Determinants of alcohol use, risky sexual behavior and sexual health problems among men in low income communities of Mumbai, India.

This paper summarizes the main results of the survey component of a mixed methods study of alcohol and sexual risk in a general population of young men 18-29 residing in low income communities in the Greater Mumbai area. The survey included demographic variables, and scales and indices measuring work related stress, social influence, exposure to alcohol in childhood, and currently, hyper masculinity, exposure to media and pornography, risk related leisure time activities and alcohol and alcohol/sex expectancies. Measures of alcohol use included frequency/amount/contextual use of six different types of alcohol, a general estimate of frequency and amount (AUDIT), and an estimate of total ml. alcohol consumed in the past 30 days, based on estimates of alcohol content in all types of alcohol consumed, by unit of consumption (glass, peg, bottle) etc. Sexual outcome measures included types and number of partners ever and in past year with and without alcohol, and a critical event with most recent partner (with or without alcohol) and culturally specific indicators of sexual health related to sexual risk taking. A cluster sampling protocol and the use of a screener produced a sample of 1239 men, 1071 thirty day drinkers and 161 nondrinkers. Logistic regression analysis (binary and multinomial) showed relationships between predictor variables and alcohol consumption and alcohol and sexual risk indicators as well as two of the sexual health indicators associated with extramarital sex. Risk behaviors are associated with higher levels of alcohol consumption in this low risk general population of married and unmarried men. Implications for intervention include: (a) reducing or eliminating home drinking, to reduce early childhood exposure; (b) including alcohol in sexual risk and HIV prevention programs; (c) improving couples (married or unmarried) communication to reduce men's search for sexual alternatives, and (d) treating garmi as an indicator of sexual risk taking rather than STIs.