Epidemiology of Alcohol Misuse and Illicit Drug Use Among Young People Aged 15-24 Years in Fishing Communities in Uganda

Abstract

Background: Alcohol use and illicit drug use are global problems that increase substantially during adolescence, and heighten the risk of HIV infection. We determined the prevalence of and risk factors for alcohol misuse and illicit drug use among young Ugandans in fishing communities, a recognised “key population” for HIV infection. Methods: We conducted a cross-sectional survey among young people (15-24 years) in fishing communities in Koome, Uganda, in December 2017-July 2018. Using Audio Assisted Self-Interviewing, we collected data on sociodemographic characteristics and alcohol use, including Alcohol Use Disorders Identification Test (AUDIT) and timeline-follow-back-calendar (TLFB). Blood samples were analysed for HIV, HSV2, and phosphatidyl ethanol (PEth 16:0/18:1). Urine samples were analysed for illicit drugs. Findings: Among 1281 participants (52.7% male, mean age 20 years), 659 (51.4%) reported ever drinking alcohol, 248 (19.4%) had 12-month-AUDIT≥8, and 261 (20.5%) had whole blood PEth 16:0/18:1 concentration ≥20ng/mL indicating significant consumption. In multivariable analyses, PEth 16:0/18:1≥20ng/mL, AUDIT≥8 and binge drinking (≥6 standard drinks per drinking occasion in the previous month from TLFB) were all strongly associated with older age, low education, smoking, and HSV2. Illicit drug use prevalence was 4.4% and was associated with older age, low education, being single, and smoking. Interpretation: Levels of alcohol misuse were high among young people in fishing communities and associated with HSV2, a proxy for risky sexual behaviour. Alcohol and illicit drug harm reduction services and HIV prevention programs in Uganda should prioritise young people in fishing communities. Funding Statement: This award is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, and by the MRC Tropical Epidemiology Group (TEG). This work was funded in part by IAVI and made possible by the support of many donors, including: the Bill & Melinda Gates Foundation, the Ministry of Foreign Affairs of Denmark, Irish Aid, the Ministry of Finance of Japan in partnership with The World Bank, the Ministry of Foreign Affairs of the Netherlands, the Norwegian Agency for Development Cooperation (NORAD), the United Kingdom Department for International Development (DFID), and the United States Agency for International Development (USAID). Declaration of Interests: E Webb and H Weiss received salary funding from MRC Grant Reference MR/K012126/1. Other authors have no conflict of interest to declare. Ethic Approval Statement: We obtained ethical approval from the Uganda Virus Research Institute research and ethics committee, the London School of Hygiene and Tropical Medicine ethics committee, and the Uganda National Council for Science and Technology. Any participants requiring medical treatment were referred to nearby government health centres where free treatment was offered.