Citation

Williams EC, Joo YS, Lipira L, Glass JE. Subst. Abuse 2016; 38(3): 269-277.

Affiliation

University of Wisconsin-Madison, School of Social Work , Madison , Wisconsin , USA.

Copyright

(Copyright © 2016, Informa - Taylor and Francis Group)

DOI

10.1080/08897077.2016.1268238

PMID

27925867

Abstract

BACKGROUND: Human Immunodeficiency Virus (HIV) is stigmatized and disproportionately impacts vulnerable populations. Thus people living with HIV (PLWH) may have greater exposure to psychosocial stressors than those without HIV. Exposure to psychosocial stressors may increase alcohol use and serve as barriers to alcohol treatment receipt. We evaluate whether psychosocial stressors, and alcohol use, symptom severity, and treatment receipt vary across HIV status in a general population sample of U.S. residents, and assess whether psychosocial stressors mediate identified associations.

METHODS: Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to assess associations between HIV status and psychosocial stressors (perceived stress, alcohol-related stigma, and perceived discrimination based on race/ethnicity, sexual orientation, or sex) and alcohol-related outcomes (any use, heavy drinking, severity, and treatment receipt). For each outcome, regression models were fit and iteratively adjusted for sociodemographic characteristics and comorbidities. Indirect effects of HIV on alcohol-related outcomes through stressors were estimated to assess mediation when main effects were significant.

RESULTS: Among 34,653 NESARC Wave 2 respondents, 161 were PLWH. PLWH were more likely than those without HIV to experience discrimination and had higher levels of perceived stress than those without HIV (p values <0.05), but did not differ regarding alcohol-related stigma. PLWH were less likely to use alcohol and had similar rates of heavy drinking relative to participants without HIV, but alcohol symptom severity and treatment receipt were greater among PLWH. Perceived stress but not discrimination mediated associations.

CONCLUSIONS: Findings from this first study of variation in psychosocial stressors, and alcohol use, severity, and treatment receipt across HIV status further highlight PLWH as a population that is particularly vulnerable to experiences of psychosocial stress and certain adverse alcohol-related outcomes. Future longitudinal research is needed in a larger sample of PLWH to identify intervention targets.

Language: en