Unhealthy Alcohol Use and Syndemic Vulnerability Among HIV-Negative MSM in Kisumu, Kenya: A Longitudinal Analysis of the Anza Mapema Cohort

Abstract

Unhealthy alcohol use is common among men who have sex with men (MSM) in Kenya and may contribute to HIV vulnerability through its association with sexual behaviors, violence exposure, substance use, and poor mental health. This secondary analysis used data from 636 HIV-negative MSM enrolled in the Anza Mapema cohort in Kisumu, Kenya. Generalized estimating equations were used to examine longitudinal associations between unhealthy alcohol use (AUDIT ≥8), heavy episodic drinking, and WHO AUDIT risk zones with sexual behaviors, violence and abuse, substance use, and moderate-severe depressive symptoms over 12 months. Unhealthy alcohol use was associated with transactional sex, violence and abuse, substance use, and moderate-severe depressive symptoms. Associations with condomless sex and multiple partnerships were attenuated after adjustment, although participants in the highest AUDIT risk category (Zone IV) remained at elevated risk for both outcomes. Among HIV-negative MSM in Kisumu, unhealthy alcohol use was most consistently associated with violence exposure, transactional sex, substance use, and moderate-severe depressive symptoms. Alcohol screening may help identify MSM at elevated risk across multiple HIV-relevant domains.