Hazardous drinking by persons living with HIV (PLHIV) is a well-established determinant of sub-optimal HIV care and treatment outcomes. Despite this, to date, few interventions have sought to reduce hazardous drinking among PLHIV in sub-Saharan Africa (SSA). We describe an iterative cultural adaptation of an evidence-based multi-session alcohol reduction intervention for PLHIV in southwestern Uganda. The adaptation process included identifying core, theoretically informed, intervention elements, and conducting focus group discussions and cognitive interviews with community members, HIV clinic staff and patients to modify key intervention characteristics for cultural relevance and saliency. Adaptation of evidence-based alcohol reduction interventions can be strengthened by the inclusion of the target population and key stakeholders in shaping the content, while retaining fidelity to core intervention elements.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Data will be made available upon request to the investigators Hahn, Camlin, and Muyindike.
UNAIDS. Global AIDS Update: Miles to go- closing gaps breaking barriers righting injustices. Geneva, Switzerland, 2018.
Duko B, Ayalew M, Ayano G. The prevalence of alcohol use disorders among people living with HIV/AIDS: A systematic review and meta-analysis. Subst Abuse Treat Prev Policy. 2019;14(1):52.
Reid MC, Fiellin DA, O’Connor PG. Hazardous and harmful alcohol consumption in primary care. Arch Intern Med. 1999;159(15):1681–9.
Ministry of Health, Uganda. Uganda Population-based HIV Impact Assessment (UPHIA) 2016–2017: Final report. Kampala, Uganda, 2019.
World Health Organization. Global status on alcohol and health 2018. Geneva: Switzerland; 2018.
Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8(2):141–51.
Woolf-King SE, Fatch R, Cheng DM, et al. Alcohol use and unprotected sex among HIV-infected Ugandan adults: Findings from an event-level study. Arch Sex Behav. 2018;47(7):1937–48.
Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: current knowledge, implications, and future directions. Alcohol ClinExp Res. 2016;40(10):2056–72.
Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic Review: Alcohol and the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(4):421–36.
Velloza J, Kemp CG, Aunon FM, Ramaiya MK, Creegan E, Simoni JM. Alcohol use and antiretroviral therapy non-adherence among adults living with HIV/AIDS in Sub-Saharan Africa: A systematic review and meta-analysis. AIDS Behav. 2020;24:1727–42.
Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva: Switzerland; 2016.
Carrasco MA, Esser MB, Sparks A, Kaufman MR. HIV-Alcohol Risk reduction interventions in Sub-Saharan Africa: A systematic review of the literature and recommendations for a way forward. AIDS Behav. 2016;20(3):484–503.
Papas RK, Gakinya BN, Mwaniki MM, et al. A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction. 2021;116(2):305–18.
Papas RK, Sidle JE, Gakinya BN, et al. Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction. 2011;106(12):2156–66.
L’Engle KL, Mwarogo P, Kingola N, Sinkele W, Weiner DH. A randomized controlled trial of a brief intervention to reduce alcohol use among female sex workers in Mombasa. Kenya J Acquir Immune Defic Syndr. 2014;67(4):446–53.
Zule W, Myers B, Carney T, Novak SP, McCormick K, Wechsberg WM. Alcohol and drug use outcomes among vulnerable women living with HIV: Results from the Western Cape Women’s Health CoOp. AIDS Care. 2014;26(12):1494–9.
Braithwaite RS, Nucifora KA, Kessler J, et al. How inexpensive does an alcohol intervention in Kenya need to be in order to deliver favorable value by reducing HIV-related morbidity and mortality? J Acquir Immune Defic Syndr. 2014;66(2):e54–8.
Chander G, Hutton HE, Lau B, Xu X, McCaul ME. Brief intervention decreases drinking frequency in HIV-infected, heavy drinking women: Results of a randomized controlled trial. J Acquir Immune DeficSyndr. 2015;70(2):137–45.
Hasin DS, Aharonovich E, O’Leary A, et al. Reducing heavy drinking in HIV primary care: A randomized trial of brief intervention, with and without technological enhancement. Addiction. 2013;108(7):1230–40.
Pew Research Center. Cell phones in Africa: Communication Lifeline, 2015.
Campbell JI, Haberer JE. Cell phone-based and adherence device technologies for HIV care and treatment in resource-limited settings: Recent advances. Curr HIV/AIDS Rep. 2015;12(4):523–31.
Savic M, Room R, Mugavin J, Pennay A, Livingston M. Editor’s Choice: Defining “drinking culture”: A critical review of its meaning and connotation in social research on alcohol problems. Drug-Educ Prev Polic. 2016;23(4):270–82.
Room R, Makela K. Typologies of the cultural position of drinking. J Stud Alcohol. 2000;61(3):475–83.
Graham K, Bernards S, Knibbe R, et al. Alcohol-related negative consequences among drinkers around the world. Addiction. 2011;106(8):1391–405.
Bond JC, Roberts SCM, Greenfield TK, Korcha R, Ye Y, Nayak MB. Gender differences in public and private drinking contexts: A multi-level GENACIS analysis. Int J Environ Res Public Health. 2010;7(5):2136–60.
Breuer C, Bloom B, Miller AP, et al. “The Bottle Is My Wife”: Exploring reasons why men drink alcohol in Ugandan fishing communities. Soc Work Public Health. 2019;34(8):657–72.
Sileo KM, Kizito W, Wanyenze RK, et al. A qualitative study on alcohol consumption and HIV treatment adherence among men living with HIV in Ugandan fishing communities. AIDS Care. 2019;31(1):35–40.
Sundararajan R, Wyatt MA, Woolf-King S, et al. Qualitative study of changes in alcohol use among HIV-infected adults entering care and treatment for HIV/AIDS in rural southwest Uganda. AIDS Behav. 2015;19(4):732–41.
Castro FG, Barrera M, Martinez CR. The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prev Sci. 2004;5(1):41–5.
Castro FG, Barrera M Jr, Holleran Steiker LK. Issues and challenges in the design of culturally adapted evidence-based interventions. Annu Rev Clin Psychol. 2010;6:213–39.
Barrera M Jr, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol. 2013;81(2):196–205.
Bernal G, Bonilla J, Bellido C. Ecological validity and cultural sensitivity for outcome research: issues for the cultural adaptation and development of psychosocial treatments with Hispanics. J Abnorm Child Psychol. 1995;23(1):67–82.
Hutton HE, Lancaster KE, Zuskov D, et al. Cultural adaptation of 2 evidence-based alcohol interventions for antiretroviral treatment clinic patients in Vietnam. J Int Assoc Provid AIDS Care. 2019;18:2325958219854368.
McKelroy VS, Galbraith JS, Cummings B, Jones P, Harshbarger C, Collings C, Gelaude D, Carey JW. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Educ Prev 2006; 18(Supplement A): 59–73.
Wingood GM, DiClemente RJ. The ADAPT-ITT model: A novel method of adapting evidence-based HIV Interventions. J Acquir Immune Defic Syndr. 2008;47(Suppl 1):S40–6.
Fisher JD, William A. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.
Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; 1986.
Borsari B, Carey KB. Descriptive and injunctive norms in college drinking: A meta-analytic integration. J Stud Alcohol. 2003;64(3):331–41.
Festinger L. Cognitive dissonance. Sci Am. 1962;207:93–102.
Wigfield A, Eccles JS. Expectancy-value theory of achievement motivation. ContempEducPsychol. 2000;25(1):68–81.
Cox WM, Klinger E. A motivational model of alcohol use. J Abnorm Psychol. 1988;97(2):168–80.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioralcounseling after screening for alcohol misuse in primary care: A systematic review and meta-analysis for the U.S. preventive services task force. Ann Intern Med. 2012;157(9):645–54.
Resnicow KS, Braithwaite RL, Ahluwalia JS, Butler J. Cultural sensitivity in substance use prevention. J Community Psychol. 2000;28(3):271–90.
Green J, Thorogood N. Qualitative methods for health research. 2nd ed. Thousand Oaks, CA: Sage; 2006.
Willis GB. Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage Publications; 2005.
Hahn JA, Cheng DM, Emenyonu NI, et al. Alcohol use and HIV disease progression in an antiretroviral naive cohort. J Acquir Immune DeficSyndr. 2018;77(5):492–501.
Hahn JA, Emenyonu NI, Fatch R, et al. Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction. 2016;111(2):272–9.
Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.
Watkins DC. Rapid and rigorous qualitative data analysis: The “RADaR” technique for applied research. Int J Qual Methods. 2017;16:1–9.
Beebe J. Rapid qualitative inquiry: A field guide to team-based assessment. 2nd ed. Lanham: Rowman & Littlefield; 2014.
Dedoose. Dedoose. 7.0.23 ed. Los Angeles, CA: SocioCultural Research Consultants, LLC, 2016.
Sileo KM, Kintu M, Chanes-Mora P, Kiene SM. “Such behaviors are not in my home village, i got them here”: A qualitative study of the influence of contextual factors on alcohol and HIV risk behaviors in a fishing community on Lake Victoria. Uganda AIDS Behav. 2016;20(3):537–47.
Wolff B, Busza J, Bufumbo L, Whitworth J. Women who fall by the roadside: Gender, sexual risk and alcohol in rural Uganda. Addiction. 2006;101(9):1277–84.
Swidler A, Watkins SC. Ties of dependence: AIDS and transactional sex in rural Malawi. Stud Fam Plann. 2007;38(3):147–62.
Siu GE, Seeley J, Wight D. Dividuality, masculine respectability and reputation: How masculinity affects men’s uptake of HIV treatment in rural eastern Uganda. Soc Sci Med. 1982;2013(89):45–52.
Chantelois-Kashal H, ApenemDagadu N, Gardsbane D. Contested femininity: Strategies of resistance and reproduction across adolescence in northern Uganda. Cult Health Sex. 2019;22:1–16.
Sudhinaraset M, Wigglesworth C, Takeuchi DT. Social and cultural contexts of alcohol use influences in a social-ecological framework. Alcohol Res-Curr Rev. 2016;38(1):35–45.
We would like to thank the participants who engaged in this study. We gratefully acknowledge the Uganda Ministry of Health, Mbarara University of Science and Technology (MUST), Mbarara Regional Referral Hospital, the staff of the Mbarara Immune Suppression Syndrome Clinic, our research and administrative teams at MUST and UCSF. We would also like to acknowledge the study counselors David Mugumya and Frances Musinguzi.
This research was supported by the National Institutes of Health (NIH) through the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with grants R01AA024990 (PI: Hahn) and K24022586 (PI: Hahn). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health.
Conflict of Interest
The authors have nothing to disclose.
This study received ethical approval from the University of California San Francisco Institutional Review Board (IRB), the Mbarara University of Science and Technology Research and Ethics Committee, and the Uganda National Council on Science and Technology.
Consent to Participate
All participants provided informed consent.
Consent for Publication
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Leddy, A.M., Hahn, J.A., Getahun, M. et al. Cultural Adaptation of an Intervention to Reduce Hazardous Alcohol Use Among People Living with HIV in Southwestern Uganda. AIDS Behav (2021). https://doi.org/10.1007/s10461-021-03186-z
- Cultural adaptation
- Alcohol reduction
- Evidence-based interventions
- People living with HIV
- Sub-saharan africa