Alcohol-related beliefs and non-adherence to antiretroviral therapy in Cape Town, South Africa
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Alcohol‑related beliefs and non‑adherence to antiretroviral therapy in Cape Town, South Africa Seth C. Kalichman1 · Catherine Mathews2 · Ellen Banas1,2 · Moira O. Kalichman1
Received: 20 August 2019 / Accepted: 10 January 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The life-saving effects of antiretroviral therapy (ART) in treating HIV infection are compromised by alcohol use. A growing body of research shows that both unintentional (e.g., memory lapses) and intentional (e.g., forgoing ART to avoid mixing with alcohol) contribute to ART nonadherence. Beliefs that it is harmful to mix alcohol with ART (alcohol-ART interactive toxicity beliefs) contribute to intentional non-adherence, but their role in overall adherence is not clear. This study conducted a clinic-based survey with 100 men and 193 women (mean age = 36) to examine the prevalence of alcohol-ART interactive toxicity beliefs and whether they contribute to treatment non-adherence in South Africa. One in three (36%, n = 106) participants reported no current alcohol use and 64% (n = 187) reported current alcohol use. The majority of participants, including current alcohol drinkers, endorsed beliefs that it is harmful to mix ART and alcohol, with 57% who currently drink reporting that they forgo taking ART when they are drinking. Participants reported being warned not to mix alcohol and ART from family, friends, and health care providers. In addition, 62% of participants who do not drink, as well as 36% of those who do drink, tell others not to mix alcohol and ART. Mediation modelling found that alcohol use directly predicts ART adherence, and that this relationship is partially mediated by alcohol-ART interactive toxicity beliefs. Health care providers can play a critical role in disputing interactive toxicity beliefs and encouraging patients to take ART even when they are drinking. * Seth C. Kalichman [email protected] 1
Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
2
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
Keywords HIV treatment · Alcohol use · Adherence · Medication beliefs
Introduction The global scale-up of antiretroviral therapy (ART) in treating HIV infection has improved health and life expectancies for people living with HIV and is the basis for efforts to end HIV epidemics (HIV.gov, 2018). The most ambitious program in the global-scale-up of ART is the UNAIDS 90-90-90 initiative, aimed at identifying and engaging 90% of people living with HIV infection in treatment and achieving HIV suppression in 90% of those treated by the year 2020 (UNAIDS, 2014). Unfortunately, few countries have achieved the 90-90-90 goals (Boerma et al., 2019). In South Africa, while 90% of people infected with HIV are now aware of their HIV status, only 61% are receiving ART and 47% are HIV suppressed (UNAIDS, 2019). The gap between receiving ART and HIV suppression is best explained by poor ART adherence, and
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