Effects of HIV and alcohol stigma on biomarker-confirmed alcohol use following a peer-delivered intervention in South Africa.

BACKGROUND

Despite documented relationships between multiple forms of stigma and health outcomes, limited research has examined the effects of both HIV and alcohol stigmas on objectively measured alcohol use. Research is needed to better understand relationships between stigma and health outcomes to inform intervention efforts that reduce stigma.

METHODS

Participants (N = 60) who met criteria for unhealthy alcohol use and suboptimal HIV medication adherence were recruited from two public HIV care sites in South Africa. Internalized alcohol stigma, enacted alcohol stigma, internalized HIV stigma and phosphatidylethanol [PEth] levels, an alcohol use biomarker, were assessed at baseline, and three- and six-months post-baseline. Participants were randomized to a peer-delivered behavioral intervention or enhanced treatment as usual (facilitated referral to a co-located substance use treatment program). A cross-lagged panel structural equation model with three mediators was used to test lagged effects of stigma on PEth outcomes and whether stigma mediated the effects of the peer intervention.

RESULTS

Significant lagged effects were identified such that higher levels of enacted alcohol stigma and internalized HIV stigma at baseline separately predicted higher PEth levels at three-month follow-up. Higher levels of internalized alcohol stigma predicted higher PEth levels at six-month follow-up. No significant intervention effects were found on stigma (ps > 0.05). Stigma did not mediate the effect of the intervention.

CONCLUSIONS

Findings suggest that higher HIV and alcohol stigma predict greater alcohol use. Future research should explore how stigma reduction strategies can be incorporated into peer-delivered interventions and evaluate the effects of reducing stigma on health outcomes.Trial Registration: ClinicalTrials.gov NCT03529409.