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König L, Petersen Williams P, Shuper PA, Probst C. The relationship between alcohol consumption and risk of HIV in married men in Sub-Saharan Africa. AIDS 2024; 38:723-730. [PMID: 38092012 DOI: 10.1097/qad.0000000000003815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
OBJECTIVE A key factor for incidence of HIV is alcohol consumption. It impacts judgment and the probability to overlook risk-relevant information, which creates a pathway to reduced adherence to biomedical prevention and engagement in condomless sex. We strengthen the understanding of the link between alcohol consumption and risk of HIV among married men in sub-Saharan Africa (SSA), as we use comprehensive population-level data to provide robust evidence with high external validity. DESIGN Cross-sectional data analysis. METHODS Based on data from Demographic and Health Surveys (DHS) from 20 countries and over 30 000 observations, a minimally and a fully adjusted model with country fixed effects examined the relationship between the men's alcohol consumption (observed by wife) and HIV status (blood test) while accounting for survey weights and controlling for potential confounders. RESULTS The data comprised a total of 35 108 men. Minimally adjusted [risk ratio (RR) 1.25; 95% confidence interval (CI) 1.14-1.37; P < 0.001] and fully adjusted (RR 1.26; 95% CI 1.15-1.38; P < 0.001) models showed a positive association between the men's alcohol consumption and HIV status. Two sensitivity analyses confirmed the association. CONCLUSION In line with previous experimental studies and theoretical framework, this study confirms a risk relationship between alcohol consumption and HIV. Thus, modern HIV/AIDS programs must continue to address the relationship in implementation of prevention and treatment programs.
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Affiliation(s)
- Lukas König
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Petal Petersen Williams
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Council
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health
- Department of Psychiatry
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Probst
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health
- Department of Psychiatry
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Rukundo GZ, Wakida EK, Karungi CK, Asasira J, Kumakech E, Obua C. Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda. PLoS One 2023; 18:e0285310. [PMID: 37146057 PMCID: PMC10162553 DOI: 10.1371/journal.pone.0285310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Mental disorders are common in people living with HIV (PLHIV) but they are often unrecognized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already limited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. METHODS We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Referral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lockdown. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to determine the burden of the disorders, and logistic regression to determine the associated factors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. RESULTS Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004-1.148, P = 0.038), lack of formal education (PR = 1.197, 95% CI 1.057-1.357, P = 0.005), substance-use disorder (PR = 0.924, 95%CI 0.859-0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722-0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787-0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876-0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834-0.941, p = 0.000*) were significantly associated with having a substance-use disorder. Only depression was independently associated with suicidality after adjusting for confounding factors (PR 0.108, 95%CI 0.054-0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidality among the PLHIV during the COVID-19 containment measures. CONCLUSION There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K Wakida
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Education, California University of Science and Technology, Milpitas, CA, United States of America
| | - Christine K Karungi
- Office of Research Administration, Mbarara University of Science and Technology Mbarara, Mbarara, Uganda
| | - Jenipher Asasira
- Office of Research Administration, Mbarara University of Science and Technology Mbarara, Mbarara, Uganda
| | - Edward Kumakech
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
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Lichtwarck HO, Kazaura MR, Moen K, Mmbaga EJ. Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:698. [PMID: 36613018 PMCID: PMC9819768 DOI: 10.3390/ijerph20010698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.
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Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Method Rwelengera Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
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Louwrens A, Fourie CM, Roux SBL, Breet Y. Age-related differences in the vascular function and structure of South Africans living with HIV. South Afr J HIV Med 2022; 23:1335. [PMID: 35284097 PMCID: PMC8905456 DOI: 10.4102/sajhivmed.23i1.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022] Open
Abstract
Background As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases. Objective We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent. Method This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined. Results Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups. Conclusion Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted.
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Affiliation(s)
- Anisca Louwrens
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Science, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Carla M.T. Fourie
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Science, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Shani Botha-Le Roux
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Science, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Science, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Knox J, Patnaik P, Hakim AJ, Telly N, Ballo T, Traore B, Doumbia S, Lahuerta M. Prevalence of condomless anal intercourse and associated risk factors among men who have sex with men in Bamako, Mali. Int J STD AIDS 2021; 32:218-227. [PMID: 33622107 DOI: 10.1177/0956462420922446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are disparately impacted by HIV in sub-Saharan Africa and condomless anal intercourse (CAI) is a major driver of HIV transmission. The objective of the current study was to identify factors associated with CAI among MSM in Bamako, Mali, among whom HIV prevalence was 13.7%. METHODS A bio-behavioral survey was conducted between October 2014 and February 2015 using respondent-driven sampling to recruit 552 adult MSM. Weighted statistical analyses were conducted to determine the prevalence of CAI with one's most recent male partner and survey logistic procedures were used to identify associated factors. RESULTS The prevalence of CAI with one's most recent male partner was 40.7%. Associated factors included: inability to get a condom when needed (aOR = 5.8, 95%CI: 2.7-12.3) and believing CAI is acceptable under some circumstances (aOR = 8.4, 95%CI: 4.4-16.2). CONCLUSIONS Programs addressing HIV among MSM in Mali should aim to increase access to condoms and education about HIV prevention through consistent condom use during anal intercourse.
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Affiliation(s)
- Justin Knox
- ICAP at Columbia University, Mailman School of Public Health, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Padmaja Patnaik
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Avi J Hakim
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nouhoum Telly
- International Center of Excellence in Research (ICER-Mali), Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Tako Ballo
- World Health Organization (WHO), Bamako, Mali
| | - Bouyagui Traore
- African Field Epidemiology Network (AFENET-Mali), Bamako, Mali
| | - Seydou Doumbia
- International Center of Excellence in Research (ICER-Mali), Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Kane JC, Sharma A, Murray LK, Chander G, Kanguya T, Lasater ME, Skavenski S, Paul R, Mayeya J, Kmett Danielson C, Chipungu J, Chitambi C, Vinikoor MJ. Common Elements Treatment Approach (CETA) for unhealthy alcohol use among persons with HIV in Zambia: Study protocol of the ZCAP randomized controlled trial. Addict Behav Rep 2020; 12:100278. [PMID: 32637558 PMCID: PMC7330869 DOI: 10.1016/j.abrep.2020.100278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS Prevalence of unhealthy alcohol use and co-occurring mental health problems is high among persons living with HIV (PLWH) in sub-Saharan Africa (SSA). Yet, there is a dearth of evidence-based treatment options that can address both unhealthy alcohol use and comorbidities in SSA HIV care settings. Recent studies testing single-session alcohol brief interventions (BIs) among PLWH in SSA have suggested that more robust treatments are needed. This paper describes the protocol of a pilot randomized controlled superiority trial that will test the effectiveness of an evidence-based transdiagnostic multi-session psychotherapy, the Common Elements Treatment Approach (CETA), compared to a control condition consisting of a single session brief alcohol intervention (BI) based on CETA, at reducing unhealthy alcohol use, mental health problems, and other substance use among PLWH in urban Zambia. METHODS The study is a single-blind, parallel, individually randomized trial conducted in HIV treatment centers in Lusaka. 160 PLWH who meet criteria for unhealthy alcohol use + mental health or substance use comorbidities and/or have a more severe alcohol use disorder are eligible. Participants are randomized 1:1 to receive the single-session BI or CETA. Outcomes are assessed at baseline and a six-month follow-up and include unhealthy alcohol use, depression, trauma symptoms, and other substance use. CONCLUSIONS The trial is a first step in establishing the effectiveness of CETA at reducing unhealthy alcohol use and comorbidities among PLWH in SSA. If effectiveness is demonstrated, a larger trial featuring long-term follow-ups and HIV treatment outcomes will be undertaken.
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Affiliation(s)
- Jeremy C. Kane
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tukiya Kanguya
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Molly E. Lasater
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ravi Paul
- University of Zambia, School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chipo Chitambi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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7
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Kabapy AF, Shatat HZ, Abd El-Wahab EW. Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis. Transbound Emerg Dis 2020; 67:2372-2388. [PMID: 32396689 DOI: 10.1111/tbed.13621] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
Abstract
Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I2 statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.
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Affiliation(s)
- Ahmed F Kabapy
- Fellow of Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt
| | - Hanan Z Shatat
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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8
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Egbe CO, Londani M, Parry CDH, Myers B, Shuper PA, Nkosi S, Morojele NK. Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study. BMC Public Health 2019; 19:1684. [PMID: 31842834 PMCID: PMC6916073 DOI: 10.1186/s12889-019-8047-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background People living with HIV (PLWH) who drink alcohol and use tobacco are particularly vulnerable to tobacco-induced diseases due to an already compromised immune system. This study investigated the prevalence and factors associated with tobacco use (cigarette and snuff) among PLWH who drink heavily. Methods Participants (n = 623) on antiretroviral therapy for HIV who reported heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C were recruited from six hospitals in Gauteng Province, South Africa. The Fagerström test was used to assess nicotine dependence. Chi Square tests and modified Poisson regression analyses were conducted to identify factors associated with tobacco use. Results Almost half of the participants reported ever smoking (44.0%; CI: 40.1–47.9) and about a quarter reported ever using snuff (25.5%; CI: 22.2–29.1). Current smokers and current snuff users comprised 27.3% (CI: 23.9–30.9) and 19.1% (CI: 16.2–22.3) of all participants respectively. Among current smokers, 37.9% (CI: 30.8–45.3) were moderately/highly dependent on nicotine. Current ‘any tobacco product users’ (ATPU: use cigarettes or snuff) were 45.4% (CI: 41.5–49.3) while 1.0% (CI: 0.4–2.0) currently used cigarettes and snuff. Adjusted regression analyses showed that, compared to males, females were less at risk of being: ever smokers (Relative Risk Ratio [RRR] = 0.33; CI: 0.27–0.41), current smokers (RRR = 0.18; CI: 0.12–0.25), and ATPU (RRR = 0.75; CI: 0.63–0.89) but were more at risk of ever snuff use (RRR = 5.23; CI: 3.31–8.25), or current snuff use (RRR = 26.19; CI: 8.32–82.40) than males. Ever snuff users (RRR = 1.32; CI: 1.03–1.70), current snuff users (RRR = 1.40; CI: 1.03–1.89) and ATPU (RRR = 1.27; CI: 1.07–1.51) were more at risk of reporting significant depressive symptoms. We found no significant associations between smoking status and years on ART and viral load. Conclusion There is a high prevalence of cigarette and snuff use among PLWH who drink heavily. Tobacco use cessation interventions tailored specifically for this population and according to their tobacco product of choice are urgently needed given their vulnerability to ill-health.
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Affiliation(s)
- Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, No. 1 Soutpansberg Road, Pretoria, 0001, South Africa. .,Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - Mukhethwa Londani
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, No. 1 Soutpansberg Road, Pretoria, 0001, South Africa
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Paul A Shuper
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, No. 1 Soutpansberg Road, Pretoria, 0001, South Africa.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sebenzile Nkosi
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, No. 1 Soutpansberg Road, Pretoria, 0001, South Africa
| | - Neo K Morojele
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, No. 1 Soutpansberg Road, Pretoria, 0001, South Africa.,Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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9
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Kuteesa MO, Seeley J, Weiss HA, Cook S, Kamali A, Webb EL. Alcohol Misuse and Illicit Drug Use Among Occupational Groups at High Risk of HIV in Sub-Saharan Africa: A Systematic Review. AIDS Behav 2019; 23:3199-3225. [PMID: 30945031 DOI: 10.1007/s10461-019-02483-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Key occupational groups in sub-Saharan Africa (SSA) are at increased risk of HIV, and may be at increased risk of substance use. In January 2018, we systematically searched for studies reporting prevalence of, and risk factors for alcohol misuse or illicit drug use and their association with HIV incidence or prevalence among fisherfolk, uniformed personnel, truckers, miners, motorcycle taxi riders and sex workers in SSA. Seventy-one studies published between 1983 and 2017 were included: 35 reported on alcohol misuse (19 using AUDIT, 5 using CAGE) and 44 on illicit drug use (eight reported both). Median prevalence of alcohol misuse based on AUDIT/CAGE was 32.8% (IQR 20.8-48.5%). Prevalence of illicit drug use ranged from 0.1% (95% CI: 0.0-0.2%) for injection drug use to 97.1% (95% CI: 85.1-99.9%) for khat (among uniformed personnel). Among papers examining associations between substance use and HIV incidence (n = 3) or prevalence (n = 14), nine papers (53%) reported a significant positive association (2 with incidence, 7 with prevalence). Harm reduction interventions in occupational settings are urgently required to prevent new HIV infections.
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Affiliation(s)
- Monica O Kuteesa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anatoli Kamali
- International AIDS Vaccine Initiative (IAVI), Nairobi, Kenya
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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10
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Kuteesa MO, Seeley J, Cook S, Webb EL. Multi-level experiences and determinants of alcohol misuse and illicit drug use among occupational groups at high-risk of HIV in sub-Saharan Africa: A thematic synthesis of qualitative findings. Glob Public Health 2019; 15:715-733. [PMID: 31640453 PMCID: PMC7175470 DOI: 10.1080/17441692.2019.1679216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk (n = 4) or sex workers (n = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings.
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Affiliation(s)
- Monica O Kuteesa
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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11
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Gender Differences and Psychosocial Factors Associated with Problem Drinking Among Adults Enrolling in HIV Care in Tanzania. AIDS Behav 2019; 23:1612-1622. [PMID: 30465107 DOI: 10.1007/s10461-018-2340-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Problem drinking is commonly reported among people living with HIV (PLWH), associated with suboptimal HIV care outcomes and differs by gender. Psychosocial factors associated with problem drinking among PLWH remain poorly understood, including whether they differ by gender. This analysis examines the relationship between psychosocial factors and problem drinking separately by gender among PLWH in Tanzania. Cross-sectional data were collected from 812 men and non-pregnant women living with HIV aged 18 or older enrolling in HIV care at four health facilities in Tanzania. Problem drinking was assessed with the CAGE Questionnaire and defined as responding yes to two or more items. Sex-stratified multivariable logistic regression modeled the association of social support, HIV-related stigma, and physical or sexual violence on problem drinking, controlling for age, relationship status, employment, having been away from home for more than one month, and timing of first HIV-positive diagnosis. Thirteen percent of the sample reported problem drinking, with problem drinking significantly more commonly reported among men than non-pregnant women (17.6% vs. 9.5%). Among men and non-pregnant women, in multivariable analyses, enacted and internalized HIV-related stigma were significantly positively associated with problem drinking. Screening and treatment of problem drinking should be integrated into HIV care. Evidence-based substance abuse interventions should be adapted to address HIV-related stigma. Future research should longitudinally investigate the interrelationships between stigma, violence, and problem drinking among PLWH.
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12
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Nouaman MN, Vinikoor M, Seydi M, Ekouevi DK, Coffie PA, Mulenga L, Tanon A, Egger M, Dabis F, Jaquet A, Wandeler G. High prevalence of binge drinking among people living with HIV in four African countries. J Int AIDS Soc 2018; 21:e25202. [PMID: 30549445 PMCID: PMC6294116 DOI: 10.1002/jia2.25202] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Excessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub-Saharan Africa. METHODS Using a cross-sectional approach, the Alcohol Use Disorders Identification Test (AUDIT-C) was administered to PLHIV attending HIV clinics in Côte d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT-C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI). RESULTS Among 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking. CONCLUSIONS Alcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV-positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.
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Affiliation(s)
| | - Michael Vinikoor
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Moussa Seydi
- Service de maladies infectieuses et tropicalesCRCF, CHU de FannDakarSénégal
| | - Didier K Ekouevi
- Programme PACCICHU de TreichvilleAbidjanCôte d'Ivoire
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
- Département de santé publiqueFaculté des Sciences de la santéUniversité de LoméLoméTogo
| | - Patrick A Coffie
- Programme PACCICHU de TreichvilleAbidjanCôte d'Ivoire
- CHU de TreichvilleService de maladies infectieuses et tropicalesAbidjanCôte d'Ivoire
| | - Lloyd Mulenga
- University Teaching HospitalLusakaZambia
- Zambia Ministry of HealthLusakaZambia
| | - Aristophane Tanon
- CHU de TreichvilleService de maladies infectieuses et tropicalesAbidjanCôte d'Ivoire
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Diseases Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | - François Dabis
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
| | - Antoine Jaquet
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
| | - Gilles Wandeler
- Service de maladies infectieuses et tropicalesCRCF, CHU de FannDakarSénégal
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
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13
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Woolf-King SE, Fatch R, Cheng DM, Muyindike W, Ngabirano C, Kekibiina A, Emenyonu N, Hahn JA. Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1937-1948. [PMID: 29327090 PMCID: PMC6041192 DOI: 10.1007/s10508-017-1131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 11/18/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Debbie M Cheng
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Winnie Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Allen Kekibiina
- Mbarara University of Science and Technology Grants Office, Mbarara, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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14
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Mabaso M, Sokhela Z, Mohlabane N, Chibi B, Zuma K, Simbayi L. Determinants of HIV infection among adolescent girls and young women aged 15-24 years in South Africa: a 2012 population-based national household survey. BMC Public Health 2018; 18:183. [PMID: 29373958 PMCID: PMC5787232 DOI: 10.1186/s12889-018-5051-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 01/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND South Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15-24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa. METHODS A secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence. RESULTS Out of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20-24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women's models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022). CONCLUSION These findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption.
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Affiliation(s)
- Musawenkosi Mabaso
- Epidemiology and Strategic Information Unit, HIV/AIDS, STIs and TB programme, Human Sciences Research Council, PO Box 37429, Overport, Durban, 4067 South Africa
| | - Zinhle Sokhela
- HIV/AIDS, STIs and TB programme, Human Sciences Research Council, Port Elizabeth, South Africa
| | - Neo Mohlabane
- HIV/AIDS, STIs and TB programme, Human Sciences Research Council, Pretoria, South Africa
| | - Buyisile Chibi
- HIV/AIDS, STIs and TB programme, Human Sciences Research Council, Port Elizabeth, South Africa
| | - Khangelani Zuma
- Research Methodology and Data Center, Human Sciences Research Council, Pretoria, South Africa
| | - Leickness Simbayi
- Office of the Deputy CEO for Research, Human Sciences Research Council, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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15
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HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention. AIDS Behav 2017; 21:144-154. [PMID: 28710711 DOI: 10.1007/s10461-017-1853-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Alcohol use is associated with increased HIV-risk behaviors, including unprotected sex and number of sex partners. Alcohol-serving venues can be places to engage in HIV-related sexual risk behaviors, but are also important sites of social support for patrons, which may mitigate risks. We sought to examine the relationship between alcohol-serving venue attendance, social support, and HIV-related sexual risk behavior, by gender, in South Africa. Adult patrons (n = 496) were recruited from six alcohol-serving venues and completed surveys assessing frequency of venue attendance, venue-based social support, and recent sexual behaviors. Generalized estimating equations tested associations between daily venue attendance, social support, and sexual behaviors, separately by gender. Interaction effects between daily attendance and social support were assessed. Models were adjusted for venue, age, education, and ethnicity. Daily attendance at venues was similar across genders and was associated with HIV-related risk behaviors, but the strength and direction of associations differed by gender. Among women, daily attendance was associated with greater number of partners and higher proportion of unprotected sex. Social support was a significant moderator, with more support decreasing the strength of the relationship between attendance and risk. Among men, daily attendance was associated with a lower proportion of unprotected sex; no interaction effects were found for attendance and social support. Frequent venue attendance is associated with additional HIV-related risks for women, but this risk is mitigated by social support in venues. These results were not seen for men. Successful HIV interventions in alcohol-serving venues should address the gendered context of social support and sexual risk behavior.
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16
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction 2017; 112:968-1001. [PMID: 28220587 PMCID: PMC5434904 DOI: 10.1111/add.13757] [Citation(s) in RCA: 633] [Impact Index Per Article: 90.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Campbell Family Mental Health Research Institute, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Gerhard E. Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Alcohol Treatment CenterLausanne University HospitalLausanneSwitzerland
- Addiction SwitzerlandLausanneSwitzerland
- University of the West of EnglandBristolUK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoOntarioCanada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
- Centre for Social Research on Alcohol and DrugsStockholm UniversityStockholmSweden
| | - Andriy V. Samokhvalov
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Kevin D. Shield
- Section of Cancer SurveillanceInternational Agency for Research on CancerLyonFrance
| | - Paul A. Shuper
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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17
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Galárraga O, Gao B, Gakinya BN, Klein DA, Wamai RG, Sidle JE, Papas RK. Task-shifting alcohol interventions for HIV+ persons in Kenya: a cost-benefit analysis. BMC Health Serv Res 2017; 17:239. [PMID: 28351364 PMCID: PMC5371255 DOI: 10.1186/s12913-017-2169-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Among HIV+ patients, alcohol use is a highly prevalent risk factor for both HIV transmission and poor adherence to HIV treatment. The large-scale implementation of effective interventions for treating alcohol problems remains a challenge in low-income countries with generalized HIV epidemics. It is essential to consider an intervention’s cost-effectiveness in dollars-per-health-outcome, and the long-term economic impact —or “return on investment” in monetary terms. Methods We conducted a cost-benefit analysis, measuring economic return on investment, of a task-shifted cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use in a modeled cohort of 13,440 outpatients in Kenya. In our base-case, we estimated the costs and economic benefits from a societal perspective across a six-year time horizon, with a 3% annual discount rate. Costs included all costs associated with training and administering task-shifted CBT therapy. Benefits included the economic impact of lowered HIV incidence as well as the improvements in household and labor-force productivity. We conducted univariate and multivariate probabilistic sensitivity analyses to test the robustness of our results. Results Under the base case, total costs for CBT rollout was $554,000, the value of benefits were $628,000, and the benefit-to-cost ratio was 1.13. Sensitivity analyses showed that under most assumptions, the benefit-to-cost ratio remained above unity indicating that the intervention was cost-saving (i.e., had positive return on investment). The duration of the treatment effect most effected the results in sensitivity analyses. Conclusions CBT can be effectively and economically task-shifted to paraprofessionals in Kenya. The intervention can generate not only reductions in morbidity and mortality, but also economic savings for the health system in the medium and long term. The findings have implications for other countries with generalized HIV epidemics, high prevalence of alcohol consumption, and shortages of mental health professionals. Trial registration This paper uses data derived from “Cognitive Behavioral Treatment to Reduce Alcohol Use Among HIV-Infected Kenyans (KHBS)” with ClinicalTrials.gov registration NCT00792519 on 11/17/2008; and preliminary data from “A Stage 2 Cognitive-behavioral Trial: Reduce Alcohol First in Kenya Intervention” (NCT01503255, registered on 12/16/2011).
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Affiliation(s)
- Omar Galárraga
- Brown University School of Public Health, G-S121-7, 121 South Main Street, Providence, RI, 02912, USA
| | - Burke Gao
- Brown University School of Public Health, G-S121-7, 121 South Main Street, Providence, RI, 02912, USA.,Brown University Alpert Medical School, 222 Richmond Street, Providence, RI, 02912, USA
| | - Benson N Gakinya
- Moi University & Moi Teaching and Referral Hospital, Nandi Rd, Eldoret, Kenya
| | | | - Richard G Wamai
- Northeastern University, Integrated Initiative for Global Health, 360 Huntington Avenue, 220G RP, Boston, MA, 02115, USA
| | - John E Sidle
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rebecca K Papas
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, 02912, USA.
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18
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. ADDICTION (ABINGDON, ENGLAND) 2017. [PMID: 28220587 DOI: 10.1111/add.13757.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Gerhard E Gmel
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,University of the West of England, Bristol, UK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Andriy V Samokhvalov
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kevin D Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Paul A Shuper
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Muyindike WR, Lloyd-Travaglini C, Fatch R, Emenyonu NI, Adong J, Ngabirano C, Cheng DM, Winter MR, Samet JH, Hahn JA. Phosphatidylethanol confirmed alcohol use among ART-naïve HIV-infected persons who denied consumption in rural Uganda. AIDS Care 2017; 29:1442-1447. [PMID: 28278568 DOI: 10.1080/09540121.2017.1290209] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Under-reporting of alcohol use by HIV-infected patients could adversely impact clinical care. This study examined factors associated with under-reporting of alcohol consumption by patients who denied alcohol use in clinical and research settings using an alcohol biomarker. We enrolled ART-naïve, HIV-infected adults at Mbarara Hospital HIV clinic in Uganda. We conducted baseline interviews on alcohol use, demographics, Spirituality and Religiosity Index (SRI), health and functional status; and tested for breath alcohol content and collected blood for phosphatidylethanol (PEth), a sensitive and specific biomarker of alcohol use. We determined PEth status among participants who denied alcohol consumption to clinic counselors (Group 1, n = 104), and those who denied alcohol use on their research interview (Group 2, n = 198). A positive PEth was defined as ≥8 ng/ml. Multiple logistic regression models were used to examine whether testing PEth-positive varied by demographics, literacy, spirituality, socially desirable reporting and physical health status. Results showed that, among the 104 participants in Group 1, 28.8% were PEth-positive. The odds of being PEth-positive were higher for those reporting prior unhealthy drinking (adjusted odds ratio (AOR): 4.7, 95% confidence interval (CI): 1.8, 12.5). No other factors were statistically significant. Among the 198 participants in Group 2, 13.1% were PEth-positive. The odds of being PEth-positive were higher for those reporting past unhealthy drinking (AOR: 4.6, 95% CI: 1.8, 12.2), the Catholics (AOR: 3.8, 95% CI: 1.3, 11.0) compared to Protestants and lower for the literate participants (AOR: 0.3, 95% CI: 0.1, 0.8). We concluded that under-reporting of alcohol use to HIV clinic staff was substantial, but it was lower in a research setting that conducted testing for breath alcohol and PEth. A report of past unhealthy drinking may highlight current alcohol use among deniers. Strategies to improve alcohol self-report are needed within HIV care settings in Uganda.
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Affiliation(s)
- Winnie R Muyindike
- a Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda.,b Department of Medicine , Mbarara Regional Referral Hospital , Mbarara , Uganda
| | | | - Robin Fatch
- d Department of Medicine , University of California , San Francisco , USA
| | - Nneka I Emenyonu
- d Department of Medicine , University of California , San Francisco , USA
| | - Julian Adong
- a Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda
| | - Christine Ngabirano
- e MUST Grants Office, Mbarara University of Science and Technology , Mbarara , Uganda
| | - Debbie M Cheng
- f Department of Biostatistics , Boston University School of Public Health , Boston , USA
| | - Michael R Winter
- c Data Coordinating Center, Boston University School of Public Health , Boston , USA
| | - Jeffrey H Samet
- g Section of General Internal Medicine, Boston University Schools of Medicine and Public Health, Boston Medical Center , Boston , USA
| | - Judith A Hahn
- d Department of Medicine , University of California , San Francisco , USA.,h Department of Epidemiology and Biostatistics , University of California , San Francisco , USA
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Rehm J, Probst C, Shield KD, Shuper PA. Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect. Popul Health Metr 2017; 15:4. [PMID: 28183309 PMCID: PMC5301358 DOI: 10.1186/s12963-017-0121-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/24/2017] [Indexed: 12/22/2022] Open
Abstract
In the first part of this review, the nature of the associations between alcohol use and HIV/AIDS is discussed. Alcohol use has been found to be strongly associated with incidence and progression of HIV/AIDS, but the extent to which this association is causal has traditionally remained in question. Experiments where alcohol use has been manipulated as the independent variable have since helped establish a causal effect of alcohol use on the intention to engage in condomless sex. As the intention to engage in condomless sex is a surrogate measure of actual condom use behavior, which itself is linked to HIV incidence and re-infection, the causal chain has been corroborated. Moreover, there are biological pathways between alcohol use and the course of HIV/AIDS, only in part being mediated by adherence to antiretroviral medication. In the second part of the contribution, we provide suggestions on the quantification of the link between alcohol use and HIV incidence, using risk relations derived from experimental data. The biological links between alcohol use and course of HIV/AIDS are difficult to quantify given the current state of knowledge, except for an operationalization for the link via adherence to medication based on meta-analyses. The suggested quantifications are exemplified for South Africa.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8 Canada
- Institute of Medical Science (IMS), University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3 M7 Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Paul A. Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3 M7 Canada
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21
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Wandera B, Tumwesigye NM, Nankabirwa JI, Mafigiri DK, Parkes-Ratanshi RM, Kapiga S, Hahn J, Sethi AK. Efficacy of a Single, Brief Alcohol Reduction Intervention among Men and Women Living with HIV/AIDS and Using Alcohol in Kampala, Uganda: A Randomized Trial. J Int Assoc Provid AIDS Care 2016; 16:276-285. [PMID: 27215561 DOI: 10.1177/2325957416649669] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We evaluated the efficacy of a brief motivational intervention (MI) counseling in reducing alcohol consumption among persons living with HIV/AIDS in Kampala, Uganda. Persons living with HIV/AIDS with Alcohol Use Disorders Identification Tool (AUDIT) score ≥3 points were randomized to either standardized positive prevention counseling alone or in combination with alcohol brief MI counseling. The mean change in AUDIT-C scores over 6 months was compared by treatment arm. The mean (standard deviation [SD]) AUDIT-C scores were 6.3 (2.3) and 6.8 (2.3) for control and MI arms ( P = .1) at baseline, respectively, and change in mean AUDIT-C score was not statistically different between arms over the 6 months ( P = .8). However, there was a statistically significant decrease in mean AUDIT-C score (-1.10; 95% confidence interval: -2.19 to -0.02, P = .046) among women in the MI arm. There was a nondifferential reduction in alcohol consumption overall, but MI appeared effective among women only. Studies with more than 1 counseling session and evaluation of gender differences in treatment response are needed.
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Affiliation(s)
- Bonnie Wandera
- 1 Department of epidemiology & Biostatistics, Makerere University School of Public Health, Kampala, Uganda.,4 Infectious Diseases Institute, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- 1 Department of epidemiology & Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - David Kaawa Mafigiri
- 3 Department of Social work and Social administration, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Rosalind M Parkes-Ratanshi
- 4 Infectious Diseases Institute, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Saidi Kapiga
- 5 Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Judith Hahn
- 6 Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Ajay K Sethi
- 7 Department of Population Health Sciences, University of Wiscsonsin School of Medicine and Public Health, Madison, WI, USA
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High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:153. [PMID: 26805868 PMCID: PMC4772173 DOI: 10.3390/ijerph13020153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/30/2015] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.
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Nanau RM, Neuman MG. Biomolecules and Biomarkers Used in Diagnosis of Alcohol Drinking and in Monitoring Therapeutic Interventions. Biomolecules 2015; 5:1339-85. [PMID: 26131978 PMCID: PMC4598755 DOI: 10.3390/biom5031339] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/15/2015] [Accepted: 05/29/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The quantitative, measurable detection of drinking is important for the successful treatment of alcohol misuse in transplantation of patients with alcohol disorders, people living with human immunodeficiency virus that need to adhere to medication, and special occupational hazard offenders, many of whom continually deny drinking. Their initial misconduct usually leads to medical problems associated with drinking, impulsive social behavior, and drunk driving. The accurate identification of alcohol consumption via biochemical tests contributes significantly to the monitoring of drinking behavior. METHODS A systematic review of the current methods used to measure biomarkers of alcohol consumption was conducted using PubMed and Google Scholar databases (2010-2015). The names of the tests have been identified. The methods and publications that correlate between the social instruments and the biochemical tests were further investigated. There is a clear need for assays standardization to ensure the use of these biochemical tests as routine biomarkers. FINDINGS Alcohol ingestion can be measured using a breath test. Because alcohol is rapidly eliminated from the circulation, the time for detection by this analysis is in the range of hours. Alcohol consumption can alternatively be detected by direct measurement of ethanol concentration in blood or urine. Several markers have been proposed to extend the interval and sensitivities of detection, including ethyl glucuronide and ethyl sulfate in urine, phosphatidylethanol in blood, and ethyl glucuronide and fatty acid ethyl esters in hair, among others. Moreover, there is a need to correlate the indirect biomarker carbohydrate deficient transferrin, which reflects longer lasting consumption of higher amounts of alcohol, with serum γ-glutamyl transpeptidase, another long term indirect biomarker that is routinely used and standardized in laboratory medicine.
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Affiliation(s)
- Radu M Nanau
- In Vitro Drug Safety and Biotechnology, University of Toronto, Toronto, ON M5G 0A3, Canada.
| | - Manuela G Neuman
- In Vitro Drug Safety and Biotechnology, University of Toronto, Toronto, ON M5G 0A3, Canada.
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON M5G 0A3, Canada.
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Rosenberg M, Pettifor A, Van Rie A, Thirumurthy H, Emch M, Miller WC, Gómez-Olivé FX, Twine R, Hughes JP, Laeyendecker O, Selin A, Kahn K. The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women: A Cross-Sectional Study. PLoS One 2015; 10:e0125510. [PMID: 25954812 PMCID: PMC4425652 DOI: 10.1371/journal.pone.0125510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk. Methods In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption. Results Visiting alcohol outlets was associated with having more sex partners [adjusted odds ratio (aOR), one versus zero partners (95% confidence interval (CI)): 1.51 (1.21, 1.88)], more unprotected sex acts [aOR, one versus zero acts (95% CI): 2.28 (1.52, 3.42)], higher levels of transactional sex [aOR (95% CI): 1.63 (1.03, 2.59)], and HSV-2 infection [aOR (95% CI): 1.30 (0.88, 1.91)]. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex. Conclusions Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2. Trial Registration HIV Prevention Trials Network HPTN 068
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Affiliation(s)
- Molly Rosenberg
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America; Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Annelies Van Rie
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael Emch
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William C Miller
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, NIAID, NIH, Baltimore, Maryland, United States of America; Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Amanda Selin
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
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25
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Rosenberg M, Pettifor A, Lippman SA, Thirumurthy H, Emch M, Miller WC, Selin A, Gómez-Olivé FX, Hughes JP, Laeyendecker O, Tollman S, Kahn K. Relationship between community-level alcohol outlet accessibility and individual-level herpes simplex virus type 2 infection among young women in South Africa. Sex Transm Dis 2015; 42:259-65. [PMID: 25868138 PMCID: PMC4436694 DOI: 10.1097/olq.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exposure to alcohol outlets may influence sexual health outcomes at the individual and community levels. Visiting alcohol outlets facilitates alcohol consumption and exposes patrons to a risky environment and network of potential partners, whereas the presence of alcohol outlets in the community may shift social acceptance of riskier behavior. We hypothesize that living in communities with more alcohol outlets is associated with increased sexual risk. METHODS We performed a cross-sectional analysis in a sample of 2174 South African schoolgirls (ages 13-21 years) living across 24 villages in the rural Agincourt subdistrict, underpinned by long-term health and sociodemographic surveillance. To examine the association between number of alcohol outlets in village of residence and individual-level prevalent herpes simplex virus type 2 (HSV-2) infection, we used generalized estimating equations with logit links, adjusting for individual- and village-level covariates. RESULTS The median number of alcohol outlets per village was 3 (range, 0-7). Herpes simplex virus type 2 prevalence increased from villages with no outlets (1.4% [95% confidence interval, 0.2-12.1]), to villages with 1 to 4 outlets (4.5% [3.7-5.5]), and to villages with more than 4 outlets (6.3% [5.6, 7.1]). An increase of 1 alcohol outlet per village was associated with an 11% increase in the odds of HSV-2 infection (adjusted odds ratio [95% confidence interval], 1.11 [0.98-1.25]). CONCLUSIONS Living in villages with more alcohol outlets was associated with increased prevalence of HSV-2 infection in young women. Structural interventions and sexual health screenings targeting villages with extensive alcohol outlet environments could help prevent the spread of sexually transmitted infections.
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Affiliation(s)
- Molly Rosenberg
- Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Carolina Population Center, University of North Carolina-Chapel Hill
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Carolina Population Center, University of North Carolina-Chapel Hill
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sheri A. Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Carolina Population Center, University of North Carolina-Chapel Hill
- Department of Geography, University of North Carolina-Chapel Hill
| | - William C. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill
| | - Amanda Selin
- Carolina Population Center, University of North Carolina-Chapel Hill
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, NIAID, NIH, Baltimore MD
- Department of Medicine, Johns Hopkins University, Baltimore MD
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
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Sundararajan R, Wyatt MA, Woolf-King S, Pisarski EE, Emenyonu N, Muyindike WR, Hahn JA, Ware NC. Qualitative study of changes in alcohol use among HIV-infected adults entering care and treatment for HIV/AIDS in rural southwest Uganda. AIDS Behav 2015; 19:732-41. [PMID: 25323678 PMCID: PMC4392168 DOI: 10.1007/s10461-014-0918-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alcohol has a substantial negative impact on the HIV epidemic in sub-Saharan Africa, particularly in Uganda, where heavy alcohol consumption is common. Using a content analytic approach, this qualitative study characterizes changes in alcohol use among 59 HIV-infected Ugandan adults (>18 years old), who reported any alcohol use in the previous year as they entered HIV care. Most participants reported attempting to cease or reduce alcohol intake over the study period. Reasons for decreased use included advice from clinicians, interference with social obligations, threats to financial security, and negative impact on social standing. Participants reported difficulty abstaining from alcohol, with incentives to continue drinking including desire for social inclusion, stress relief, and enjoyment of alcohol. These contrasting incentives created a moral quandary for some participants, who felt 'pulled' between 'good' and 'bad' influences. Results suggest brief interventions addressing self-identified obstacles to change may facilitate long-term reductions in drinking in this population.
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Tat SA, Marrazzo JM, Graham SM. Women Who Have Sex with Women Living in Low- and Middle-Income Countries: A Systematic Review of Sexual Health and Risk Behaviors. LGBT Health 2015; 2:91-104. [PMID: 26790114 DOI: 10.1089/lgbt.2014.0124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women who have sex with women (WSW) have long been considered at low risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs). However, limited research has been conducted on WSW, especially those living in low-and middle-income countries (LMICs). We reviewed available research on sexual health and risk behaviors of WSW in LMICs. We searched CINAHL, Embase, and PubMed for studies of WSW in LMICs published between January 1, 1980, and December 31, 2013. Studies of any design and subject area that had at least two WSW participants were included. Data extraction was performed to report quantifiable WSW-specific results related to sexual health and risk behaviors, and key findings of all other studies on WSW in LMICs. Of 652 identified studies, 56 studies from 22 countries met inclusion criteria. Reported HIV prevalence among WSW ranged from 0% in East Asia and Pacific and 0%-2.9% in Latin America and the Caribbean to 7.7%-9.6% in Sub-Saharan Africa. Other regions did not report WSW HIV prevalence. Overall, many WSW reported risky sexual behaviors, including sex with men, men who have sex with men (MSM), and HIV-infected partners; transactional sex; and substance abuse. WSW are at risk for contracting HIV and STIs. While the number of research studies on WSW in LMICs continues to increase, data to address WSW sexual health needs remain limited.
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Affiliation(s)
- Susana A Tat
- 1 Department of Medicine, University of Washington , Seattle, Washington
| | - Jeanne M Marrazzo
- 1 Department of Medicine, University of Washington , Seattle, Washington
| | - Susan M Graham
- 1 Department of Medicine, University of Washington , Seattle, Washington.,2 Department of Epidemiology, University of Washington , Seattle, Washington.,3 Department of Global Health, University of Washington , Seattle, Washington
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Sharma A, Sachdeva RK, Kumar M, Nehra R, Nakra M, Jones D. Effects of Lifetime History of Use of Problematic Alcohol on HIV Medication Adherence. J Int Assoc Provid AIDS Care 2014; 13:450-3. [PMID: 23792711 PMCID: PMC4732521 DOI: 10.1177/2325957413491430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The effects of previous alcohol abuse on antiretroviral therapy (ART) adherence have been less studied. MATERIALS AND METHODOLOGY Participants were randomized to a 3-month group intervention or an individual-enhanced standard-of-care condition and assessed over 6 months. Individual assessment at baseline, 3, and 6 months was done; interviews included lifetime history of problematic alcohol use. RESULTS A total of 80 HIV-positive individuals on ART were recruited. In all, 35% of participants reported a history of problematic alcohol use, 37% had a detectable viral load, 55% were nonadherent, and 24% reporting skipping medication in the previous 3 months. There was no association between a history of problematic use and an adherence at any time point, that is, at baseline (t = -.7, P = .47), midpoint (t = -.39, P = .69), and 6-month follow-up (t = -1.2, P = .23). CONCLUSION Results suggest that a history of problematic alcohol use may not impact ART adherence.
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Affiliation(s)
- Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ravinder Kaur Sachdeva
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Mahendra Kumar
- Department of Psychiatry and Neurosciences, Molecular Neuroendocrinology/Neurotransmitters Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Monika Nakra
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Lusey H, San Sebastian M, Christianson M, Dahlgren L, Edin KE. Conflicting discourses of church youths on masculinity and sexuality in the context of HIV in Kinshasa, Democratic Republic of Congo. SAHARA J 2014; 11:84-93. [PMID: 25000272 PMCID: PMC4272190 DOI: 10.1080/17290376.2014.930695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: 'we are aware of the church message on sex', 'young men need sex', 'young women need money', 'to use or not to use condoms' and 'we trust in the church message'. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV.
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Affiliation(s)
- Hendrew Lusey
- (RN, MPH, PhD student) is the Central Africa Regional Coordinator of the Ecumenical HIV and AIDS Initiative in Africa (EHAIA), World Council of Churches, Kinshasa, Democratic Republic of Congo
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Miguel San Sebastian
- (MD, PhD) is associate Professor at the Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Monica Christianson
- (PhD, MPH, RNM) is Senior Lecturer at the Department of Nursing, Umeå University, Umeå, Sweden
| | - Lars Dahlgren
- (PhD) is Professor Emeritus at the Department of Sociology, Umeå University, Umeå, Sweden
| | - Kerstin E. Edin
- (PhD, MPH, RNM) is Senior Lecturer both at the Department of Nursing, Umeå University and at the Deparment of Public Health and Clinical Medicine, Umeå Center for Global Health Research, Umeå University, Sweden
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How inexpensive does an alcohol intervention in Kenya need to be in order to deliver favorable value by reducing HIV-related morbidity and mortality? J Acquir Immune Defic Syndr 2014; 66:e54-8. [PMID: 24828269 DOI: 10.1097/qai.0000000000000140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Cain D, Pitpitan EV, Eaton L, Carey KB, Carey MP, Mehlomakulu V, Harel O, Simbayi LC, Mwaba K, Kalichman SC. Collective efficacy and HIV prevention in South African townships. J Community Health 2014; 38:885-93. [PMID: 23660646 DOI: 10.1007/s10900-013-9694-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community's ability to prevent HIV and their personal HIV risk behaviors. Men (n = 1,581) and women (n = 718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.
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Affiliation(s)
- Demetria Cain
- Center for Health Intervention and Prevention, University of Connecticut, 2006 Hillside Road Unit 1248, Storrs, CT 06269, USA.
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Braithwaite RS, Nucifora KA, Kessler J, Toohey C, Mentor SM, Uhler LM, Roberts MS, Bryant K. Impact of interventions targeting unhealthy alcohol use in Kenya on HIV transmission and AIDS-related deaths. Alcohol Clin Exp Res 2014; 38:1059-67. [PMID: 24428236 PMCID: PMC4017636 DOI: 10.1111/acer.12332] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/31/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND HIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths. METHODS We estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub-Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on HIV transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year). RESULTS Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence. CONCLUSIONS A substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to HIV.
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Affiliation(s)
- R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, New York
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Prevalence and correlates of alcohol dependence disorder among TB and HIV infected patients in Zambia. PLoS One 2013; 8:e74406. [PMID: 24069309 PMCID: PMC3775777 DOI: 10.1371/journal.pone.0074406] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/31/2013] [Indexed: 12/29/2022] Open
Abstract
Objectives To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia. Methods 649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering. Results The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38). Conclusions Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.
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Kiene SM, Subramanian SV. Event-level association between alcohol use and unprotected sex during last sex: evidence from population-based surveys in sub-Saharan Africa. BMC Public Health 2013; 13:583. [PMID: 23767763 PMCID: PMC3686662 DOI: 10.1186/1471-2458-13-583] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV and risky alcohol use are intertwined public health issues in sub-Saharan Africa. Research supports the association between alcohol and unprotected sex, but there is limited data using event-level analysis to examine this relationship. METHODS Using data from Demographic Health Surveys and AIDS Information Surveys collected in 8 sub-Saharan African countries (Kenya, Lesotho, Mozambique, Rwanda, Swaziland, Tanzania, Zambia, and Zimbabwe) drunkenness (reporting male partner or both male and female partner being drunk during last sexual intercourse) at last sex was tested as a predictor of unprotected last sex among the male (n = 24,512) and female (n = 28,229) participants. Partner type, HIV test results, and the other variables were evaluated as effect modifiers of this relationship. RESULTS Drunkenness at last sex had a negative effect on the likelihood of condom use among men (AOR 0.84, 95% CI 0.72-0.99) and a marginally significant effect among women (AOR 0.87, 95% CI 0.59-1.02) in Southern Africa. However, for men in Southern Africa, this effect was primarily observed with steady partners. Contrary to predictions, in both Southern and Eastern Africa, for men, drunkenness during sex with casual partners increased the odds of condom use. CONCLUSIONS These data indicate a need to implement HIV prevention efforts that consider the role of alcohol use in precipitating unprotected sex and how it varies based upon partner type.
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Affiliation(s)
- Susan M Kiene
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - SV Subramanian
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA
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Peltzer K, Pengpid S, Tiembre I. Mental health, childhood abuse and HIV sexual risk behaviour among university students in Ivory Coast. Ann Gen Psychiatry 2013; 12:18. [PMID: 23758850 PMCID: PMC3682872 DOI: 10.1186/1744-859x-12-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/24/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little focus has been paid to the role of poor mental health and childhood abuse among young people with regard to human immunodeficiency virus (HIV) risk behaviour and HIV prevention in Africa. The aim of this study was to determine the association between mental health, childhood abuse and HIV sexual risk behaviour among a sample of university students in Ivory Coast. METHODS A cross-sectional survey was conducted with undergraduate students that were recruited randomly from classes at the Félix Houphouët Boigny University of Cocody. The sample included 824 university students (50% men and 50% women), with a mean age of 23.7 years (SD = 2.7). RESULTS Of the 824 university students who completed the survey, 17.6% reported depression, 10.8% screened positive for post-traumatic stress disorder, 8.3% reported at least monthly heavy episodic drinking, 13.5% reported childhood physical abuse and 4.7% sexual abuse, 33.9% had two or more sexual partners in the past 12 months, 66.3% had inconsistent condom use, 23.6% had alcohol use in the context of sex and 16.7% had a history of a sexually transmitted infection In multivariable analysis among men, lack of religiousness and alcohol use in the context of sex were associated with HIV risk behaviour, and among women, poorer family background, experience of sexual and physical partner violence, alcohol use in the context of sex and depression were associated with HIV risk behaviour. CONCLUSIONS Poor mental health (depression) including alcohol use and partner violence was found to be associated with HIV risk behaviour. Coordinated mental health and sexual and reproductive health services to meet the needs of university students would be desirable.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS, STI and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria, South Africa.
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Trillo AD, Merchant RC, Baird JR, Ladd GT, Liu T, Nirenberg TD. Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients. BMC Emerg Med 2013; 13:9. [PMID: 23721108 PMCID: PMC3686630 DOI: 10.1186/1471-227x-13-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 04/03/2013] [Indexed: 01/29/2023] Open
Abstract
Background Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. Methods A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. Results Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women. Conclusions The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.
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Cain D, Pare V, Kalichman SC, Harel O, Mthembu J, Carey MP, Carey KB, Mehlomakulu V, Simbayi LC, Mwaba K. HIV risks associated with patronizing alcohol serving establishments in South African Townships, Cape Town. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 13:627-34. [PMID: 22992872 DOI: 10.1007/s11121-012-0290-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alcohol use has been closely linked with HIV risk behaviors in South Africa. The places where people drink are often the same settings in which they meet new sex partners and may contribute independently to sexual risk. This current study examines the independent effects of patronizing alcohol serving establishments (shebeens) and alcohol use in predicting HIV risk behaviors. Men (n = 981) and women (n = 492) were recruited from inside shebeens and surrounding areas proximal to shebeens in eight separate neighborhoods in a Township in Cape Town, South Africa. Anonymous community surveys measured demographic characteristics, alcohol use, shebeen attendance, and sexual risk behaviors. Comparisons of 1210 (82 %) participants who patronized shebeens in the past month with 263 (18 %) participants who did not patronize shebeens demonstrated higher rates of alcohol use frequency and quantity, more sexual partners, and higher rates of vaginal intercourse without condoms for the patrons. Multiple linear regression analysis found shebeen attendance in the past month predicted greater sexual risk for HIV beyond demographic characteristics and alcohol use. Social influences and environmental factors in shebeens could be contributing to sexual risk behavior independently of alcohol consumption. Further research is needed to understand the environmental factors of shebeens that promote and influence HIV risk behaviors.
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Affiliation(s)
- Demetria Cain
- Center for Health Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269, USA.
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Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol 2012; 4:81-90. [PMID: 22489260 PMCID: PMC3321494 DOI: 10.4254/wjh.v4.i3.81] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/07/2011] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
Alcohol use disorders affect millions of individuals worldwide. Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs. Alcoholic liver disease (ALD) may take the form of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis). The severity and prognosis of alcohol-induced liver disease depends on the amount, pattern and duration of alcohol consumption, as well as on the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. While steatosis is an almost completely benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. The median survival of patients with advanced cirrhosis is 1-2 years. Severe acute alcoholic hepatitis (AH) is associated with mortality as high as 50%. It has been managed with corticoids, pentoxifylline and enteral nutrition, although evidence based data are still conflicting. Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH. Absolute abstinence is a basic condition for any treatment of acute or chronic ALD, the other therapeutical procedure being of a supportive nature and questionable significance. Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alcohol dependent patients. Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation, which leads to a markedly prolonged life expectancy. The crucial step in ALD prevention is in the prevention of alcohol abuse, whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.
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Affiliation(s)
- Radan Bruha
- Radan Bruha, 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, 12808 Prague, Czech Republic
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Alcohol Consumption, Progression of Disease and Other Comorbidities, and Responses to Antiretroviral Medication in People Living with HIV. AIDS Res Treat 2012; 2012:751827. [PMID: 22496971 PMCID: PMC3310201 DOI: 10.1155/2012/751827] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/13/2011] [Accepted: 01/02/2012] [Indexed: 12/13/2022] Open
Abstract
The present paper describes the possible connection between alcohol consumption and adherence to medicine used to treat human deficiency viral (HIV) infection. Highly active antiretroviral therapy (HAART) has a positive influence on longevity in patients with HIV, substantially reducing morbidity and mortality, including resource-poor settings such as South Africa. However, in a systematic comparison of HAART outcomes between low-income and high-income countries in the treatment of HIV-patients, mortality was higher in resource-poor settings. Specifically, in South Africa, patients often suffer from concomitant tuberculosis and other infections that may contribute to these results. Alcohol influences the use of medicine for opportunistic infections (e.g., pneumonia, tuberculosis), or coinfections HIV-hepatitis viruses-B (HBV) and C (HCV), cytomegalovirus, or herpes simplex virus. Furthermore, alcohol use may negatively impact on medication adherence contributing to HIV progression. The materials used provide a data-supported approach. They are based on analysis of published (2006–2011) world literature and the experience of the authors in the specified topic. Intended for use by health care professionals, these recommendations suggest approaches to the therapeutic and preventive aspects of care. Our intention was to fully characterize the quality of evidence supporting recommendations, which are reflecting benefit versus risk, and assessing strength or certainty.
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Shin SS, Livchits V, Nelson AK, Lastimoso CS, Yanova GV, Yanov SA, Mishustin SP, Connery HS, Greenfield SF. Implementing evidence-based alcohol interventions in a resource-limited setting: novel delivery strategies in Tomsk, Russia. Harv Rev Psychiatry 2012; 20:58-67. [PMID: 22335183 PMCID: PMC3318976 DOI: 10.3109/10673229.2012.649121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Effective implementation of evidence-based interventions in "real-world" settings can be challenging. Interventions based on externally valid trial findings can be even more difficult to apply in resource-limited settings, given marked differences-in provider experience, patient population, and health systems-between those settings and the typical clinical trial environment. Under the auspices of the Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis Patients (IMPACT) study, a randomized, controlled effectiveness trial, and as an integrated component of tuberculosis treatment in Tomsk, Russia, we adapted two proven alcohol interventions to the delivery of care to 200 patients with alcohol use disorders. Tuberculosis providers performed screening for alcohol use disorders and also delivered naltrexone (with medical management) or a brief counseling intervention either independently or in combination as a seamless part of routine care. We report the innovations and challenges to intervention design, training, and delivery of both pharmacologic and behavioral alcohol interventions within programmatic tuberculosis treatment services. We also discuss the implications of these lessons learned within the context of meeting the challenge of providing evidence-based care in resource-limited settings.
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Affiliation(s)
- Sonya S Shin
- Harvard Medical School, Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA 02115, USA.
| | | | - Adrianne K Nelson
- Division of Global Health Equity, Brigharn & Women's Hospital, Boston, MA
| | | | | | - Sergey A Yanov
- Tomsk Oblast Clinical Tuberculosis Hospital, Belmont, MA
| | - Sergey P Mishustin
- Tomsk Oblast Clinical Tuberculosis Hospital, Belmont, MA,Tomsk Oblast Tuberculosis Dispensary, Belmont, MA
| | - Hilary S Connery
- Harvard Medical School, Brigharn & Women's Hospital, Boston, MA,Tomsk, Russian Federation; McLean Hospital, Belmont, MA
| | - Shelly F Greenfield
- Harvard Medical School, Brigharn & Women's Hospital, Boston, MA,Tomsk, Russian Federation; McLean Hospital, Belmont, MA
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Hahn JA, Woolf-King SE, Muyindike W. Adding fuel to the fire: alcohol's effect on the HIV epidemic in Sub-Saharan Africa. Curr HIV/AIDS Rep 2011; 8:172-80. [PMID: 21713433 DOI: 10.1007/s11904-011-0088-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alcohol consumption adds fuel to the HIV epidemic in sub-Saharan Africa (SSA). SSA has the highest prevalence of HIV infection and heavy episodic drinking in the world. Alcohol consumption is associated with behaviors such as unprotected sex and poor medication adherence, and biological factors such as increased susceptibility to infection, comorbid conditions, and infectiousness, which may synergistically increase HIV acquisition and onward transmission. Few interventions to decrease alcohol consumption and alcohol-related sexual risk behaviors have been developed or implemented in SSA, and few HIV or health policies or services in SSA address alcohol consumption. Structural interventions, such as regulating the availability, price, and advertising of alcohol, are challenging to implement due to the preponderance of homemade alcohol and beverage industry resistance. This article reviews the current knowledge on how alcohol impacts the HIV epidemic in SSA, summarizes current interventions and policies, and identifies areas for increased research and development.
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Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, USA.
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Brion JM, Rose CD, Nicholas PK, Sloane R, Corless IB, Lindgren TG, Wantland DJ, Kemppainen JK, Sefcik EF, Nokes KM, Kirksey KM, Eller L, Hamilton MJ, Holzemer WL, Portillo CJ, Mendez MR, Robinson LM, Moezzi S, Rosa M, Human S, Maryland M, Arudo J, Ros AV, Nicholas TP, Cuca Y, Huang E, Bain C, Tyer-Viola L, Zang SM, Shannon M, Peters-Lewis A, Willard S. Unhealthy substance-use behaviors as symptom-related self-care in persons with HIV/AIDS. Nurs Health Sci 2011; 13:16-26. [PMID: 21352430 PMCID: PMC4179294 DOI: 10.1111/j.1442-2018.2010.00572.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.
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Affiliation(s)
- John M Brion
- Schools of Nursing, Duke University, Durham, USA
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Setshedi M, de la Monte SM. Changing trends and the impact of alcohol on the HIV/AIDS epidemic in South Africa: review. SAHARA J 2011; 8:89-96. [PMID: 23237686 PMCID: PMC4550305 DOI: 10.1080/17290376.2011.9724990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The association between increased HIV infection and alcohol use has been extensively studied and is established. South Africa is among one of the sub-Saharan African countries with the highest prevalence and number of people living with HIV/AIDS in the world. Although recent evidence suggests that the epidemic has stabilised, infection rates remain unacceptably high. Alcohol use is on the increase, particularly in the groups most susceptible to HIV infection, namely women and young adults, and informs poor choices with respect to safer sexual practices. This paper reviews the association between alcohol and HIV. More specifically, however, it aims to explore the potential socio-politico-biological and cultural explanations as to the factors that intersect to drive these two epidemic diseases: alcoholism and HIV/AIDS in South Africa. Understanding some of the underlying factors will provide a framework to implement public health measures to curb HIV.
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Affiliation(s)
- Mashiko Setshedi
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Suzanne M de la Monte
- Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital
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