Does perceived life stress mediate the association between HIV status and alcohol use? Evidence from adults living in Cape Town, South Africa

Abstract

South Africa has the highest prevalence of HIV in the world. Because living with HIV is stressful and because alcohol consumption is often used to cope with stress, we examined whether stress mediates the association between HIV status and alcohol use among adults residing in South African townships. Field workers approached pedestrians or patrons of informal alcohol-serving venues (i.e., shebeens) and invited their participation in a survey. Of the 1,717 participants (98% Black, 34% women, mean age = 31), 82% were HIV-negative, 9% were HIV-positive, and 9% did not know their test result. Participants living with HIV reported greater perceived life stress compared to participants whose HIV status was negative or unknown. Perceived stress was associated with increased alcohol use (frequency of drinking days, frequency of intoxication, and frequency of drinking in shebeens/taverns). Subsequent analyses showed that stress mediated the association between HIV status and alcohol use. These findings indicate that greater frequency of drinking days, perceived intoxication, and drinking at shebeens was associated with elevated stress levels among participants who were HIV-positive. Perceived life stress mediates the association between HIV status and alcohol use. Programs to enhance stress management among HIV-positive South Africans may help to reduce alcohol consumption which may, in turn, lead to reduced rates of HIV transmission.

Contextualizing Psychosocial Determinants of Alcohol Use by Age Cohorts of Adults Living With HIV, Ages 50 and Older

“…Our finding that life stress in the younger cohort was positively associated with alcohol consumption was supported by research indicating that younger HIV-infected individuals who reported greater perceived life stress drank more frequently and were more regularly intoxicated (Scott-Sheldon et al, 2013) as well as research demonstrating a positive relationship between stress and more frequent intoxication (Pence et al, 2008). Social support may protect individuals from feeling increased levels of stress, and may also help moderate the effect of negative affective states for those who already experience stress.…”

Changes and determinants of health-related quality of life among people newly diagnosed with HIV in China: a 1-year follow-up study

“…Consistent with cross-sectional studies in Nepal and Hong Kong, this study found that higher levels of stress were associated with worse HRQoL [ 18 , 48 ]. The fact that HIV-positive individuals experienced higher levels of stress than the general population has been consistently documented by many previous studies [ 49 ]. Moreover, we found that the negative association between HIV-related stress and PHS increased over time.…”

High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa

“…37 On the other hand, studies have shown that HIV infection is associated with higher rates of depression and stress, which may lead to increased levels of alcohol use. 38,39 There was a negative association between high-risk alcohol use and the spirituality/religion/personal beliefs score. A possible explanation for this may be that most religions put a restriction on alcohol use.…”