Correlates and Effects of Alcohol Use Expectancies Among Persons Living with HIV in Uganda

Exploring Alcohol Use Expectancies as Mediators in the Relationship Between Psychological Stressors and Substance Use Among Youths Living with HIV in Uganda

We investigated the mediating role of alcohol use expectancies between three psychological/emotional states (depressive symptoms, hopelessness, and adverse childhood experiences (ACE)) and problematic alcohol and substance use among YLHIV in Uganda. We defined problematic substance use according to the National Institute on Drug Abuse (NIDA)-modified Alcohol, Smoking, and Substance Involvement Screening Test (NM-ASSIST) to derive a Substance Involvement (SI) score to identify participants' risk level. We grouped moderate and high risk into one category to represent 'problematic use' or use that would qualify as a substance use disorder. We tested the proposed mediation models using the PROCESS macro for mediation, moderation, and conditional process analysis version 4.1 for SPSS. We observed that higher scores for depressive symptoms, hopelessness, and ACE, were each associated with increased levels of global AUE (GAUE). However, mediation analyses revealed significant indirect effects of depressive symptoms (1.03, 95% CI 1.0002 to 1.0926), hopelessness (1.11, 95% CI 1.0172 to 1.3349), and ACE (1.08, 95% CI 1.0027 to 1.2695) on problematic substance use via GAUE. Also negative AUE (NAUE) significantly mediated the relationship between depressive symptoms, hopelessness, and ACE and problematic substance use. Our study highlights the significant role of GAUE and NAUE in mediating the relationship between ACE, depressive symptoms, hopelessness, and problematic substance use among YLHIV. The findings suggest that interventions targeting GAUE and NAUE and possibly providing effective coping mechanisms for managing depressive symptoms, hopelessness, and the impact of ACE may be crucial in reducing substance use among YLHIV.

Prevalence of alcohol use by gender and HIV status in rural Uganda

BACKGROUND

Alcohol use is a major contributor to mortality and morbidity worldwide. Uganda has a high level of alcohol use per capita. Compared to men, women are less likely to consume alcohol globally; however, women who drink have increased risks for co-occurring conditions, including depression, intimate partner violence, and HIV. This study assessed the prevalence of alcohol use and correlates of harmful alcohol use by gender and HIV status in rural Uganda.

METHODS

We used cross-sectional data from a study among women and men aged 15-59 residing in rural, central Uganda and accepting home-based HIV testing (Nov 2017 to Dec 2020). We estimated the prevalence of levels of alcohol use (categorized as no alcohol use (score 0), low (score 1-3 for men; 1-2 for women), medium (score 4-5 for men; 3-5 for women), high (score 6-7), and very-high (score 8-12) use with the AUDIT-C), stratified by gender and HIV status. We assessed correlates of harmful alcohol use using multivariable logistic regression models for women and men.

RESULTS

Among 18,460 participants, 67% (95% CI: 66-67%) reported no alcohol use, 16% (95% CI: 16-17%) reported low, 5% (95% CI: 4.8-5%) reported medium, 5% (95% CI: 4-5%) reported high, and 3% (95% CI: 2.8-3) reported very high alcohol use. Compared to women, men were more likely to report alcohol use (Chi-squared p-value<0.0001). People diagnosed with HIV (both newly diagnosed and previously aware of their status prior to home-based HIV testing) were more likely to report low, medium, high, and very high alcohol use compared to those who were HIV negative (Chi-squared p-value<0.0001). Among women, those who were newly diagnosed were more likely report alcohol use, compared to those who were HIV negative. In multivariable models, being newly diagnosed with HIV (compared to HIV negative) increased the odds of harmful alcohol use among women, but not men.

CONCLUSION

While alcohol use was higher among men and people living with HIV, being newly diagnosed with HIV had a stronger relationship with harmful alcohol use among women than men. More research is needed to understand how alcohol use may increase the risks of HIV acquisition among women and to identify gender-responsive services to address harmful alcohol use and increase access to HIV testing and linkage to care for women who use harmful levels of alcohol.

Global prevalence of depressive symptoms among people living with HIV/AIDS: a systematic review and meta-analysis of the past five years

A clear and accurate assessment of depressive symptoms among people living with HIV/AIDS (PLWHA) in the past five years is essential to help develop reasonable and sound interventions to improve their depressive symptoms. PubMed, Web of Science, MEDLINE, Cochrane, Embase, CINAHL, and APA were searched from 1 January 2017 to 12 April 2022. The data were analyzed using STATA 15 Software to pool the global prevalence of depressive symptoms in PLWHA. Ultimately, 103785 PLWHA from 81 original studies were included. The pooled analysis showed that the global prevalence of depressive symptoms in PLWHA over the past five years was 0.35 (95% CI: 0.31-0.38), with differences in depressive symptoms in PLWHA by geographic location, gender, assessment instruments, alcohol use, smoking, marriage, co-morbid disease, financial situation, and educational level. Scientific and timely public health interventions should be developed among PLWHA to improve their depressive symptoms and thereby improve mental health and clinical outcomes.

Heavy drinking and problem drinking among youth in Uganda: A structural equation model of alcohol marketing, advertisement perceptions and social norms

Introduction

To determine the role of alcohol marketing, perceptions of marketing and social norms on heavy alcohol use and problem drinking among vulnerable youth in Uganda.

Methods

The Kampala Youth Survey is a cross‐sectional study conducted in 2014 with service‐seeking youth (ages 12–18 years) living in the slums of Kampala (n = 1134) who were participating in Uganda Youth Development Link drop‐in centres. Survey measures assessed perceptions of alcohol advertisements, social norms regarding alcohol use, heavy alcohol use and problem drinking. Factor analyses and structural equation models were computed to determine the predictors (e.g. social norms and alcohol marketing exposure) for drinking amounts, heavy drinking and problem drinking.

Results

Alcohol marketing allure, perceptions of adults' alcohol attitudes and respondent's male gender were significantly predictive of heavy drinking. Similarly, in addition to drinking amount and heaviness, only alcohol marketing exposure and friends' alcohol attitudes, as well as respondent's own attitudes about alcohol, significantly predicted variation in problem drinking.

Discussion and Conclusions

Alcohol marketing exposure and allure are significant predictors of heavy drinking and problem drinking among youth in Uganda. Prevention programs that reduce exposure to and allure of alcohol marketing may prove promising for reducing alcohol use and related problems among these vulnerable youth in a low‐resource setting.