Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
PLoS One. 2020 Sep 30;15(9):e0239330. doi: 10.1371/journal.pone.0239330. eCollection 2020.
Hazardous alcohol use is prevalent among people living with HIV (PWH), leading to sub-optimal HIV treatment outcomes. In Vietnam, alcohol use is highly normative making it socially challenging for PWH to reduce or abstain. We used mixed methods to develop a quantitative scale to assess alcohol abstinence stigma and examined the association between alcohol abstinence stigma with alcohol use among PWH in Vietnam.
We conducted qualitative interviews with 30 PWH with hazardous alcohol use from an antiretroviral therapy (ART) clinic in the Thai Nguyen to inform item development. Alcohol use was assessed using the Alcohol Use Disorders Identification Test. We tested items in a survey of 1,559 ART clinic patients to assess internal consistency and structural validity. We used log binomial modeling to estimate associations between any reported alcohol abstinence stigma and alcohol use.
Using the results from the qualitative interview data, we developed the alcohol abstinence stigma scale with seven final items with scores ranging from 0 (no stigma) to 28 (high stigma). The scale had good internal consistency (α = 0.75). Exploratory factor analysis suggested the presence of three factors: internalized, experienced, and anticipated stigma that explained 56.9% of the total variance. The mean score was 2.74, (SD = 4.28) and 46% reported any alcohol abstinence stigma. We observed a dose-response relationship between alcohol abstinence stigma and alcohol use. PWH who reported any alcohol abstinence stigma had greater hazardous alcohol use (aPR = 1.32, 95% CI: 1.12, 1.56), harmful alcohol use (aPR = 2.26, 95% CI: 1.37, 3.72), and dependence symptoms (aPR = 3.81, 95% CI: 2.19, 6.64).
Alcohol abstinence stigma is associated with increased alcohol levels of alcohol use among PWH in Vietnam, signaling challenges for alcohol reduction. Consideration of alcohol abstinence stigma will be essential for the design of effective alcohol reduction interventions and policy efforts to prevent adverse health consequences of alcohol use among PWH.
在感染艾滋病毒的人群（PLHIV）中，危险饮酒较为普遍，导致艾滋病毒治疗效果不理想。在越南，饮酒是一种高度规范化的行为，这使得 PLHIV 很难减少或戒除酒精。我们采用混合方法开发了一个评估酒精戒除污名的定量量表，并研究了该量表与越南 PLHIV 饮酒行为之间的关系。
我们对来自泰宁省一个抗逆转录病毒治疗（ART）诊所的 30 名危险饮酒的 PLHIV 进行了定性访谈，以获取项目开发的信息。使用酒精使用障碍识别测试（AUDIT）评估饮酒情况。我们在 1559 名 ART 诊所患者的调查中测试了项目，以评估内部一致性和结构有效性。我们使用对数二项式模型来估计任何报告的酒精戒除污名与饮酒之间的关联。
利用定性访谈数据的结果，我们开发了一个由七个最终项目组成的酒精戒除污名量表，分数范围为 0（无污名）至 28（高污名）。该量表具有良好的内部一致性（α=0.75）。探索性因素分析表明，存在内化、体验和预期污名三个因素，解释了总方差的 56.9%。平均得分为 2.74（SD=4.28），46%的人报告有任何酒精戒除污名。我们观察到酒精戒除污名与饮酒之间存在剂量-反应关系。报告有任何酒精戒除污名的 PLHIV 有更高的危险饮酒（aPR=1.32，95%CI：1.12，1.56）、有害饮酒（aPR=2.26，95%CI：1.37，3.72）和依赖症状（aPR=3.81，95%CI：2.19，6.64）。
酒精戒除污名与越南 PLHIV 的饮酒量增加有关，表明减少饮酒存在挑战。考虑酒精戒除污名对于设计有效的减少饮酒干预措施和政策努力以防止 PLHIV 饮酒的不良健康后果至关重要。
