Expanding Research on the Role of Alcohol Consumption and Related Risks in the Prevention and Treatment of HIV_AIDS

Abstract

This article is a review of some of the major epidemiological, behavioral, biological, and integrative prevention research issues and priorities in the area of HIV/AIDS and alcohol consumption. Drinking alcohol increases both the risk for infection with HIV and related illnesses and the morbidity and mortality of patients who progress to AIDS. New and improved measurement procedures have helped in assessment of the complex patterns of alcohol use, identification of intervening explanatory mechanisms for risk behaviors and contexts, and determination of intervention outcomes. Both the direct and indirect effects of alcohol misuse appear to be major contributors to both the risk for infection with HIV and the transmission of HIV/AIDS at the individual and population levels. There is increasing evidence that perhaps no level of alcohol consumption is "safe" for those who are HIV infected and receiving antiretroviral treatment. Interdisciplinary basic behavioral and biomedical research is needed to develop comprehensive culturally appropriate strategies for programs that can be effectively delivered in community contexts in the United States and abroad and that focus on the integration of our understanding of individual behaviors, high-risk group membership, biological mechanisms, and the social and physical environments that place individuals at risk for HIV infection. High-priority topics include improving adherence to antiretroviral medications, prevention of infection in young minority women in the United States, and treatment of HIV+ pregnant women who are alcohol abusers to prevent adverse fetal outcomes, which is an international focus in under-resourced settings in Africa.

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

“…multiple sexual partners, unprotected vaginal and anal intercourse, inconsistent condom use, and paying for or selling sex) (Alem, Kebede, Mitike, Enqusellase & Lemma, 2006;Lurie et al, 2008;Weiser et al, 2006). A number of theories have been proposed to explain the complex relationship between alcohol consumption and sexual risk behaviour, including the psychoactive effects of alcohol on sexual decision-making, expectations surrounding the effects of alcohol, high-risk settings and risk-taking personality characteristics (Bryant, 2006;Corte & Sommers, 2005;Kalichman, Simbayi, Jooste, Cain & Cherry, 2006;Morojele et al, 2006).…”

“…In addition, the effect of alcohol on liver function may affect its ability to metabolise certain HIV medication, thus reducing their therapeutic efficacy. This, together with non-compliance to ART, not only results in poorer HIV treatment outcomes, but can also lead to the development of drug-resistant HIV strains (Bekker, 2005;Bryant 2006). …”

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

“…Studies have shown that immediately after consuming alcohol, the likelihood of risky sexual activity increases, as alcohol is thought to decrease an individual's ability to consider negative consequences [56]. Adolescent drinkers have been found to be more likely to report multiple sexual partners, inconsistent condom use, sexually transmitted infections, and unplanned pregnancy [8,12,34].…”

Increased HIV Risk Associated with Criminal Justice Involvement among Men on Methadone

“…It is estimated that more than 20,000 offenders with a recent history of injection drug use enter the New York City criminal justice system every year (Belenko et al 2004). Elevated sexual HIV risk behaviors have been associated with excessive use of alcohol (Bryant 2006), marijuana and cocaine (Braithwaite and Stephens 2005), methamphetamines (Molitor et al 1998;Wohl et al 2002), and club drugs (Colfax and Guzman 2006). Risky sexual practices were also found to be associated with crack cocaine use and polysubstance abuse (Booth et al 1993;Campsmith et al 2000;Chesney et al 1998;Stephens et al 2004).…”