AIDS and Behavior

, Volume 23, Issue 12, pp 3247–3256 | Cite as

Alcohol, But Not Depression or IPV, Reduces HIV Adherence Among South African Mothers Living with HIV Over 5 Years

  • Mary Jane Rotheram-BorusEmail author
  • Thomas W. Weichle
  • Adriane Wynn
  • Ellen Almirol
  • Emily Davis
  • Jacqueline Stewart
  • Sarah Gordon
  • Julia Tubert
  • Mark Tomlinson
Original Paper


Alcohol, depression, and intimate partner violence (IPV) are endemic in sub-Saharan Africa. This article examines whether and how these conditions affect mothers living with HIV (MLH), compared to mothers without HIV (MWOH). In particular, we assess the influence of these comorbidities on engagement in HIV care and adherence to antiretroviral therapies (ARV) among MLH. Data on maternal HIV care are typically based on clinic samples, with substantial loss to follow-up. This study fills that gap by including all mothers in specified areas. A cohort study examines MLH in Cape Town, South Africa recruited in pregnancy and followed repeatedly for 5 years, compared to MWOH. Almost all (98%) pregnant women in 12 neighborhoods (N = 594) were recruited in pregnancy. Mothers and children were reassessed five times over 5 years with high retention rates at each of the six assessments, from 98.7% at 2 weeks to 82.8% at 5 years post-birth. MLH’s uptake and adherence to HIV care was evaluated over time associated with maternal comorbidities of alcohol use, depressed mood, and IPV using mixed effects logistic regression. MLH have fewer resources (income, food, education) and are more likely to face challenges from alcohol, depression, and having seropositive partners over time than MWOH. Only 22.6% of MLH were consistently engaged in HIV care from 6 months to 5 years post-birth. At 5 years, 86.7% self-reported engaged in HIV care, 76.9% were receiving ARVs and 87% of those on ARV reported consistent ARV adherence. However, data on viral suppression are unavailable. Alcohol use, but not depressed mood or IPV, was significantly related to reduced uptake of HIV care and adherence to ARV over time. Adherence to lifelong ARV by MLH requires a combination of structural and behaviorally-focused interventions. Alcohol abuse is not typically addressed in low and middle-income countries, but is critical to support MLH.


Alcohol use HIV Depression Intimate partner violence Adherence 



This work was supported by the National Institute on Alcohol Abuse and Alcoholism (R01AA017104, R24AA022919), National Institute of Mental Health (P30MH058107), Ilifa Labantwana, National Institute of Allergy and Infectious Diseases (AI028697), and the National Center for Advancing Translational Science (UL1TR000124). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

10461_2019_2617_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Biobehavioral Sciences, Semel InstituteUniversity of California at Los AngelesLos AngelesUSA
  2. 2.Institute for Life Course Health Research, Department of Global HealthStellenbosch UniversityCape TownSouth Africa
  3. 3.Division of Infectious Diseases & Global Public Health, School of MedicineUCSDLa JollaUSA
  4. 4.School of Nursing and MidwiferyQueens UniversityBelfastUK

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