High prevalence of unhealthy alcohol use and comparison of self-reported alcohol consumption to phosphatidylethanol among women engaged in sex work and their male clients in Cambodia

BACKGROUND:

In Cambodia, most of the female sex workers (FSW) work in venues where unhealthy alcohol use is ubiquitous and potentially contributing to the HIV epidemic. However, no accurate data exists. We compare self-reported unhealthy alcohol consumption to a biomarker of alcohol intake in Cambodian FSW and male clients, and determine factors associated with unhealthy alcohol use.

METHODS:

A cross-sectional study was conducted among FSW (n=100) and male clients (n=100) in entertainment and sex work venues in Cambodia. Self-reported unhealthy alcohol use (AUDIT-C) was compared to phosphatidylethanol (PEth) positive (≥50ng/ml), a biomarker of alcohol intake. Sociodemographics data was collected. Correlates of self-reported unhealthy alcohol use and PEth positive were determined.

RESULTS:

The prevalence of PEth positive in FSW was 60.0%. Self-reported unhealthy alcohol consumption was reported by 85.0% of the women. Almost all women (95.0%) testing PEth positive also reported unhealthy alcohol use. Prevalence of unhealthy alcohol consumption (self-report and PEth positive) was higher in FSW working in entertainment establishments compared to other sex work venues (p<0.01). Among male clients, 47.0% reported unhealthy alcohol consumption and 42.0% had a PEth positive. However, only 57.1% of male clients with PEth positive reported unhealthy alcohol use.

CONCLUSIONS:

Unhealthy alcohol consumption is prevalent in Cambodian sex work settings. Self-reported unhealthy alcohol use is well reported by FSW, but less by male clients. These findings highlight the urgency of using accurate measures of unhealthy alcohol consumption and integrating this health issue into HIV prevention interventions.

Purchase full article at:  http://goo.gl/OVW2hK

By:  Couture MC¹, Page K², Sansothy N³, Stein E⁴, Vun MC⁵, Hahn JA⁶.

¹Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, United States. Electronic address: mcouture@usfca.edu.

²University of New Mexico Health Sciences Center, Dept. of Internal Medicine MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States.

³National Center for HIV, AIDS, Dermatology and STDs, #245H, Street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia; University of Health Sciences-Cambodia, #73 Monivong Boulevard, Srah Chak, Phnom Penh, Cambodia.

⁴Global Health Sciences/Prevention and Public Health Group, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.

⁵National Center for HIV, AIDS, Dermatology and STDs, #245H, Street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia.

⁶Department of Medicine, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.

Drug Alcohol Depend. 2016 May 21. pii: S0376-8716(16)30117-X. doi: 10.1016/j.drugalcdep.2016.05.011. [Epub ahead of print]

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Alcohol and violence in nightlife and party settings: A qualitative study

INTRODUCTION AND AIMS:

In 'binge drinking' cultures, there is a strong association between alcohol consumption and violence. At the same time, several studies suggest that this link is cultural and contextual. We explore the role of alcohol in incidents of violence in nightlife settings.

DESIGN AND METHODS:

We used qualitative interviews with 104 Norwegians (52 men and 52 women, mean age 25 years) who binge drink and party in nightlife settings.

RESULTS:

Alcohol both sparks and constrains violence in these contexts. When participants use alcohol, they expect conflicts to occur and blame alcohol intoxication for such behaviour. The packed settings of nightlife and parties combined with the effects of alcohol can induce violence through personal affronts, heightened emotions and jealousy. At the same time, nightlife settings constrain violence. That is, binge drinkers excuse misbehaviour when it is attributed to alcohol. In addition, audiences in these setting often go to great lengths to stop fights. Combined, these factors help explain why violence occurs and why it usually does not escalate.

DISCUSSION AND CONCLUSIONS:

The association between alcohol and violence can be understood by more closely examining the cultural and situational context where the events occur. This link is not primarily related to the psychopharmacological properties of alcohol, but rather it is associated with situational factors and cultural norms regarding how to behave while intoxicated. Strategies aiming at reducing violence in nightlife should take such factors into consideration. 

Purchase full article at:   http://goo.gl/6I7IaY

By:  Pedersen W1, Copes H2, Sandberg S3.

• 1Department of Sociology and Human Geography, University of Oslo, Oslo, Norway.
• 2Department of Justice Sciences, University of Alabama, Birmingham, USA.
• 3Department of Criminology and Sociology of Law, University of Oslo, Oslo, Norway.
• Drug Alcohol Rev. 2016 Apr 7. doi: 10.1111/dar.12395. 

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Perceived benefits and negative consequences of alcohol consumption in cving with HIV: A qualitative study

BACKGROUND:

Women living with HIV have increased prevalence of medical and psychological comorbidities that could be adversely affected by alcohol consumption. Little is known about their unique motivations for drinking or perceptions of HIV-related consequences. In preparation for an alcohol intervention study, we sought to better understand reasons for drinking and perceived consequences of alcohol consumption among a sample of women living with HIV.

METHODS:

Four focus groups, with a total of 24 adult women (96 % African-American, 88 % HIV-positive), were conducted in Jacksonville, FL, Washington, DC and Chicago, IL. Focus group discussions were tape-recorded and transcribed verbatim; a conventional content analysis approach was used to identify themes, that were then grouped according to a biopsychosocial model.

RESULTS:

Regarding reasons for drinking, women described themes that included biological (addiction, to manage pain), psychological (coping, to escape bad experiences, to feel in control), and social (peer pressure, family). Themes related to consequences from alcohol included biological (damage to body, poor adherence to medications), psychological (risky or regrettable behavior, memory loss), and social (jail, loss of respect, poor choices). When discussing how their drinking impacted their health, women focused on broader issues, rather than HIV-specific issues.

CONCLUSION:

Many women living with HIV are drinking alcohol in order to self-manage pain or emotions, and their perceived consequences from drinking extend beyond HIV-specific medical issues. Most participants described themes related to psychological issues and situations that are common in women living with HIV. Interventions to address drinking should inquire more specifically about drinking to manage pain or emotion, and help women to recognize the potential adverse impact of alcohol on comorbid health issues, including their own HIV infection.

Full article at:   http://goo.gl/vA9COI

By:  Cook RL1, Cook CL2, Karki M3, Weber KM4, Thoma KA5, Loy CM6, Goparaju L7, Rahim-Williams B8.

• 1Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA. cookrl@ufl.edu.
• 2Department of Family, Community, and Health System Science, University of Florida College of Nursing, PO Box 100197, Gainesville, FL, 32610-0197, USA.
• 3Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, 32610, USA.
• 4Cook County Health and Hospital System and Hektoen Institute of Medicine, 2225 W Harrison St, Chicago, IL, 60612, USA.
• 5Clinical Research Specialist, UF CARES, University of Florida Center for HIV/AIDS, Research, Education & Service, 653-1 West 8th Street, LRC 3rd Floor L-13, Jacksonville, FL, 32209, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
• 7Women's Interagency HIV Study (WIHS), Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 130, Washington DC, 20007, USA.
• 8Department of Public Health, Bethune-Cookman University, College of Health Sciences, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, Florida, 32114, USA. 
• BMC Public Health. 2016 Mar 15;16(1):263. doi: 10.1186/s12889-016-2928-x.

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The Effect of Glass Shape on Alcohol Consumption in a Naturalistic Setting: A Feasibility Study

BACKGROUND:

Alcohol-related harms are a major public health concern, and population-level interventions are needed to reduce excessive alcohol consumption. Glass shape is an easily modifiable target for public health intervention. Laboratory findings show beer is consumed slower from a straight glass compared to a curved glass, but these findings have not been replicated in a naturalistic setting. The purpose of this study is to investigate the feasibility of conducting a randomised controlled trial investigating the effect of glass shape on alcohol consumption in public houses.

METHODS:

Straight and curved half-pint and pint glasses were delivered to three public houses over two weekends. Glass type was counterbalanced over the two weekends and between the public houses. Monetary takings were recorded as an indirect measure of consumption.

RESULTS:

Replacing stocks of glassware in public houses was feasible and can be enacted in a short space of time. One landlord found the study too disruptive, possibly due to a laborious exchange of glassware and complaints about the new glassware from some customers. One public house's dishwasher could not accommodate the supplied curved full-pint glasses. Obtaining monetary takings from public house staff was a feasible and efficient way of measuring consumption, although reporting absolute amounts may be commercially sensitive. Monetary takings were reduced by 24 % (95 % confidence interval 77 % reduction to 29 % increase) when straight glasses were used compared to curved glasses.

CONCLUSIONS:

This study shows that it is feasible to carry out a trial investigating glass shape in a naturalistic environment, although a number of challenges were encountered. Brewery owners and landlords are willing to engage with public health research in settings where alcohol is consumed, such as public houses. Good communication with stakeholders was vital to acquire good data, and highlighting the potential commercial benefits of participating was vital to the study's success. A full scale evaluation of the effects of glass shape on alcohol consumption could inform local and national policy.

Below:  Shapes of glasses. a Sahm’s Tokyo glass, pint glass: Art. Nr. 1005428 and half-pint glass: Art. Nr. 1005930. b Arcoroc’s Geo glass 20 oz (58.5 cl) glass. c Paşabahçe’s highball long drinking glass can hold 285 cc, 9.5 oz (US) and 10.25 oz (UK)

Full article at:   http://goo.gl/prVkw8

By:  Troy DM1, Maynard OM1, Hickman M2, Attwood AS1, Munafò MR1.

• 1MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK ; UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.
• 2School of Social and Community Medicine, University of Bristol, Bristol, UK. 
• Pilot Feasibility Stud. 2015 Dec 1;1(1):27.

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Number of Drinks to "Feel a Buzz" by HIV Status and Viral Load in Men

The impact of HIV and its treatment on the effects of alcohol remain unclear. Blood alcohol concentrations have been noted to be higher in HIV infected individuals prior to antiretroviral initiation. 

Our goal was to compare number of drinks to "feel a buzz or high" among HIV infected and uninfected men, stratified by viral load (VL) suppression. Data includes 1478 HIV infected and 1170 uninfected men in the veterans aging cohort study who endorsed current drinking. 

Mean (SD) number of drinks to feel a buzz was 3.1 (1.7) overall. In multivariable analyses, HIV infected men reported a lower mean number of drinks to feel a buzz compared to uninfected men (coef = -14 for VL < 500; -34 for VL ≥ 500; p ≤ .05). Men with HIV, especially those with a detectable VL, reported fewer drinks to feel a buzz. 

Future research on the relationship between alcohol and HIV should consider the role of VL suppression.

Below:  Number of Drinks to Feel a Buzz by HIV, Viral Load, and Alcohol Use

Below: Number of Drinks to Feel a Buzz by HIV, Viral Load, and Age

Full article at:   http://goo.gl/rYu8ah

By:  Kathleen A. McGinnis,1,2 David A. Fiellin, MD,2,3,4 Janet P. Tate,2,3,4 Robert L Cook,5 R. Scott Braithwaite,6 Kendall J. Bryant,7 E. Jennifer Edelman,2,3,4 Adam J. Gordon,1,8 Kevin L. Kraemer, MD,8 Stephen Maisto,9 Amy C. Justice,2,3,4and For the Veterans Aging Cohort Study

• 1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. kathleen.mcginnis3@va.gov.
• 2Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA. kathleen.mcginnis3@va.gov.
• 3Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
• 4Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
• 5Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, Gainesville, FL, USA.
• 7Department of Population Health, New York University School of Medicine, New York, USA.
• 8National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
• 9Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
• 10Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
• 11Department of Psychology, Syracuse University, Syracuse, NY, USA.
• AIDS Behav. 2016 Mar;20(3):504-11. doi: 10.1007/s10461-015-1053-7.

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Decreased Injecting Is Associated with Increased Alcohol Consumption among Injecting Drug Users in Northern Vietnam

Background

Reducing injecting frequency may reduce the risk of HIV infection and improve health outcomes among injection drug users (IDU). However, the reduction of one risk behavior may be associated with an increase in other risk behaviors, including the use of other risk-associated substances. Our objective was to determine if an association exists between a reduction in injecting and level of alcohol use among IDU.

Methods

We conducted a longitudinal analysis of data collected for a randomized controlled trial examining the efficacy of a peer education intervention in reducing HIV risk among IDU and their network members in Thai Nguyen, Vietnam. Our analysis included active male injectors (n=629) who were study participants and attended both baseline and 3-month visits. Frequency of alcohol consumption was assessed as the number of alcoholic drinks in the past 30 days. Change in risk and outcome behaviors was calculated as the difference in frequencies of behaviors between baseline and 3-month follow-up visits. The outcome of interest was concurrent decreased drug injection and increased alcohol consumption.

Results

The mean difference between baseline and 3-month follow-up of alcohol consumption and injection frequency in the past 30 days was 19.03 drinks (93.68 SD) and 20.22 injections (35.66 SD), respectively. Participants who reported reduced injection frequency were almost three times as likely to report increased alcohol consumption (OR 2.8; 95% CI, 2.0, 4.0). The proportion that both decreased injecting and increased alcohol by any amount in the past 30 days was 35.6%. In multivariate analysis higher education was significantly associated with an increase in alcohol and decrease in injecting of any amount.

Conclusion

Male IDU may be at risk for increasing alcohol consumption when they reduce injection frequency. Interventions with male IDU that encourage reduction of injection may need to review specific strategies to limit alcohol consumption.

Below:  Change in # days consumed alcohol (y-axis) by Change in # days injected drugs (x-axis), in past 3 months: Visit2 – Visit1 = (3 months – Baseline).

Full article at:   http://goo.gl/quESju

By:  Vivian F. Go,^a,* Nguyen Le Minh,^b Constantine Frangakis,^c Tran Viet Ha,^a Carl A. Latkin,^d Teerada Sripaipan,^a Wendy Davis,^a Carla Zelaya,^a Nguyen Phuong Ngoc,^b and Vu Minh Quan^a

^aJohns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St. Baltimore, Maryland 21205 USA

^bThai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam

cJohns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe St. Baltimore, Maryland 21205 USA

^dJohns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway, Baltimore, Maryland 21205 USA

Corresponding Author: Vivian F. Go, PhD, MPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E6610, Baltimore, MD 21205, USA, Phone: 1-215-572-5736, Fax: 1-215-616-2334, Email: ude.hpshj@ogv

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A Model for Lesbian, Bisexual & Queer-Related Influences on Alcohol Consumption & Implications for Policy & Practice

Research consistently reports higher rates of problematic drinking among lesbian, bisexual and queer women than among heterosexual women, but relatively little research has identified underlying factors. 

Within this context, the aim of the present study was to qualitatively explore the sociocultural influences on alcohol consumption among lesbian, bisexual and queer women in Australia. An ethnographic study including in-depth interviews and 10 sessions of participant observation was conducted with 25 Australian lesbian, bisexual and queer women. 

Analysis of transcripts and fieldnotes focused on lesbian, bisexual and queer-related influences on alcohol consumption. Three lesbian, bisexual and queer-related factors were identified that influenced alcohol use: (1) coping, (2) connection and (3) intersections with lesbian, bisexual and queer identity. Most participants reported consuming alcohol to cope with discrimination or to connect with like-minded others. Alcohol use had positive influences for some women through facilitating social connection and wellbeing. Women with a high lesbian, bisexual and queer identity salience were more likely to seek lesbian, bisexual and queer community connection involving alcohol, to publicly identify as lesbian, bisexual and queer and to experience discrimination. National policies need to address underlying causes of discrimination against lesbian, bisexual and queer women. 

Alcohol policies and clinical interventions should acknowledge the impact of discrimination on higher alcohol consumption amongst lesbian, bisexual and queer women compared with heterosexual women, and should utilise health promotion messages regarding safe drinking that facilitate lesbian, bisexual and queer social connection.

Purchase full article at:   http://goo.gl/Wq32j9

By:  McNair R1, Pennay A2,3, Hughes T4, Brown R5, Leonard W6, Lubman DI7.

• 1 Department of General Practice, University of Melbourne, Melbourne , Australia.
• 2 Centre for Health Equity, University of Melbourne.
• 3 Centre for Alcohol Policy Research, and Turning Point, Fitzroy , Australia.
• 4 School of Nursing, The University of Illinois at Chicago, Chicago , USA.
• 5 School of Nursing and Midwifery, Faculty of Health, Deakin University , Burwood , Australia.
• 6 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne , Australia.
• 7 Turning Point and Eastern Health Clinical School , Monash University , Fitzroy , Australia.
• Cult Health Sex. 2016 Apr;18(4):405-21. doi: 10.1080/13691058.2015.1089602. Epub 2015 Oct 14. 

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Individual Differences in Men's Misperception of Women's Sexual Intent: Application and Extension of the Confluence Model

Men are more likely than women to misperceive a cross-sex companion's degree of sexual interest. The current study extends previous research by using the confluence model (Malamuth et al., 1991) to examine how narcissism and impulsive sensation-seeking are directly and indirectly associated with men's misperception of women's sexual interest. 

A community sample of young, single men (N = 470) completed audio computer-assisted self-interviews. Using path analyses, hostile masculinity and impersonal sexual orientation were proximal predictors of men's misperception of women's sexual intent. 

Additionally, narcissism was indirectly related to men's misperception through hostile masculinity. Impulsive sensation-seeking was directly and indirectly related to men's misperceptions through impersonal sexual orientation. Although there was a bivariate relationship between alcohol consumption and misperception, this relationship was not significant in the path model. 

Overall, these findings demonstrate the importance of considering how personality traits increase the risk for misperception.

Purchase full article at:   http://goo.gl/ATrWgx

By:  Wegner R1, Abbey A1.

• 1Wayne State University. 
• Pers Individ Dif. 2016 May 1;94:16-20.

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Differences by Gender in Completed Suicides in a Mexican Population: A Psychological Autopsy Study

Highlights

• We examined differences by gender and suicide characteristics in a Mexican population.
• Between the years 2007–2014, 182 psychological autopsies were documented.
• Our results suggest that there are differences by gender between subjects with completed suicide.

Objective

Using the method of psychological autopsy, we identified differences by gender in socio-demographic aspects, signs and symptoms, and suicide characteristics in a population of the state of Tabasco. Mexico.

Methods

Between the years 2007–2014, 182 psychological autopsies were documented by the Secretary of Health of the State of Tabasco, Mexico. A structured questionnaire was used to obtain information on socio-demographic aspects and suicide characteristics.

Results

The sample was mainly formed by males (78%). 84% of the sample used hanging as suicide method. However, in comparison with the male group, females were older on the average (p = 0.002); they were mostly housewives (37.5%) and had more years of schooling (p = 0.004). Other significant differences predominantly present in the male group were: the use of alcohol at the time of suicide (52.1%), job retirement, and increases in apathy (50.7%) and aggressiveness (36.6%) (p < 0.05).

Conclusion

Our results suggest that there are differences by gender between subjects with completed suicide. Factors such as alcohol consumption, job retirement, aggressiveness and isolation/social apathy certainly render men more vulnerable to suicide in the Mexican population.

  

Purchase full article at:   http://goo.gl/fyWQ5d

By:  González-Castro TB1, Hernández-Díaz Y2, Tovilla-Zárate CA3, González-Gutiérrez KP4, Fresán A5, Juárez-Rojop IE6, López-Narváez L7, Villar Soto M8, Genis A9.

• 1Universidad Juárez Autónoma de Tabasco, División Académica de Jalpa de Méndez, Cunduacán, Tabasco, Mexico. Electronic address: thelma.glez.castro@gmail.com.
• 2Universidad Juárez Autónoma de Tabasco, División Académica de Jalpa de Méndez, Cunduacán, Tabasco, Mexico. Electronic address: yazmin.hdez.diaz@gmail.com.
• 3Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico. Electronic address: alfonso_tovillaz@yahoo.com.mx.
• 4Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico. Electronic address: payo2306@hotmail.com.
• 5Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México, D. F., Mexico. Electronic address: fresan@imp.edu.mx.
• 6Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico. Electronic address: iselajuarezrojop@hotmail.com.
• 7Hospital General de Yajalón, Secretaría de Salud, Yajalón, Chiapas, Mexico. Electronic address: dralilialonar@yahoo.com.mx.
• 8Hospital de Alta Especialidad "Gustavo A. Rovirosa P, Villahermosa, Tabasco, Mexico. Electronic address: mariovillarsoto@hotmail.com.
• 9Instituto Nacional de Medicina Genómica (INMEGEN), Servicios de Atención Psiquiátrica (SAP), Secretaría de Salud, México, D. F, Mexico. Electronic address: adgenis@inmegen.gob.mx. 

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Social Interactions, Trust & Risky Alcohol Consumption

Background

The association of social capital and alcohol consumption is one of the most robust empirical findings in health economics of the past decade. However, the direction of the relationship between the two is heavily dependent on which dimension of social capital is studied and which alcohol measure is used. In this paper, we examine the effect of social interactions and generalised trust on drinking in the general Danish population survey.

Methods

Participants (n = 2569) were recruited as part of a larger study. The double-hurdle model for the volume of alcohol consumption and the multivariate logistic model for heavy episodic drinking were estimated.

Results

We found evidence that social networking with male friends, membership in voluntary organisations, and generalised trust were significantly associated with the mean volume of alcohol consumption and heavy drinking. We also observed that social support at the community level had a buffering effect against heavy episodic drinking.

Conclusions

The findings support previous findings in which social interactions and generalised trust were found to predict individuals’ volume of drinking and heavy episodic drinking. However, the results varied across the indicators.

Full article at:   http://goo.gl/t9xECa

By:  Abdu Kedir Seid

Centre for Alcohol and Drug Research, Aarhus University, Artillerivej 90, 2. 2300 København S, Denmark

Abdu Kedir Seid, Phone: +4531847979, Email: kd.ua.ysp@frc.ka.

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Declining & Rebounding Unhealthy Alcohol Consumption During the First Year of HIV Care in Rural Uganda, Using Phosphatidylethanol to Augment Self-Report

AIMS:

We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone.

DESIGN:

A prospective 1-year observational cohort study with quarterly visits.

SETTING:

Large rural HIV clinic in Mbarara, Uganda.

PARTICIPANTS:

A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption.

MEASUREMENTS:

Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use.

FINDINGS:

The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively.

CONCLUSIONS:

Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.

Purchase full article at: http://goo.gl/IEbnbc

By:  Hahn JA1,2, Emenyonu NI1, Fatch R1, Muyindike WR3, Kekiibina A3, Carrico AW4, Woolf-King S1, Shiboski S2.

• 1University of California, Department of Medicine, San Francisco, CA, USA.
• 2University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
• 3Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda.
• 4University of California, Department of Community Health Systems, San Francisco, CA, USA.
• Addiction. 2016 Feb;111(2):272-9. doi: 10.1111/add.13173. Epub 2015 Nov 5. 

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