Gutin Sarah A, Mulauzi Nancy, Jere Jane, Sungani Cobbener, Tebbetts Scott, Ruark Allison, Mkandawire James, Conroy Amy A
Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, United States of America.
Division of Prevention Sciences, School of Medicine, University of California San Francisco, San Francisco, California, United States of America.
PLoS One. 2025 Aug 29;20(8):e0331202. doi: 10.1371/journal.pone.0331202. eCollection 2025.
Unhealthy alcohol use is prevalent in sub-Saharan Africa and can worsen poverty, couple relationships, and HIV treatment outcomes. In response, we assessed participant experiences with Mlambe, a pilot study of an economic and relationship-strengthening intervention for couples living with unhealthy alcohol use and HIV. Exit interviews were conducted with a subset of 20 couples who participated in a pilot trial of Mlambe in Zomba, Malawi. A 10-month intervention consisted of financial literacy and couples counseling sessions and incentivized savings accounts. Eligible couples were married, ≥ 18, with at least one partner with unhealthy alcohol use (according to AUDIT-C screen), and currently on antiretroviral therapy (ART). Interviews were recorded, transcribed, translated, and analyzed using dyadic framework analysis. Intervention couples reported that alcohol use caused many problems and that reducing or quitting use brought improvements to their physical and emotional health, and the well-being of their marriages and households. Before Mlambe, couples reported that quarrels about alcohol use were common. After the intervention, couples reported improvements to their relationships and less alcohol use, which led to more open and respectful couple communication and other marital improvements including increased sexual satisfaction and trust. Women and men described that post-intervention, men reduced spending on alcohol which improved availability of money for household needs such as food and clothing, and that feeling more economically secure reduced stress and led to a more "peaceful family." After Mlambe, male drinkers described more motivation to pursue income-generating activities, and that reduced alcohol use led to greater medication adherence as they no longer forgot to take ART when drinking. Mlambe may contribute to positive change for couple relationships and health behaviors through mechanisms including reduced conflict and poverty related to reduced alcohol use. The model appears promising for couples in resource-poor settings where HIV, poverty, and alcohol use are mutually reinforcing.
不健康饮酒在撒哈拉以南非洲地区很普遍，会加剧贫困、夫妻关系问题以及艾滋病毒治疗效果恶化。作为应对措施，我们评估了参与“姆拉姆贝”项目的参与者的经历，这是一项针对有不健康饮酒习惯且感染艾滋病毒的夫妇的经济和关系强化干预试点研究。对在马拉维宗巴参与“姆拉姆贝”试点试验的20对夫妇中的一部分进行了退出访谈。为期10个月的干预包括金融知识普及和夫妻咨询课程以及有激励措施的储蓄账户。符合条件的夫妇为已婚，年龄≥18岁，至少有一方有不健康饮酒习惯（根据酒精使用障碍识别测试-消费版筛查），且目前正在接受抗逆转录病毒治疗（ART）。访谈进行了录音、转录、翻译，并使用二元框架分析进行了分析。参与干预的夫妇报告称，饮酒导致了许多问题，如果减少或戒酒，他们的身心健康、婚姻和家庭幸福都会得到改善。在参与“姆拉姆贝”项目之前，夫妇们报告说，因饮酒问题发生争吵很常见。干预之后，夫妇们报告说他们的关系有所改善，饮酒减少，这带来了更开放和相互尊重的夫妻沟通以及其他婚姻方面的改善，包括性满意度和信任度的提高。女性和男性都表示，干预后，男性减少了在酒精上的支出，这使得家庭在食品和衣物等需求上有了更多可用资金，而且经济上更有保障的感觉减轻了压力，营造了一个更“和睦的家庭”。参与“姆拉姆贝”项目之后，男性饮酒者表示更有动力去从事创收活动，而且减少饮酒使他们更能坚持服药，因为他们不再在饮酒时忘记服用抗逆转录病毒药物。“姆拉姆贝”项目可能通过减少与饮酒相关的冲突和贫困等机制，为夫妻关系和健康行为带来积极变化。对于艾滋病毒、贫困和饮酒相互影响的资源匮乏地区的夫妇来说，该模式似乎很有前景。
