Amplifying the HIV Risks - Patterns of alcohol and drugs among female sex workers and men who as sex with men in Mozambique

Abstract Background: Abusive alcohol and drug consumption can increase the risk of acquiring HIV due to compromised decision-making linked to risky sexual behaviors. In this study, we explore the patterns of hazardous alcohol and drug use and correlates among female sex workers (FSW) and men who as sex with men (MSM) in Mozambique. Methods: We conducted a secondary data analysis of a bio-behavioral survey (BBS) using a respondent-driven sampling method, which was conducted in five main urban areas of Mozambique from 2019-21. Selection criteria for the MSM were being a biological male with at least 18 years of age and reported oral or anal intercourse with a man in the previous 12 months; FSWs criteria was being a biological female with at least 15 years of age and reported exchanging sex for money, services or goods in the previous 6 months. Results: The prevalence of hazardous alcohol drinking was 47.1% for FSW and 48.9% for MSM. Current drug use was reported in 13.3% of FSW. FSW with hazardous alcohol drinking were 47.1%. They reported higher number of sexual partners in the last month (55.3% vs 47,1%, p<0.001), STI in the last year (62,5% vs 48,2%, p<001), physical (53.5% vs 46.7%, p<0.0001) and sexual violence (54.7% vs 44.2%, p< 0.001), and HIV prevalence (55.2% vs 44.2 p<0.001). MSM with hazardous alcohol drinking was 48.9%. They reported higher STI (52.8%vs 45.4%, p<001), sexual violence (18.0% vs 8.3%, p<0.001) and HIV prevalence (53.0% vs 46.3 p<0.001). In addition, FSW that used drugs had a high perception of HIV risk, (14.2% vs 9.7%, p=0.005), had their first sexual experience when younger than 15 years old (15.4% vs 5.3% p<0.001), self-reported an STI (17.9% vs 10.2%, p< 0.001) in the last year, experienced physical violence (17.4% vs 7.0% p<0.001) and sexual violence (18.6% vs 8.9%, p<0.001). Conclusion: There is an immediate need for the introduction and integration of site-specific substance use harm mitigation and mental health interventions into HIV prevention programs, particularly those targeting key populations in Mozambique.