Hazardous alcohol use and HIV indicators in six African countries: results from the Population‐based HIV Impact Assessments, 2015–2017

Abstract

Introduction: Hazardous alcohol use (HAU), defined as a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others, is associated with an elevated risk of human immunodeficiency virus (HIV) infection and poor health outcomes. We describe the association between people living with HIV (PLHIV) who report HAU and key HIV indicators. Gaps in current literature in estimating HAU on HIV outcomes at the regional level of Eastern and Southern Africa still exist and our analysis aims to address this issue. Methods: We used weighted pooled data (2015-2017) from the nationally representative Population-based HIV Impact Assessments among adults who provided written consent aged 18-59 years from Eswatini, Malawi, Namibia, Tanzania, Zambia and Zimbabwe. We estimated differences in the prevalence of HIV infection and The Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 indicators between PLHIV by HAU status using log-binomial regression, stratified by sex. HAU was determined using the Alcohol Use Identification Test-Consumption. Results: Among the 9755 women and 4444 men who tested HIV positive, 6.6% of women and 21.8% of men engaged in HAU. Women who reported HAU were more likely to be HIV positive (adjusted prevalence ratio [aPR] = 1.31, 95% CI: 1.18-1.46) compared to those who did not report HAU. For the UNAIDS 90-90-90 targets, women who engaged in HAU were more likely to be unaware of their HIV-positive status (aPR = 1.22, 95% CI: 1.01-1.47) and not on antiretroviral therapy (ART) (aPR = 1.73, 95% CI: 1.26-2.37). Men who engaged in HAU were more likely to be unaware of their HIV-positive status (aPR = 1.56, 95% CI 1.39-1.76) and not on ART (aPR = 1.72, 95% CI: 1.30-2.29). No difference in viral load suppression, defined as <1000 copies/ml of HIV RNA, was seen by sex. Conclusions: PLHIV who engage in HAU were more likely to have suboptimal outcomes along the HIV care continuum when compared to those who did not engage in HAU. Targeted interventions, such as alcohol screening for HAU in HIV testing and treatment settings and HIV prevention efforts in alcohol-based venues, may help countries reach HIV epidemic control by 2030.

Factors associated with use of community-based, peer-led sexual and reproductive health services by adolescent boys and young men aged 18–24 in Lusaka, Zambia: A case control study nested in the Yathu Yathu trial

“…We found no statistical evidence to support this in this study. This is similar to a study assessing alcohol consumption as a barrier to HIV testing in Uganda, which found it was not a barrier in men but was a potential barrier among women [45].This finding highlights a gap in research on whether being at risk of alcohol misuse is actually a barrier to use of SRH services by ABYM or whether it is the way services are provided not meeting the needs of those at risk of alcohol use [38,46,47].…”

“…On the other hand, despite almost a quarter of all study participants reporting being susceptible to peer pressure, we found no evidence of an association with not accessing services at hubs. This may suggest that while peers or other men may negatively influence sexual behaviours such as condom use, they could also positively influence access to HIV services, as was found in studies in Tanzania [35,38] and Zambia [39]. In addition, while most sexual behaviours in our study were not associated with accessing hub services, a higher percentage of ABYM who attended hubs tested for HIV and screened for STIs than those who didn't attend hubs, which could have been a result of accessing Yathu Yathu services.…”

The Impacts of Stigma Against Sexual Minority Men Within and Between Various Socioecological Levels: Breaking the Vicious Cycle in Zambia

“…Concordant with the emerging literature, where substance use burdens have been reported to be the highest among those aged 25 to 39 years and people living with HIV, concerns from the study population of young SMM (i.e., HIV epidemic priority population) regarding the frequency and quantity of peer substance use are validated ( Nouaman et al, 2018 ; Yaya & Bishwajit, 2019 ). Within the emerging literature, substance use has been associated with increased likelihood of sexual risk-taking behaviors, HIV transmission and acquisition, lower odds of viral suppression, and suboptimal outcomes along the HIV care continuum ( Chang et al, 2022 ; Daniels et al, 2018 ; Vinikoor et al, 2022 ). Emergent themes demonstrate the associations between stigma-induced substance use among SMM and high-risk sexual behaviors such as unprotected sex with STI prevalence and HIV infection ( Rogers et al, 2019 ; Stephenson et al, 2021 ).…”