Perceptions of Alcohol and Alcohol Use among Community Members and Young Adults in Ukraine

High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine

BACKGROUND

HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations.

METHODS

A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians.

RESULTS

Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p<0.001) less likely to have ART deferred compared with those who were not (range: 7.8%-12.7%) on methadone. Men who have sex with men (range: 5.4%-10.8%), transgender women (range: 4.9%-11.3%), sex workers (range: 3.9%-10.3%),and having an HIV-uninfected sex partner (range: 3.9%-9.3%) had the lowest likelihood of ART deferral. Increasing levels of stigma (i.e., feeling thermometers) towards a key population was correlated with ART deferral (i.e., discrimination).

CONCLUSIONS

Despite international and Ukrainian guidelines recommending ART prescription for all PWH, irrespective of risk or CD4 count, ART deferral by experienced HIV experts remains high in certain key populations, especially in PWH and substance use disorders. Strategies that initiate ART immediately after diagnosis (i.e., rapid start antiretroviral therapy), independent of risk group, should be prioritized to truly mitigate the current epidemic.

Exposure to alcohol promotions on web-based media, sex and college risky drinking

Objective: Internet and development of digital media as a tool for online promotions provides avenues for early recruitment of college students into risky drinking. The objective of the study was to examine prevalence of alcohol promotions on web-based media and its possible effects on alcohol drinking by sex among college students in Kenya. Participants and Methods: A sample of 836 out of 1354 (61.7%) second and final year students in the school of education of a public urban university in Kenya participated in this online cross-sectional survey using awareness of online alcohol marketing and TWEAK questionnaires. Results: Facebook attracted most alcohol post per day (χ=3.6) and other apps collectively had least alcohol post per day (χ=0.8). Spearman's correlation show significant association between online alcohol promotions and risky drinking (0.37; p < 0.001). At the overall level of exposure to online alcohol promotions on web-based media and risky drinking, we perceived a statistical significance difference (p < 0.001) in favor of male respondents. The regression model was successful in explaining approximately 56% of the adjusted variance in risky drinking habits. Conclusion: This significant level presence of online liquor promotions suggest that the youth had fairly open access to the mixed beverage creator's items through web-based media stages which could impact youth to take part in early liquor drinking propensity. There was substantial presence of online alcohol promotions via web-based media scene that was related to risky drinking. Lastly, sex and online alcohol promotions could contribute to risky drinking among college students in Kenya.

Alcohol Consumption Patterns: A Systematic Review of Demographic and Sociocultural Influencing Factors

Background: Excessive alcohol consumption has negative effects not only on the drinkers’ health but also on others around them. Previous studies suggest that excessive alcohol consumption can be related to a combination of factors such as age, family background, religiosity, etc. Investigating and clarifying these roots of alcohol consumption is crucial so that the right type of interventions can be designed in a specific and targeted manner. Objectives: This work was conducted as a systematic review to reveal the factors associated with alcohol consumption and to heighten the understanding of the differences among various communities and segments of the population regarding their usage of alcohol. Data sources: A systematic search of Web of Science, PubMed, ScienceDirect, and Google Scholar was performed. Results: Forty-five studies were included in the review after excluding irrelevant records and duplicates. Conclusions: Alcohol consumption patterns can be associated with several factors related to communities and individuals, and our review revealed demographic factors, including age and proximity to alcohol outlets, as well as social factors, including family background, socioeconomic background, and religious influence. These findings can be used to establish a guideline for further studies in understanding alcohol consumption patterns among individuals according to their personal characteristics and sociocultural backgrounds.

HISTORICAL AND CONTEMPORARY CONTEXTS OF ALCOHOL CONSUMPTION IN MODERN UKRAINE

OBJECTIVE

The aim: To identify and to describe the historical and current factors that determine the patterns of alcohol consumption in modern Ukraine.

PATIENTS AND METHODS

Materials and methods: A review and analysis of existing literature focused on historical and contemporary contexts of alcohol use in modern Ukraine. Epidemiological data from general population adolescents survey (N=2038; 2020) and adults survey (N=1200; 2019) conducted in the Lviv region are analyzed from the sociological perspective.

CONCLUSION

Conclusions: Studies results demonstrate the existence of special mechanism that conserves and strengthens the predisposition of positive attitude towards alcohol since early childhood. This information will help to shift the focus of anti-alcohol policy towards a more diverse set of strategies (including administrative intervention and harm reduction strategy).

Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects

Issues.

The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign’s policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign’s end, the region faces diverse challenges in relation to alcohol.

Approach.

The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments.

Key Findings.

Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three ‘best buys’ put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries.

Implications.

In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions.

Conclusion.

Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.