Publication Cover
AIDS Care
Psychological and Socio-medical Aspects of AIDS/HIV
Volume 29, 2017 - Issue 2
381
Views
25
CrossRef citations to date
0
Altmetric
Articles

The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi

, , , , , , , , & show all
Pages 197-203 | Received 23 Feb 2016, Accepted 05 Jul 2016, Published online: 21 Jul 2016
 

ABSTRACT

Female sex workers (FSW) have a high prevalence of substance use and HIV, but the impact of substance use on HIV treatment engagement is not well established. We evaluated the association between alcohol and marijuana use and sub-optimal HIV treatment engagement outcomes among HIV-infected FSW in Lilongwe, Malawi. We enroled FSW using venue-based recruitment into a cross-sectional evaluation assessing substance use and HIV treatment engagement. Seropositive FSW, identified through HIV rapid testing, received rapid CD4 count and viral load testing. We used Poisson regression with robust variance estimates to ascertain associations of alcohol and marijuana use with sub-optimal HIV treatment outcomes: (1) lack of ART use among previously diagnosed, ART-eligible FSW and (2) viral nonsuppression among FSW on ART. Of previously diagnosed, ART-eligible FSW (n = 96), 29% were not using ART. Patterns of hazardous drinking were identified in 30%, harmful drinking in 10%, and alcohol dependence in 12%. ART-eligible FSW with harmful drinking or alcohol dependency were 1.9 (95% CI: 1.0, 3.8) times as likely to not use ART compared to FSW without harmful or dependent drinking. Among those on ART, 14% were virally nonsuppressed. The prevalence ratio for viral nonsuppression was 2.0 (95% CI: 0.6, 6.5) for harmful drinkers and alcohol-dependent FSW. Over 30% of ART-eligible FSW reported using marijuana. Marijuana-using FSW were 1.9 (95% CI: 0.8, 4.6) times as likely to not use ART compared to FSW who were not using marijuana. Given the high prevalence of alcohol use and its association with lack of ART use, ART uptake and alcohol reduction strategies should be tailored for alcohol-using FSW in Malawi.

Acknowledgements

We gratefully acknowledge the outreach team for their dedication, interviewing skills, knowledge, and commitment to this work. We are also grateful to the study participants who courageously shared their time, thoughts, and stories to this research. All participants provided written informed consent and the study was approved by the Institutional Review Board at the University of North Carolina and the Malawi Ministry of Health and Population National Health Sciences Research Committee.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the NIH Research Training Grant (R25 TW009340) funded by the Fogarty International Center, the NIH Office of the Director Office of AIDS Research, ORWH, NCI, and NHLBI, the NIAID T32 training grant (T32 AI0700), the UNC Center for AIDS Research, an NIH funded program (P30 AI50410), and the National Institutes of Health (KL2 TR001109).

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.