Alcohol Consumption among HIV-Infected Persons in a Large Urban HIV Clinic in Kampala Uganda: A Constellation of Harmful Behaviors

Abstract

IntroductionAlcohol use by persons living with HIV/AIDS (PLWHA) negatively impacts the public health benefits of antiretroviral therapy (ART). Using a standardized alcohol assessment tool, we estimate the prevalence of alcohol use, identify associated factors, and test the association of alcohol misuse with sexual risk behaviors among PLWHA in Uganda.MethodsA cross-section of PLWHA in Kampala were interviewed regarding their sexual behavior and self-reported alcohol consumption in the previous 6 months. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). Gender-stratified log binomial regression analyses were used to identify independent factors associated with alcohol misuse and to test whether alcohol misuse was associated with risky sexual behaviors.ResultsOf the 725 subjects enrolled, 235 (33%) reported any alcohol use and 135 (18.6%) reported alcohol misuse, while 38 (5.2%) drank hazardous levels of alcohol. Alcohol misuse was more likely among subjects not yet on ART (adjusted prevalence ratio [aPR] was 1.65 p=0.043 for males and 1.79, p=0.019 for females) and those with self-reported poor adherence (aPR for males=1.56, p=0.052, and for females=1.93, p=0.0189). Belonging to Pentecostal or Muslim religious denominations was protective against alcohol misuse compared to belonging to Anglican and Catholic denominations in both sexes (aPR=0.11 for men, p<0.001, and aPR=0.32 for women, p=0.003). Alcohol misuse was independently associated with reporting risky sexual behaviors (aPR=1.67; 95% CI: 1.07–2.60, p=0.023) among males, but not significant among females (aPR=1.29; 95% CI: 0.95–1.74, p=0.098). Non-disclosure of HIV positive status to sexual partner was significantly associated with risky sex in both males (aPR=1.69; p=0.014) and females (aPR 2.45; p<0.001).ConclusionAlcohol use among PLWHA was high, and was associated with self-reported medication non-adherence, non-disclosure of HIV positive status to sexual partner(s), and risky sexual behaviors among male subjects. Interventions targeting alcohol use and the associated negative behaviors should be tested in this setting.

Efeito do álcool em pessoas com HIV: tratamento e qualidade de vida

“…Alcohol has a negative influence on health status and adherence to treatment, and increases the risk of virus transmission and unprotected sex. (16) In another study conducted with patients on ART, the frequency of alcohol consumption, and of at-risk drinkers, was 33.0%, therefore higher than the present sample.…”

“…(16) The history of alcohol use had a significant relation with its current harmful use, demonstrating the importance of investing in expanded alcohol prevention strategies involving the political and social spheres. These actions should include family, school, and health services participation, in order to avoid the early onset of alcohol use in childhood and adolescence, based on awareness of the negative impact of this substance on social, financial, and health aspects.…”

“…(24) In general, alcohol use is a strong predictor of drug adherence failures, and worsens the clinical outcome of PLWHA. (2,16,25) The consumption of alcohol and other substances that cause dependence in PLWHA can trigger competition and interactions with antiretrovirals, and change their binding protein, because ethanol competes with the drugs in the isoenzyme linkages of the metabolization process. Thus, these consumers may be at increased risk of toxicity and ineffective therapy due to inadequate concentrations of the drug in plasma.…”

“…These risk situations may make PLWHA using alcohol harmfully more susceptible to opportunistic infections and death. (2,16,25) In general, alcohol use has been shown to be a strong predictor of drug adherence failures, and worsens the clinical outcome of PLWHA when compared to patients who do not consume alcoholic beverages. (2,17,27) The higher the alcohol consumption, the higher the rate of nonadherence to ART.…”

“…(2,17,27) The higher the alcohol consumption, the higher the rate of nonadherence to ART. (16,20) Regarding the correlation of alcohol use, quality of life, and adherence to ART, a study showed that patients who were not alcohol users and who are on ART were 1.69 times more likely to have a better quality of life when compared to those who used this substance. Thus, alcohol use had a significant negative association with overall quality of life.…”