Estimating the Association between Alcohol Consumption, Tobacco Smoking, and Sexual Behaviors among Men in Côte d'Ivoire

Aims: In this study, we aim to assess the relationship between alcohol consumption, tobacco smoking, and sexual behaviors, and to examine whether alcohol consumption and tobacco use are predictors of sexual behaviors among men in Cote d’Ivoire.

Study Design: This study is a cross-sectional study using a nationally representative sample from the 2021 Code d’Ivoire Demographic and Health Survey (N=5,309) datasets, conducted among men aged 15 to 59 years old.

Place and Duration: The comprehensive survey spanned from September 8, 2021, to December 30, 2021, covering urban and rural areas in all 14 administrative districts in Cote d’Ivoire.

Methodology: Utilizing the IBM SPSS version 29, the prevalence estimates were derived as frequencies and proportions, while a multivariate logistic regression model analyzed the association between independent (alcohol consumption and tobacco smoking) and dependent variables (sexual behaviors).

Results: Among the participants, 5% reported alcohol use, while 9.4% were tobacco smokers, but 79.5% were sexually active with 27.6% reporting multiple sexual partnerships outside their spouse, yet only 16.1% used condoms during their last sexual encounter. Additionally, only 20.1% had undergone HIV testing, while 57.2% were aware of other Sexually Transmitted Infections (STIs). The multivariate logistic regression analysis shows significantly higher likelihood of alcohol consumption among sexually active participants (AOR = 3.85, 95% CI = 1.83 - 8.11, P<.001), with multiple sexual partnerships excluding their spouse (AOR = 1.79, 95% CI re= 1.35 – 2.38, P<.001), had tested for HIV (AOR = 1.40, 95% CI = 1.06-1.85, P<.001), and were aware of other STIs (AOR = 2.2, 95% CI = 1.60 - 3.06, P<.001) respectively. Similarly, sexually active participants (AOR = 5.94, 95% CI = 3.32-10.61, P<.001), who had multiple sexual partners (AOR = 1.11, 95% CI = 0.88-1.40, P<.001), and were aware of other STIs (AOR =1.31, 95% CI=1.06-1.62, P=0.012) also had greater odds of tobacco smoking. Conversely, participants who were aware of Pre-Exposure Prophylaxis (PrEP) were significantly less likely to smoke tobacco (AOR = 0.69, 95% CI = 0.49-0.96, P = 0.029).

Conclusion: Alcohol consumption and tobacco smoking appear to be strong predictors of male sexual behaviors in relation to recent sexual activity, multiple sexual partnerships, and awareness of STIs in Cote d’Ivoire. Interventions to reduce negative sexual reproductive health outcomes among men should also involve stricter innovative alcohol and tobacco control measures in Cote d’Ivoire. Future studies among men in Cote d’Ivoire should consider adopting interventions to encourage safe sex, and sexual reproductive health education.