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Hazardous and Harmful use of Alcohol and/or Other Drugs and Health Status Among South African Patients Attending HIV Clinics

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Abstract

There is growing recognition of the influence of substance use, particularly alcohol use, on HIV disease progression. This study investigated how hazardous/harmful use of alcohol and drugs impacts the health status of 1503 patients attending HIV clinics. Of the sample, 37 % indicated hazardous/harmful drinking and 13 % indicated a drug problem. Hazardous/harmful use of alcohol and drugs was significantly related to health status, with participants using substances more likely to have TB-positive status (χ2 = 4.30, p < 0.05), less likely to be on ARVs (χ2 = 9.87, p < 0.05) and having lower CD4 counts (t = 4.01, p < 0.05). Structural equation modelling confirmed the centrality of hazardous/harmful use of alcohol as a direct and indirect determinant of disease progression. Based on these findings it is recommended that patients attending HIV clinics be routinely screened for problematic alcohol and/or drug use, with strong emphasis on ensuring ARV adherence in those with problematic alcohol use.

Resumen

Existe un creciente reconocimiento de la influencia del consumo de sustancias, en particular el uso de alcohol, en la progresión de la enfermedad del VIH. Este estudio investigó cómo el uso riesgoso/nocivo de alcohol y drogas afecta el estado de salud de 1.503 pacientes que acuden a las clínicas de VIH. De la muestra, el 37 % indicó consumo riesgoso/nocivo y 13 % indicó un problema de drogas. El uso riesgoso/nocivo del alcohol y las drogas estuvo significativamente asociado con el estado de salud, con los participantes que usaron sustancias mostrando mayor probabilidades de tener TB positiva (c2 = 4.30, p < 0.05), menor probabilidad de estar en ARV (c2 = 9.87, p < 0.05) y que tiene más bajos recuentos de CD4 (t = 4.01, p < 0.05). Modelos de ecuaciones estructurales confirmaron la centralidad del consumo riesgoso/nocivo del alcohol como un determinante directo e indirecto de la progresión de la enfermedad. Basándose en estos resultados, se recomienda que los pacientes que asisten a clínicas de VIH se examinan rutinariamente para detectar alcohol problemático y/o el consumo de drogas, con un fuerte énfasis en asegurar la adherencia al ARV en los pacientes con consumo problemático de alcohol.

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Acknowledgments

This research has been supported by the US President’s Emergency Fund for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC), under the terms of Co-operative agreement grant number 5U2GPS001137. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or PEPFAR. The authors would also like to acknowledge Carlos Toledo at the CDC in Pretoria for his technical support and encouragement throughout the project.

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Authors and Affiliations

  1. Alcohol and Drug Abuse Research Unit, Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town, 7505, South Africa

    R. Kader, S. Seedat, R. Govender, J. R. Koch & C. D. Parry

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  1. R. Kader
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  2. S. Seedat
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  3. R. Govender
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  4. J. R. Koch
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  5. C. D. Parry
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Correspondence to R. Kader.

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Kader, R., Seedat, S., Govender, R. et al. Hazardous and Harmful use of Alcohol and/or Other Drugs and Health Status Among South African Patients Attending HIV Clinics. AIDS Behav 18, 525–534 (2014). https://doi.org/10.1007/s10461-013-0587-9

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  • DOI: https://doi.org/10.1007/s10461-013-0587-9

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