The Association Between Alcohol Use and HIV Testing in a National Sample of Women

Background and purpose: The HIV/AIDS epidemic continues to disproportionately affect racial and ethnic minority groups and women in the United States. Research shows that drug and alcohol use are associated with HIV risky behaviors. Prevention research suggests that HIV prevention and outreach services are associated with reduced HIV risk behaviors. HIV prevention and adherence to treatment contribute to increased longevity and improved health outcomes. However, despite the high incidence and prevalence of HIV infection among women and individuals aged 50 and above in recent years, there is limited empirical evidence on the role of alcohol in the transmission of HIV/AIDS among women. The objective of this study is to examine the association between alcohol use and HIV testing in a nationally representative sample of women. 

Methods: Secondary data analyses of the 2009 National Health Interview Survey (NHIS) were performed to identify the association between alcohol use, and HIV risk and protective behaviors among women (N=15,233). Two comprehensive sets of analyses were conducted using original and imputed data. The first analysis comprised of the original sample of individuals who had complete data. The second analysis comprised of multiple imputation procedures for missing data. Analyses were conducted to determine the type and extent of missing data for outcome and predictor variables. Multivariate logistic regression techniques were used to model HIV risk and protective behaviors controlling for individual, interpersonal, organizational, and community level factors such as age, race, income, education, health insurance status, marital status, and region. Data were analyzed using SAS version 9.3.

Results: There is a significant association between level of alcohol use and HIV testing among women. Controlling for micro and macro level factors, women who identified as heavy drinkers (Original model OR = 0.162, p< 0.001; Imputed model OR = 0.112, p<0.001) and moderate drinkers (Original model OR=0.494, p< 0.01; Imputed model OR=0.317, p<0.001) were much less likely to report ever testing for HIV. Older women,  those with less than high school education, and women living in the Midwest were less likely to report ever testing for HIV  (p<0.05). Black/African American women were more than twice as likely to report ever testing for HIV compared to White women. Further, compared to White women who did not drink alcohol, the odds for ever testing for HIV among Black/African American women who drink moderately increased by 1.373 (p< 0.05).

Conclusions and implications: Results show that higher levels of alcohol use are associated with less HIV testing protective behaviors.  Social workers, public health practitioners, and policy makers should consider targeting resources to more comprehensive HIV prevention efforts with alcohol-using women. In addition, given the dramatic increase in newly HIV infected older adults, prevention of HIV is a critical health issue for older women. Alcohol related HIV prevention and outreach efforts need to expand to better serve women who may not be traditionally targeted. Social workers need to continue to advocate, support, and provide prevention and treatment services to at risk populations such as women.