Drink­ing while HIV+

Al­co­hol not only in­creases the like­li­hood of risky sex­ual be­hav­iour, it also af­fects HIV treat­ment ad­her­ence

CityPress - - News - ZINHLE MAPUMULO zinhle.mapumulo@city­press.co.za

Booze and HIV do not mix, in more ways than we think. Dur­ing the SA Aids Con­fer­ence in Dur­ban last week, Dr Paul Shu­per, an ex­pert sci­en­tist in the field of al­co­hol and HIV, said that “when you con­sume al­co­hol, you might for­get to take your med­i­ca­tion or may not even have it with you”.

“There is ev­i­dence from a num­ber of stud­ies that link al­co­hol to non-ad­her­ence to an­tiretro­vi­ral drugs [ARVs]. What they found was that al­co­hol use was the strong­est pre­dic­tor of non-ad­her­ence, and an­other study showed that, in binge drinkers, the like­li­hood of non-ad­her­ence in­creased nine­fold,” he said.

But Shu­per also dis­pelled the myth that ARVs should not be taken while drink­ing.

“We need to change per­cep­tions about an­tiretro­vi­ral ther­apy and al­co­hol tox­i­c­ity. We need to work with health­care pro­fes­sion­als to en­sure non­judge­men­tal at­ti­tudes when it comes to drink­ing and tak­ing ARVs,” he said.

“In­stead, we need to cre­ate an en­vi­ron­ment where peo­ple can come and talk about their al­co­hol use, and providers can help them take their med­i­ca­tion even when drink­ing.”

So while al­co­hol in­creases the like­li­hood of en­gag­ing in risky sex­ual be­hav­iour and get­ting in­fected with HIV, it also af­fects ad­her­ence to HIV treat­ment, which then neg­a­tively af­fects the spread of HIV. Drink­ing al­co­hol is the main driver of risky sex­ual be­hav­iour and there are many the­o­ries around al­co­hol’s causal role in sex­ual risk-tak­ing.

How­ever, it’s not just al­co­hol that leads to un­pro­tected sex – the per­son’s per­son­al­ity traits and their sex­ual ex­pec­ta­tions af­ter drink­ing also con­trib­ute.

“There are other ar­gu­ments, such as that it might not be al­co­hol that causes risky be­hav­iour, but the in­di­vid­ual’s per­son­al­ity. For ex­am­ple, as a risky per­son, I might like to go out and drink a lot; on the other hand, I may like to go out and meet part­ners and have sex with­out a con­dom,” Shu­per said.

“It might look like al­co­hol is caus­ing risky be­hav­iour, but, in fact, both of those things are stem­ming from me as a risky per­son.

“There are also ex­pec­ta­tions sur­round­ing al­co­hol use. Some peo­ple be­lieve that when they con­sume al­co­hol, they will en­gage in risky sex­ual be­hav­iours and those thoughts end up con­tribut­ing to this,” he ex­plained.

Shu­per and his col­leagues tested this the­ory on a group of 140 men who have sex with men, who were re­cruited from a clinic spe­cial­is­ing in HIV care in Toronto, Canada, and they looked at the the­ory of al­co­hol, sex­ual arousal, per­son­al­ity traits and in-the­mo­ment risk fac­tors in sex­ual de­ci­sion mak­ing.

They then took the par­tic­i­pants to a spe­cialised lab­o­ra­tory that re­sem­bled a bar. To en­sure that it met “bar stan­dards”, re­searchers poured 30ml of vodka into a shal­low con­tainer out of sight behind the bar about 20 min­utes be­fore the par­tic­i­pants ar­rived. This pro­vided a strong al­co­hol ol­fac­tory cue that could be sensed im­me­di­ately upon en­ter­ing the bar.

Half of the par­tic­i­pants were given real al­co­hol, a quar­ter got placebo al­co­hol, which smells and tastes like al­co­hol, but isn’t, and the other quar­ter were just given wa­ter to drink. Shu­per said what was sur­pris­ing was that the group that re­ceived placebo al­co­hol be­lieved that they were drunk af­ter the ex­per­i­ment.

Af­ter­wards, par­tic­i­pants were pre­sented with hy­po­thet­i­cal sce­nar­ios of imag­i­nary part­ners and were asked if they would en­gage in con­dom­less sex with these part­ners. Many in­di­cated that they would.

“The the­ory behind this sug­gests that, when we con­sume al­co­hol, it’s not that we be­come com­pletely un­in­hib­ited, but rather that our cog­ni­tive ca­pac­ity be­comes very con­strained. Be­cause of this, we fo­cus on the cues that drive us to­wards risky be­hav­iour – being sex­u­ally aroused at the time and being pre­sented with an at­trac­tive sex­ual en­counter,” Shu­per said.

“We fo­cus on those as­pects and, with lim­ited cog­ni­tive ca­pac­ity, we dis­re­gard the prospects of be­com­ing in­fected with HIV or pass­ing on the virus.”

TALK TO US Do you find that you are more likely to en­gage in risky sex­ual be­hav­iour when you have had al­co­hol, or does it not make a dif­fer­ence?

SMS us on 35697 us­ing the key­word BOOZE and tell us what you think. Please in­clude your name and prov­ince. SMSes cost R1.50

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