HIV-Positive African Americans' Experiences of Alcohol Abuse and Dependence

BACKGROUND & PURPOSE

Alcohol misuse is thought to contribute to disparities in the health and survival of HIV-positive African Americans, yet little research focuses on the etiology of this phenomenon. This analysis explores the perspectives of HIV-positive African Americans on the issues that influence their alcohol abuse and dependence in the context of living with HIV/AIDS, the impact of alcohol abuse and dependence on their HIV-related self care behaviors and the factors critical to their recovery in the context of HIV/AIDS.

METHODS

40 open-ended interviews were conducted with HIV-positive African Americans identified through the alcohol section of the SCID-II as having histories of alcohol abuse or dependence since being diagnosed with HIV/AIDS. Participants were asked open-ended questions about their HIV self care behaviors, the impact of alcohol abuse and dependence on their HIV self care and other HIV-related behaviors and the factors related to their cessation of alcohol abuse and/or dependence in the context of HIV/AIDS. Using QSR Nvivo, interview transcripts were subjected to qualitative analysis using the 'coding, consensus, co-occurrence and comparison' method of content analysis rooted in grounded theory. Based on the codes and themes that emerged from this analysis, categories, trees and nodes were generated and then incorporated into visual maps of the identified thematic patterns.

RESULTS

The patterns that emerged from this analysis suggested a model in which two parallel processes influence both alcohol misuse and HIV self care. In it, both of these processes are set into action by contextual factors related to participants' historical backdrops of childhood abuse and adult victimization and then triggered at critical points when the deficits created by this backdrop compromise appraisal of and coping with contemporary life stressors. Analysis revealed that participants perceived stress, depression, lack of positive social support and engagement in unhealthy social networks as influencing them toward alcohol misuse. They described alcohol misuse as impacting their HIV self care through the failure to respond to initial HIV diagnoses as well as longer term neglect of HIV-related medical, emotional and spiritual care needs. Participants identified the factors critical to their recovery from alcohol abuse and dependence in the context of HIV/AIDS as making individual decisions to recover, participating in formal treatment, 12 step or peer support programs, developing greater self awareness and addressing unresolved underlying emotional issues and creating and sustaining social networks more supportive of their physical and emotional health and sobriety.

CONCLUSIONS & IMPLICATIONS

Interventions focused on reducing alcohol abuse and dependence among HIV-positive African Americans must address issues related to the medical, emotional and social aspects of living with HIV/AIDS as well as substance abuse. Most centrally, they should focus on bolstering social support for these individuals through the creation, support and reinforcement of positive social networks. While this approach emphasizes a traditional cultural strength among African Americans, educational efforts that reduce the social stigma, shame and isolation related to HIV/AIDS in the African American community may help to increase the social support available to HIV-positive African Americans who are alcohol abusing or dependent.