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Excessive alcohol consumption has been implicated in unsafe sex and the spread of sexually transmitted infections.1 Cross sectional surveys in sexual health clinics have shown that most patients drink alcohol regularly,2 but the proportion misusing alcohol has not been reported. Brief interventions for alcohol misuse have been shown to be beneficial across a range of medical settings,3 but their use in sexual health clinics has not been explored. We therefore examined the acceptability of offering brief advice to people identified as misusing alcohol in a sexual health clinic.
Two doctors (PCL, CB) set out to recruit consecutive attendees at walk-in clinics at the Jefferiss Wing Centre for Sexual Health at St Mary’s Hospital in London over a 3 month period. Consenting patients were interviewed using the Paddington Alcohol Test (PAT).4 Those drinking excessively were offered a self help leaflet, “Think about Drink,” and/or an appointment with an alcohol health worker (AHW). Acceptance of brief intervention was noted, and AHW records examined to find out whether patients attended their appointment.
Three hundred and five people were invited to take part in the study, of whom 302 (99%) agreed. The sample comprised 210 women and 92 men, of whom 284 were heterosexual and 18 bisexual or homosexual. In all, 253 (84%) reported drinking alcohol and 98 (32%) were drinking excessively according to PAT. Men were more likely to be consuming excessive alcohol than women (46% compared to 27%, χ2 = 9.8, p = 0.001). Thirty nine (39.8%) of those consuming excessive alcohol stated that their attendance in the clinic was related to alcohol. The most commonly stated reasons for this were either that being drunk led to sexual contact which would not otherwise have taken place or that alcohol consumption had resulted in sex without use of a condom.
Brief written advice was accepted by 91 (93%) of those drinking excessively. A further 30 (31%) accepted an appointment with an AHW. Those who stated they would accept an appointment with an AHW drank a median of 13.5 units of alcohol per session compared to 10 units among those who declined an appointment (Z = −2.5, p = 0.01), but no other differences were found. Subsequent examination of hospital records revealed that only one of those given an appointment actually attended it.
Levels of alcohol misuse in this sample are higher than in the general population and in medical settings like accident and emergency departments where there has been far greater discussion of the importance of this problem.5 Over 90% of those drinking excessively were willing to accept written advice, an intervention that may reduce levels of alcohol misuse.6 However, less than a third were willing to accept an appointment with an AHW and only one person attended the appointment. The likelihood of someone accepting an appointment with an AHW is increased by ensuring that it is delivered at a time and place of convenience; when offered in this way it is usually accepted.5
We believe that providing even brief interventions for alcohol misuse in sexual health clinics would not be straightforward. Further development of interventions that are acceptable to patients is needed and evidence that interventions are effective and impact on sexual health outcomes may be needed if screening and intervention are considered worth the initial investment that would be required.
We thank Ian Forde, Adrian Brown, and others for their help with data collection.
Contributors MJC, PL, and LG designed the study; PL and CB collected the data; MJC and PL analysed the data; all authors contributed to writing the paper and reviewed the final version of the manuscript; MJC is guarantor.