Sustained Sobriety: A Qualitative Study of Persons with HIV and Chronic Hepatitis C Coinfection and a History of Problem
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ORIGINAL PAPER
Sustained Sobriety: A Qualitative Study of Persons with HIV and Chronic Hepatitis C Coinfection and a History of Problematic Drinking Abigail Howell1 · Audrey Lambert2,3 · Megan M. Pinkston4 · Claire E. Blevins4 · Jumi Hayaki5 · Debra S. Herman4 · Ethan Moitra4 · Michael D. Stein3 · H. Nina Kim1 Accepted: 13 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract For persons diagnosed with HIV and who are coinfected with hepatitis C virus (HCV), chronic liver disease is a leading cause of death and excessive consumption of alcohol can be a contributing factor. Little is known about the factors these individuals identify as key to achieving sustained sobriety. In this qualitative study, fourteen HIV/HCV coinfected persons who endorsed past problematic drinking were interviewed about their path to sustained sobriety. In open-ended interviews, participants often described their drinking in the context of polysubstance use and their decision to become sober as a singular response to a transcendent moment or a traumatic event. All articulated specific, concrete strategies for maintaining sobriety. The perceived effect of the HIV or HCV diagnosis on sobriety was inconsistent, and medical care as an influence on sobriety was rarely mentioned. Qualitative interviews may offer new insights on interventions and support strategies for heavy-drinking persons with HIV/HCV coinfection. Keywords HIV · Chronic hepatitis C · Alcohol · Sobriety · Qualitative interview
Introduction Up to 25% of persons living with HIV are coinfected with hepatitis C virus (HCV) in the United States [1]. For these individuals, chronic liver disease is a leading cause of death [2]. One of the major factors contributing to the progression of liver disease is the excessive consumption of alcohol [3, 4]. Alcohol use disorder (AUD) has high prevalence in HIV/HCV coinfected individuals [4–7]. In addition to liver * H. Nina Kim [email protected] 1
Department of Medicine, University of Washington, 325 Ninth Avenue Box 359930, Seattle, WA 98104, USA
2
Section of General Internal Medicine, CARE Unit, Boston Medical Center, Boston, MA, USA
3
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
4
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
5
Department of Psychology, College of the Holy Cross, Worcester, MA, USA
disease, heavy alcohol consumption in the coinfected population is associated with greater risk for nonadherence to highly active antiretroviral therapy and lack of engagement in medical care [8–10]. When compared with HIV mono-infected individuals, those living both with HIV and HCV may be more likely to abstain from alcohol, although the subset that does drink are likely to drink to excess [11]. Indeed, coinfected abstainers from alcohol may be more than twice as likely as HIV mono-infected individuals to have a prior AUD, suggesting that many coinfected persons can
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