AIDS and Behavior

, Volume 22, Issue 6, pp 1802–1813 | Cite as

The Relationship Between Spirituality/Religiousness and Unhealthy Alcohol Use Among HIV-Infected Adults in Southwestern Uganda

  • Julian Adong
  • Christina Lindan
  • Robin Fatch
  • Nneka I. Emenyonu
  • Winnie R. Muyindike
  • Christine Ngabirano
  • Michael R. Winter
  • Christine Lloyd-Travaglini
  • Jeffrey H. Samet
  • Debbie M. Cheng
  • Judith A. Hahn
Original Paper


HIV and alcohol use are two serious and co-existing problems in sub-Saharan Africa. We examined the relationship between spirituality and/or religiousness (SR) and unhealthy alcohol use among treatment-naïve HIV-infected adults attending the HIV clinic in Mbarara, Uganda. Unhealthy alcohol was defined as having either an alcohol use disorders identification test—consumption score of ≥4 for men or ≥3 for women, or having a phosphatidylethanol level of ≥50 ng/ml based on analysis of dried bloodspot specimens. Of the 447 participants, 67.8% were female; the median age was 32 years (interquartile range [IQR] 27–40). About half reported being Protestant (49.2%), 35.1% Catholic, and 9.2% Muslim. The median SR score was high (103 [IQR 89–107]); 43.3% drank at unhealthy levels. Higher SR scores were associated with lower odds of unhealthy drinking (adjusted odds ratio [aOR]: 0.83 per standard deviation [SD] increase; 95% confidence interval [CI] 0.66–1.03). The “religious behavior” SR subscale was significantly associated with unhealthy alcohol use (aOR: 0.72 per SD increase; 95% CI 0.58–0.88). Religious institutions, which facilitate expression of religious behavior, may be helpful in promoting and maintaining lower levels of alcohol use.


Spirituality/religiousness Alcohol HIV Phosphatidylethanol Uganda 


El VIH y el consumo de alcohol son dos problemas graves que coexisten en el África subsahariana. Examinamos la relación entre la espiritualidad y/o religiosidad (ER) y el consumo dañino de alcohol entre adultos VIH + ingenuos con respecto al tratamiento que se atendían en la clínica de VIH de Mbarara, Uganda. El consumo dañino de alcohol se definía como tener una calificación de consumo de ≥4 para hombres o ≥3 para mujeres en la Prueba de Identificación de Trastornos de Consumo de Alcohol o tener un nivel de fosfatidiletanol de ≥50 ng/ml basado en un análisis de muestras de manchas de sangre seca. De los 447 participantes, el 67.8% era femenino; la edad mediana era de 32 años; (rango intercuartil [RIC] 27–40). Alrededor de la mitad reportó ser protestante (49.2%), el 35.1% católico y el 9.2% musulmán. La calificación mediana de ER era alta (103 [RIC 89–107]); el 43.3% tomaba alcohol en niveles dañinos. Las calificaciones de SR más altas se asociaban con menores probabilidades de consumo dañino de alcohol (proporción de probabilidades ajustadas [PPa]: 0.83 por incremento de la desviación estándar [DE]; intervalo de confianza de 95% [IC] de 0.66–1.03). La subescala de ER de “comportamiento religioso” se asociabasignificativamente con el consumo dañino de alcohol (PPa: 0.72 por incremento de la DE; 0.58–0.88 IC de 95%). Las instituciones religiosas, que facilitan la expresión decomportamientos religiosos, pueden ser útiles en la promoción y mantenimiento de niveles reducidos de consumo de alcohol.

Palabras clave

Espiritualidad/Religiosidad Alcohol VIH fosfatidiletanol Uganda 



We would like to acknowledge the study participants and the ISS clinic counselors, as well as the study research assistants for their tireless effort in collecting the data. University of California, San Francisco International Traineeship in Aids Prevention Studies (ITAPS): NIMH, R25MH064712 and CV Starr foundation for the technical help in preparing this manuscript. We would also like to thank Gail Ironson and Lauren Kaplan for providing guidance on how to interpret the spirituality/religiousness scale.


Funding for this project was provided by the National Institutes for Health (NIH): URBAN-ARCH: NIH U01 AA20776; U24 AA020778, and U24 AA020779 and K24 AA022586.

Compliance with Ethical Standards

Conflicts of interest

The authors declares that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Julian Adong
    • 1
  • Christina Lindan
    • 2
  • Robin Fatch
    • 2
  • Nneka I. Emenyonu
    • 2
  • Winnie R. Muyindike
    • 3
    • 4
  • Christine Ngabirano
    • 4
  • Michael R. Winter
    • 5
  • Christine Lloyd-Travaglini
    • 5
  • Jeffrey H. Samet
    • 5
    • 6
  • Debbie M. Cheng
    • 5
  • Judith A. Hahn
    • 2
    • 7
  1. 1.Mbarara University of Science and TechnologyMbararaUganda
  2. 2.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of MedicineMbarara Regional Referral HospitalMbararaUganda
  4. 4.Mbarara University of Science and TechnologyMbararaUganda
  5. 5.School of Public HealthBoston UniversityBostonUSA
  6. 6.School of MedicineBoston UniversityBostonUSA
  7. 7.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA

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