Alcohol consumption patterns among men who have sex with men in major cities of Myanmar: A cross-sectional study

Introduction

Globally, alcohol is widely consumed as a beverage and for recreation and socialization. Alcohol consumption patterns vary widely across the regions, ranging from daily heavy drinking to occasional hazardous drinking (Ennett et al., 2016; World_Health_Organization, 2018). Excessive alcohol use and chronic alcohol binging are associated with high morbidity and mortality (Stockings et al., 2016). About 40% of global population aged over 15 years had consumed alcohol while 2.3 billion of them are current drinkers. Worldwide, 44.8% of total recorded alcohol is consumed in the form of spirits. The second most consumed type of beverage is beer (34.3%) followed by wine (11.7%) (World_Health_Organization, 2018).

Types of alcoholic beverage varied among countries in South-East Asia region. Spirit was most common in Democratic People’s Republic of Korea (97%), India (92%), Sri Lanka (85%), Philippines (72%), Thailand (69%) and Myanmar (68%). Similarly, wine was the commonest type in Indonesia (76%), Nepal (49%), and Maldives (37%) while beer was common in Brunei Darussalam (100%), Vietnam (91%), Cambodia (88%), Singapore (70%), Timor-Leste (68%), and Malaysia (61%) (World_Health_Organization, 2018). The most common type of alcoholic beverage in Myanmar was spirits, which was consumed by 68% of drinkers (World_Health_Organization, 2018).

Previous studies have highlighted that hazardous alcohol drinking was common among men who have sex with men (MSM), ranging from incidences of 14% to 52%, and it was also associated with unsafe sexual behaviours (Davis et al., 2016; Herrera et al., 2016; Liu et al., 2016; Santos et al., 2018). Furthermore, a significant association was noted between hazardous alcohol drinking and sexually transmitted infections, including HIV. According to a study conducted in China, 14.4% of MSM reported hazardous drinking and 16.8% reported binge drinking. Hazardous or binge drinkers were associated with various risky sexual behaviours such as have multiple partnerships, pay for sex, and have condomless insertive anal intercourse (Liu et al., 2016). In a study in Peru, 45% of MSM and transgender women had an alcohol use disorder. Higher incidence of condomless anal intercourse was seen among participants with alcohol use disorder (AUD). However, AUD positivity was not associated with either condomless anal intercourse or recent STI/HIV infection (Herrera et al., 2016). Another study in US has documented the heavy alcohol use patterns and correlates in a diverse sample of MSM using respondent-driven sampling. It was found that prevalence of RDS adjusted weekly drinking was 24.9% and weekly binge drinking was 19.3%. Independent correlates of hazardous alcohol consumption were identified as being moderately or extremely interested in reducing alcohol use; ever receiving alcohol treatment; using ecstasy; reporting syphilis diagnosis; and having more than five male partners (Santos et al., 2018).

In Myanmar, HIV is concentrated among key affected populations like MSM, whereas HIV prevalence was over 10% among them (UNAIDS, 2015). Alcohol drinking was common among MSM, as it was with other men. Although previous studies have focused on risky sexual behaviours among MSM, few studies assessed hazardous alcohol drinking among MSM. According to a previous study in Myanmar, there was 50% of lifetime drinkers and 20% of current drinker among general men (Oo et al., 2015). Similarly, in Myanmar, we know of no studies to have reported on alcohol consumption among MSM. Therefore, current study was conducted to identify the alcohol consumption patterns and binge drinking at different time periods among men who have sex with men in Myanmar.

Methods

Results

A total of 256 MSM were included in the study, of whom 151 participants were residents of Yangon and 105 participants were residents of Mandalay. Mean age of MSM was 27.33±7.7 years and ranged from 18 to 57 years. Tables were presented according to the age group that was categorized as 18–24 years as young MSM and ≥25 years as adult (older) MSM. As shown in Table 1, 39.1% of 18–24 years age group and 58.9% of ≥25 years age group were “apwint” (open). Regarding their education status, 52.7% of the younger age group and 39% of the older age group had attended education up to high school level. Over 46% of young MSM and over 66% of adult MSM have regular income earning job. Median monthly income was 200,000 MMK in both groups. Over 33% of young MSM were private/government staff while over 35% of adult MSM were running their own business. Individual-level responses from each participant are available as Underlying data (Htut et al., 2020a)

Of the 256 participants, 225 had experience of alcohol consumption in their lifetime (225/256, 87.9%). Among ever drinkers, 152 had consumed alcohol within the past three months (152/225, 67.6%). The amount and frequency of different types of alcohol consumption within three months in terms of amount, frequency, with whom they drink together, time of consumption and reasons are shown in Table 2. Regarding beer consumption, the mean amount consumed was 4.1±2.5 standard drinks by young MSM and 4.5 ± 3.0 standard drinks by adult MSM (ethanol concentration of 41 and 45 grams, respectively), highest proportions of MSM from both groups (42.8%, 36.8%) consumed 1–3 times per week.

Table 3 shows the types of person that MSM drink with, the reasons and timings of different types of alcohol consumption by age group of MSM within three months. Over 57.2% of young MSM and 41.2% of adult MSM consumed beer together with their friends. A majority of younger and older MSM consumed beer in the evening or at night (96% and 94.2%, respectively). Nearly 34% of young MSM and nearly 38% of adult MMS consumed beer for the reason of a friends’ gathering.

Table 4 shows that binge drinking was associated with type of MSM. At different time periods, higher proportions of Thange (partner of MSM) had experienced of binge drinking than apwint (open) and apone (hidden), and the association was statistically significant (p<0.05).

Discussion and recommendation

Worldwide, the prevalence of alcohol consumption was 43% in general population while about half has never consumed alcohol. Of all participants in present study, nearly 90% have ever consumed alcohol in their life time and over 50% were current drinkers within one month. Previous studies have documented the alcohol consumption among general population in Myanmar. They reported the prevalence of 50% lifetime drinkers and 20% current drinkers. The proportion of ever drinkers in current study was much higher than those from previous studies done in two different townships in Myanmar (Oo et al., 2015; Win & Areesantichai, 2014). These studies focused on the general adult population, which might differ from the MSM population. These differences in study population and time periods might contribute to the discrepancy. Regarding the types of alcoholic beverages, as reported in the report of World Health Organization, common types of alcoholic beverages consumed in Myanmar included spirits, beer and wine. Likewise, beer, whisky and wine were the common alcoholic beverages stated by MSM in current study.

Studies in China and other countries also highlighted alcohol consumption among MSM and general population but using different screening tools. Additionally, previous studies have documented the prevalence of alcohol consumption at different time periods (Liu et al., 2016; Lu et al., 2019). In present study, nearly 70% of MSM had consumed alcohol within the past 3 months and 36.2% of Apwint (open type), 35.3% of Apone (hidden type) and 62.8% of Thange (sexual partners of MSM) had experience of binge drinking. In a large-scale study in China, over 56% of 3,588 MSM had consumed alcohol in the past 3 months and 17% were binge drinkers (Liu et al., 2016). Though recent alcohol consumption within 3 months among MSM was similar between the studies, the proportion of binge drinkers was higher in present study.

In Peru, 45% of MSM had an alcohol use disorder and over 90% were hazardous drinkers (Herrera et al., 2016). Another study in China among a general adult population aged 18 to 34 years also identified the prevalence of alcohol consumption as about 45% (Lu et al., 2019). Similarly, another study in US among MSM documented that nearly 14% and 25% were monthly and weekly binge drinkers (Santos et al., 2018). Unlike other studies in China, Fan et al. (2016) documented that 23% of MSM had consumed a drink containing alcohol in the previous year while 7% were heavy alcohol drinkers.

The current study also identified the proportion of drinkers and binge drinkers in different time periods (one month, three months, six months, one year and lifetime). and over one third to nearly two third among different types of MSM reported binge drinking within three months. A higher proportion of participants drinking alcohol was noted in current study than in previous studies among MSM population. Differences in background sociocultural conditions may contribute to this discrepancy. (Liu et al., 2016; Lu et al., 2019). It was detected that binge drinking was more common among Thange than other two types of MSM at different time periods showing higher risk among that particular group of MSM.

There was a limitation in the present study that should be acknowledged. Alcohol consumption patterns were self-reported and their behaviours could not be validated with other methods, such as observation. However, we tried to overcome this limitation by carefully explaining the objectives of the study to allow participants to answer with accurate responses.

The development and implementation of an alcohol control policy for MSM should be considered, since over half of them were current drinkers (within one month). Between one-third and three-quarters of them had binge drinking at different time periods, which could lead to adverse health and social consequences. Emphasis should be done more on the partners of MSM as higher proportion of them had practice of binge drinking.

Data availability