Alcohol Use and Antiretroviral Therapy Adherence Among People Living with HIV: A Qualitative Study of Patient-Provider Communication

Introduction: Alcohol use accelerates HIV progression directly through interference with antiretroviral therapy (ART) and indirectly via decreased ART adherence. Despite the high prevalence of alcohol use among people living with HIV (PLWH) and its impact on ART adherence, HIV-positive patients and their healthcare providers do not commonly discuss such use. Few studies have qualitatively examined this topic from the perspective of PLWH. 

Methods: Twenty semi-structured qualitative interviews were conducted between June-December 2014 with PLWH. Thematic content analysis was performed. The majority was male (75%) and had been living with HIV for an average of 17 years (range=1-29). The mean age was 49.1 years (range=31-60). Most participants (n=16) reported annual incomes of <$20,000, and 80% were unemployed.

Results: Three major themes arose: 1) Established relationship with provider: Participants discussed the importance of open communication and providers’ time and effort in disease management. 2) Honesty about alcohol consumption: Most reported that their provider was aware of their alcohol use. Hiding alcohol use was perceived as a deterrent to the providers’ ability to help them. 3) Discussion regarding alcohol’s effect on ART: Some indicated that providers consistently review alcohol's impact on ART adherence; others stated that providers rarely engage in such conversation, focusing instead on other substance use.  

Conclusion: Overall, participants described high levels of satisfaction with their HIV providers. However, multiple factors limited discussion of alcohol consumption and its role in ART adherence. Effective patient-provider communication has the potential to address the influential role of alcohol in medication nonadherence among PLWH.