Background: As reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience.

Methods: A cross-sectional survey was carried out in 2010 among 1954 students at Mbarara University of Science and Technology, Uganda, using a self-administered questionnaire. Alcohol use was measured as consumption over the previous 12 months, during situations related to sexual activity and on the most recent occasion of sexual intercourse. Risky sexual behavior was defined as having two or more sexual partners in the previous 12 months or inconsistent condom use with new partners. Bivariate and multivariate logistic regression was performed to analyze the association between alcohol use and risky sexual behavior separately for males and females.

Results: Even after adjusting for confounders, the odds ratio (OR) of having two or more sexual partners in the past year indicated a statistically significant association with alcohol use on all levels (global, situational, and event) for both males and females. The ORs of inconsistent condom use with a new partner were significant for males who often consumed alcohol in relation to sexual activity—even after adjusting for potential confounders (OR, 1.75; confidence interval, 1.01–3.08). The risk of inconsistent condom use with a new partner was twice as high for females who often consumed alcohol in relation to sexual activity, although this association was not statistically significant.

Conclusions: The study supports previous research that alcohol consumption is associated with having multiple sexual partners. Inconsistent condom use was associated with the situational use of alcohol in relation to sexual activity and was similar for both genders. Interventions to reduce alcohol-related risky sexual behavior should target both male and female drinkers, particularly subgroups of students, who often consume alcohol in relation to sexual activity.