Perinatal alcohol use among young women living with HIV in South Africa: Context, experiences, and implications for interventions

ABSTRACT

Perinatal alcohol use is common in South Africa, including among young women living with HIV (WLHIV), but there are few insights into the drivers of alcohol use in this population. Following the completion of a pilot trial of a peer support intervention for WLHIV aged 16–24 years in Cape Town, we purposively selected participants who had reported perinatal alcohol use at ≥1 study visits to complete a qualitative in-depth interview exploring their experiences of substance use. Of 119 women enrolled, 28 reported alcohol use, and 24 were interviewed, with ≥1/3 reporting drinking throughout their pregnancy. Women described living in a community where heavy perinatal alcohol consumption is normalised, including among their peers, leading to social pressure. Despite being aware of the risks of perinatal alcohol use, women described a disconnect between public health messaging and their experiences. Although most acknowledged the negative effects of alcohol in their lives, self-efficacy to reduce consumption was diminished by peer influences and the lack of formal employment and opportunities for recreation. These findings provide insights into the drivers of perinatal alcohol use in this setting, and suggest that without meaningful community-level changes, including employment opportunities and alternatives for socialising, interventions may have limited impact.

KEYWORDS:

• Alcohol
• pregnancy
• HIV
• young women
• South Africa

Acknowledgements

The authors would like to thank the women who participated in this study, as well as the study staff for their support of this research. This research was supported by a Providence/Boston Center for AIDS Research (CFAR) international developmental award with co-funding from the National Institute Of Allergy And Infectious Diseases (NIAID) under award number P30AI042853. The authors would like to thank the CFAR Substance Use Research Core for their input into development of the in-depth interview guide. The primary trial was funded by the Fogarty International Center, National Institute of Mental Health (NIMH) of the National Institutes of Health under award number R21TW011047. Dr. Pellowski was supported by a career development grant from the NIMH (K01MH112443). Drs. Mellins and Remien are supported by a grant from the NIMH to the HIV Center for Clinical and Behavioral Studies (P30-MH45320).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Fogarty International Center: [Grant Number R21TW011047]; Providence/Boston Center for AIDS Research: [Grant Number P30AI042853].