Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa. (1st April 2022)

• Record Type: Journal Article
• Authors: Regenauer, Kristen S.; Kleinman, Mary B.; Belus, Jennifer M.; Myers, Bronwyn; Joska, John A.; Magidson, Jessica F.
• Is Part Of: Drug and alcohol dependence. Volume 233(2022)
• Publication Date: 2022-04-01
• Subjects: Stigma -- HIV -- Alcohol use -- Antiretroviral therapy (ART) adherence -- Global mental health -- South Africa; ART Antiretroviral Therapy -- DBS Dried Blood Spot -- PEth Phosphatidylethanol -- PWH People With HIV -- SA South Africa -- SU Substance Use -- TFV-DP Tenofovir Diphosphate -- VL Viral Load; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2022.109364
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: Despite HIV and problematic drinking often co-occurring in South Africa (SA), limited research has examined how HIV stigma relates to alcohol outcomes, how alcohol stigma relates to HIV outcomes, and moderators of these associations. This study examined the intersection of HIV and alcohol stigmas on HIV and alcohol outcomes, and the role of avoidant behavior in moderating these relationships in SA. Methods: We assessed biomarker-verified measures of antiretroviral therapy (ART) adherence, HIV viral load (VL), and alcohol consumption, and self-reported measures of internalized HIV/alcohol stigmas, avoidant behavior, ART adherence, and problematic drinking—alcohol use that will likely lead to health or other problems—cross-sectionally among people with HIV (PWH) and problematic drinking ( N = 64). We conducted regression analyses with interaction terms. Findings: A significant relationship was found between internalized alcohol stigma and VL suppression, with higher levels of alcohol stigma associated with a lower likelihood of suppression (OR=1.68, 95%CI[1.11–2.65], p = .02). Avoidance significantly moderated the relationship between internalized HIV stigma and problematic drinking; higher HIV stigma was associated with lower problematic drinking only at low levels of avoidance ( b (SE)= −1.92(.85), p = .03). Conclusions: This study is the first to examine associations between HIV and alcohol stigmas, avoidance, and both HIV and alcohol outcomes in SA. Findings contribute to our understanding of how alcohol stigma relates to biological HIV outcomes, and the role of avoidance in the relationship between internalized HIV stigma and problematic drinking. Findings may inform future clinical interventions aiming to address the impact of stigma on HIV treatment outcomes and alcohol use among PWH in SA. Highlights: HIV and alcohol stigmas were examined in a low-resource, high HIV burden setting. High alcohol stigma was associated with lower likelihood of viral load suppression. Avoidance moderated the relationship between HIV stigma and alcohol use. Findings may inform future intervention efforts for HIV and alcohol stigmas.