There has been ongoing research into identifying negative associations between alcohol and drug use and HIV, in that it can lead to disease progression, transmission of the virus and treatment efficacy. According to new research, alcohol use among South African adults with HIV is common, and causes decreased antiretroviral therapy (ART) initiation and lower retention in HIV care.
This means that alcohol and drug use interferes with patients accessing care, receiving ART, and adhering to their daily medication regimen.
The study was carried out by researchers from the University of KwaZulu-Natal, the University of Washington, and the AIDS Healthcare Foundation and is the first study of a South African population looking at the effects of drug and alcohol use on HIV outcomes.
The study surveyed 2 374 HIV-infected adults attending an urban clinic in Umlazi township in Durban, and were followed for one year. Results indicated that 502 males and 281 females consumed alcohol within a 30 day period. The average age of participants was 31 years old.
Participants also self-reported on marijuana and other drug use within this period.
ART programmatic success requires that patients on ART remain on treatment and attend follow-ups regularly. However, the study reports that alcohol use significantly decreased the odds of patients attending their follow-ups and remaining on treatment at 12 months, and increased the odds of death or loss-to-follow-up at 12 months.
It also found that drug use, including marijuana, was strongly associated with significantly decreased odds of viral load (VL) suppression by month 12. Viral load refers to the amount of HIV in a person's blood, and treatment aims to reduce the load until the virus is undetectable and therefore untransmittable.
Alcohol and drug use and HIV
HIV damages the immune system and therefore makes it harder for the body to fight off infections, and alcohol consumption and drug use only causes further damage. More than this, alcohol and drug use also compromises a critical HIV treatment regimen – which comprises a combination of HIV medicines – since it can make it hard for people to focus on sticking to their daily treatment.
A 2016 Yale-affiliated study supports this finding, with the study’s co-author and former professor at the Yale School of Medicine, Amy Justice, saying that even among people who were taking their medication, alcohol was associated with both higher mortality rates, at every level of drinking, and physiologic frailty.
Interactions between HIV medication and drugs, such as ecstasy (MDMA) and GHB have also been found to increase the risk of dangerous side effects such as drug overdose, and can make it easier for HIV to enter the brain, causing nerve cell injury and problems with learning, thinking and memory.
Under the influence of alcohol and drugs, your judgement can also be impaired and your inhibitions lowered to a point where you engage in risky behaviour, such as increasing the risk of getting or transmitting HIV by having unprotected sex, or sharing needles when injecting drugs, for example. Engaging in unprotected sexual activity with someone who is HIV positive is one of the main ways South Africans put themselves at risk for HIV.
Since results of the South African study were based on participants’ self-reports, the study’s researchers note a limitation of possible under-reporting due to stigmatised behaviour. Based on the observations, the researchers place emphasis on interventions that reduce alcohol and drug use among people with HIV, so that HIV care outcomes in South Africa can be improved.