Sub-Saharan Africa: binge drinking more common among people living with HIV
West and southern Africa study reveals significantly higher levels of binge drinking among people living with HIV than the general population.
The study of people living with HIV in Côte d'Ivoire, Togo, Senegal and Zambia, published in the Journal of the International AIDS Society, is one of the first large-scale studies to examine alcohol consumption among HIV positive people in sub-Saharan Africa.
Studies conducted elsewhere have found a link between excessive alcohol consumption and poor health for people living with HIV, including reduced adherence to antiretroviral therapy (ART) and engagement in care, but evidence is missing from the area of the world most impacted by the virus.
Between 2013 and 2015, 1,050 people living with HIV in West Africa (from Abidjan in Côte D'Ivoire, Lomé in Togo and Dakar in Senegal) were randomly selected for the study during hospital visits. Using a similar system, 795 people living with HIV were enrolled in Lusaka, Zambia. Data from 1,824 participants was included in the final analysis.
The proportion of people on ART was high in Côte d'Ivoire and Senegal at 96%, and in Zambia at 100%, but low in Togo at 51%. In Zambia, participants had a median age of 34 and 54% were female, while in West Africa participants had a median age of 43 and 70% were female.
Participants were asked to take the Alcohol Use Disorders Identification Test (AUDIT‐C), which focuses on the quantity and frequency of alcohol consumption. Those with high scores were defined as hazardous drinkers. AUDIT-C includes a question on binge drinking, which it defines as six or more drinks at least once a month. The prevalence of binge drinking among participants was then compared to World Health Organization country-level estimates of binge drinking in the general population.
Around 37% of all participants reported drinking alcohol in the past year. Among those who drank, 41% of women and 73% of men reported binge drinking.
Those from Senegal were more likely to abstain from alcohol (91%), reflecting the predominately Muslim population. Zambian participants were more likely to drink alcohol and reported significantly higher levels of hazardous and binge drinking than those in West Africa. For instance, 36% of all participants in Zambia reported binge drinking, followed by 18% in Togo, 11% in Côte d'Ivoire and 1% in Senegal.
Despite the differences in drinking patterns, the study found people living with HIV who drink were significantly more likely to binge drink than the general population in each country.
The contrast was particularly stark in Zambia, where 82% of participants who drank reported binge drinking, compared to 7% of the general population. Differences in binge drinking between people living with HIV and the general population were more moderate in Côte d'Ivoire (23%, compared to 10%) and Senegal (14%, compared to 3%), and similar in Togo (44%, compared to 39%).
Previous studies have linked high levels of harmful drinking among people living with HIV with experiences of stigma, stress and depression, as well as precarious socio‐economic situations and unemployment.
Men in Senegal, Côte d’Ivoire and Togo were more likely to binge drink than women. However, Zambian women also showed extremely high levels of binge drinking, although this may be linked to the younger age of study participants in this country.
Overall, 22% of participants were engaged in hazardous levels of drinking. Hazardous drinking was reported by 38% of participants in Zambia, 14% in Togo and 11% in Côte d'Ivoire, but by only 0.9% of Senegalese participants.
Men were around three times more likely to drink harmfully than women, with 40% of men reporting this behaviour compared to 13% of women.
In light of previous evidence on the impact excessive drinking can have on ART adherence and engagement in care, this study suggests interventions to limit the detrimental effects of alcohol among people living with HIV could help people maintain better health and curtail onward transmission.