Hazardous alcohol use is associated with sexual behaviors that increase risk for HIV acquisition among fishermen in a high HIV prevalence area of Kenya.

Links between hazardous alcohol use and HIV acquisition are well documented, with less known about this relationship among fishermen, a priority group for HIV prevention. We examined associations between hazardous alcohol use and sexual risk behaviors among fishermen in Kenya using 2022 data from 733 fishermen in three Lake Victoria communities. Measures included the AUDIT-C and sexual relationship histories. Logistic regression models assessed associations between hazardous alcohol use and (1) any concurrent sexual relationships, (2) concurrency among non-polygynous men, (3) any higher HIV risk sexual relationships, and (4) higher HIV risk sexual relationships among non-polygynous men in past six months, controlling for covariates and clustering. Among 713 sexually active men. PrEP (8%) and condom use (<5%) were low; 16% reported hazardous alcohol use. Hazardous alcohol use was associated with greater odds of concurrency (aOR = 1.38, 95%CI: 0.96-1.98), though not statistically significant. Among non-polygynous men, hazardous alcohol use was significantly associated with concurrency (aOR = 1.74, 95%CI:1.18-2.56). No association was observed with higher-risk relationships among all men (aOR = 1.72, 95%CI:0.91-3.25) and among non-polygynous men (aOR = 1.67, 95%CI:0.84-3.34). Hazardous alcohol use is linked to sexual behaviors that heighten HIV risk and support integrating alcohol risk reduction into HIV prevention strategies for fishermen in East Africa.