. Caucasian ethnicity (AOR = 0.56), ≥ daily heroin injection (AOR = 0.81) and engagement in addiction treatment (AOR = 0.84) were negatively associated with hazardous alcohol use (all p