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AIDS and Behavior (2018) 22:2851–2860
https://doi.org/10.1007/s10461-018-2167-5
ORIGINAL PAPER
Alcohol and Cannabis Use and Sexual Risk Behaviors in the Malawi
Defence Force
Bonnie Robin Tran
1,2
· Anthony Davis
1,2
· Stanley I. Ito
1,2
· Faustin Matchere
1
· Elizabeth Reader
1,2
·
Victor Nkhoma
3
· Michael Grillo
1
· Alfred Chitsa Banda
3
Published online: 5 June 2018
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018
Abstract
Substance abuse is a public health priority in the context of the HIV epidemic, especially in military communities. This
cross-sectional study quantified alcohol and cannabis use in the Malawi Defence Force and investigated its associations
with condom use, transactional sex, multiple sexual partners, and sexual violence. Participants were 944 male and female
service members ≥ 18 years old. Data were collected in 2013 using a computer-assisted self-interview. Twenty-four per-
cent of men and women screened positive for hazardous and harmful drinking [Alcohol Use Disorders Identification Test
(AUDIT) score ≥ 8]. About 6% reported using cannabis in the past year and 10% reported using cannabis prior to 1 year ago.
Multivariable models found elevated adjusted odds of transactional sex and multiple sexual partners for men with an AUDIT
score ≥ 8, and men who reported ever using cannabis. The adjusted odds of experiencing sexual violence were also elevated
for men who reported ever using cannabis. These findings add to the growing concern that substance use may perpetuate
the HIV epidemic in Sub-Saharan Africa by increasing risky sexual behaviors. A comprehensive military HIV prevention
response should include substance use education and appropriate care and treatment for individuals screening positive for
hazardous and harmful drinking.
Keywords Alcohol abuse · Cannabis use · Military · Sub-Saharan Africa · Sexual behaviors
Introduction
Alcohol and cannabis use are associated with risky sexual
behaviors, making them significant public health priorities
to address in the HIV epidemic. Use of these substances may
affect cognitive processes [1, 2], impairing an individual’s
ability to process information, make decisions, and identify
potential risks with regards to sexual behaviors. Studies have
linked alcohol consumption to multiple and/or casual part-
ners, unprotected sex, and participation in transactional sex
[3, 4]. Cannabis use has been shown to be correlated with a
higher number of reported lifetime sexual partners, multiple
partners, and lower frequency of condom use [5, 6].
Military personnel are no exception to the detrimental
effects of alcohol and cannabis use. However, military per-
sonnel are exposed to different risk factors (e.g., deploy-
ment) that may influence their use compared to the gen-
eral population. Historically, service members have used
alcohol and other substances (including cannabis) to cope
with stress, hazardous situations, boredom, and being away
from family and friends for long periods of time [7, 8]. The
risk of developing new-onset heavy weekly drinking, binge
drinking, or alcohol-related problems has been shown to
increase with deployments or exposure to combat [9, 10].
Furthermore, increased experiences of traumatic events dur-
ing military service (e.g., “severe physical injury” or “killing
or mutilating someone”) were shown to be associated with
problematic alcohol use [11]. Alcohol and cannabis use may
lead to decreased work productivity and have profound nega-
tive effects on the physical and psychological well-being of
military personnel.
* Bonnie Robin Tran
bonnie.r.tran.ctr@mail.mil
1
Department of Defense HIV/AIDS Prevention Program,
Naval Health Research Center, Sylvester Road, San Diego,
CA 92106-3521, USA
2
Leidos Inc., Reston, VA, USA
3
Malawi Defence Force, Lilonge, Malawi
@Phil_Robichaud
@deepthiw
@JoseServera