Stigmatisation of alcohol use among people receiving antiretroviral therapy for HIV infection, Cape Town, South Africa

ABSTRACT

Antiretroviral therapy (ART) effectively treats HIV infection, with improved longevity and quality of life among people living with HIV. Alcohol use, however, remains a robust barrier to ART. This study, for the first time, examined the effects of the stigmatisation of alcohol use on ART adherence. Patients receiving ART in Cape Town, South Africa who currently drink alcohol (N = 187) and those who do not drink alcohol (N = 106) completed measures of alcohol use, alcohol-ART adherence, and alcohol-ART stigma. Participants also provided permission to access their most recent HIV viral load from clinic medical records. Results of a mediation model demonstrated significant detrimental effects of alcohol use on ART adherence. In addition, the indirect effects of alcohol use on ART adherence through alcohol-ART stigma was also significant, indicating that alcohol-ART stigma at least in part mediates the association between alcohol use and ART adherence. The same pattern of results was observed in relation to HIV viral load obtained from medical records. Interventions designed to address alcohol use as a barrier to ART adherence should incorporate alcohol-ART stigma as a barrier to adherence as well as a barrier to participating in adherence interventions.

KEYWORDS:

• HIV treatment
• alcohol use
• stigma
• adherence

Acknowledgements

The authors wish to thank Karen Jennings and the City of Cape Town Health Department for their support of this research.

Disclosure statement

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

Data availability statement

Data from this study are available upon request from the authors.

Additional information

Funding

This work was supported by the National Institute of Mental Health (NIMH) under Grant R21MH121314.