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Alcohol use among people who inject drugs living with HIV in Kenya is associated with needle sharing, more new sex partners, and lower engagement in HIV care

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Abstract

We assessed the prevalence and correlates of alcohol use among 870 people who inject drugs living with HIV in Kenya, with attention toward (1) sexual and injecting risk behaviors for HIV transmission and (2) HIV care engagement. We defined heavy alcohol use as > 14 drinks/week for men and > 7 drinks/week for women, moderate alcohol use as any lesser but non-zero amount, and any alcohol use as either moderate or heavy use. Approximately 39% of participants reported any alcohol use and 15% heavy use. In multivariate analysis, any alcohol use compared to no use was associated with needle sharing, > 3 new sex partners in the past 3 months, being unaware of HIV status, never enrolling in HIV care, and not being on ART (all p < 0.05). Heavy alcohol use as compared to no use was associated with needle sharing (aOR = 2.72; 95% CI 1.43, 5.13), injection equipment sharing (aOR = 1.80; 95% CI 1.00, 3.16), > 3 new sex partners in the past 3 months (aOR = 1.99; 95% CI 1.12, 3.49), and being unaware of HIV status (aOR = 2.77; 95% CI 1.46, 5.19). There was no association between any measure of alcohol use and unsuppressed viral load. Alcohol use among people who inject drugs living with HIV may carry elevated risk of HIV transmission mediated by sexual and injecting practices and is associated with lower engagement in multiple stages of the HIV care cascade.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available because the local ethics review committee requires oversight of use of research data but are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

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Acknowledgements

We wish to acknowledge all partnering organizations and staff, particularly the peer educators for their contributions to data collection and the needle and syringe and methadone programs that worked with us (SAPTA, MEWA, The Omari Project, Reachout, Ngara Health Center, Mathari Referral Hospital). We would like to recognize the National AIDS and STI and Control Programme and Kenyatta National Hospital for their collaboration.

Funding

Collaborating authors are supported by a US National Institutes of Health (NIH) National Institute on Drug Abuse (NIDA) funded study (R01 DA043409). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Washington, Seattle, USA

    N. DesLauriers & C. Farquhar

  2. HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya

    B. Sambai, L. Mbogo & D. Bukusi

  3. Department of Global Health, University of Washington, Seattle, USA

    N. Ludwig-Barron, B. Chohan, S. Masyuko, J. Herbeck, B. L. Guthrie, C. Farquhar & A. Monroe-Wise

  4. Department of Epidemiology, University of Washington, Seattle, USA

    N. Ludwig-Barron, B. L. Guthrie & C. Farquhar

  5. Institute for Public Health Genetics, University of Washington, Seattle, USA

    H. Kingston

  6. Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    B. Chohan

  7. Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya

    E. Gitau & W. Sinkele

  8. National AIDS and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya

    S. Masyuko

Authors
  1. N. DesLauriers
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Contributions

ND: conceptualization, data analysis and writing original draft. AMW, NLB, and CF: conceptualization, writing - review and editing. AMW, BG, BC, JH, CF: study design and data collection structure. AMW, BC, BG, BS, DB, EG, EK, EW, HK, LM, RB, SM, WS: writing - review and editing.

Corresponding author

Correspondence to N. DesLauriers.

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The authors declare that they have no competing interests.

Ethics Approval

All study procedures and materials were approved by the University of Washington Institutional Review Board (Seattle, WA, USA) and the Kenyatta National Hospital/University of Nairobi Ethical Review Committee (Nairobi, Kenya). This study was carried out in accordance with the Declaration of Helsinki.

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Informed consent was obtained from all study participants.

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DesLauriers, N., Sambai, B., Mbogo, L. et al. Alcohol use among people who inject drugs living with HIV in Kenya is associated with needle sharing, more new sex partners, and lower engagement in HIV care. AIDS Behav 27, 3970–3980 (2023). https://doi.org/10.1007/s10461-023-04113-0

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