HIV/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status

Objectives To quantify HIV/AIDS mortality attributable to alcohol use in the adult general population of South Africa in 2012 by socioeconomic status (SES). Design Comparative risk assessment based on secondary individual data, aggregate data and risk relations reported in the literature. Setting South African adult general population. Participants For metrics of alcohol use by SES, sex and age: 27 070 adults that participated in a nationally representative survey in 2012. For HRs of dying from HIV/AIDS by SES: 87 029 adults that participated in a cohort study (years 2000 to 2014) based out of the Umkhanyakude district, KwaZulu-Natal. Main outcome measures Alcohol-attributable fractions for HIV/AIDS mortality by SES, age and sex were calculated based on the risk of engaging in condom-unprotected sex under the influence of alcohol and interactions between SES and alcohol use. Age-standardised HIV/AIDS mortality rates attributable to alcohol by SES and sex were estimated using alcohol-attributable fractions and SES-specific and sex-specific death counts. Rate ratios were calculated comparing age-standardised rates in low versus high SES by sex. Results The age-standardised HIV/AIDS mortality rate attributable to alcohol was 31.0 (95% uncertainty interval (UI) 21.6 to 41.3) and 229.6 (95% UI 108.8 to 351.6) deaths per 100 000 adults for men of high and low SES, respectively. For women the respective rates were 10.8 (95% UI 5.5 to 16.1) and 75.5 (95% UI 31.2 to 144.9). The rate ratio was 7.4 (95% UI 3.4 to 13.2) for men and 7.0 (95% UI 2.8 to 18.2) for women. Sensitivity analyses corroborated marked differences in alcohol-attributable HIV/AIDS mortality, with rate ratios between 2.7 (95% UI 0.8 to 7.6; women) and 15.1 (95% UI 6.8 to 27.7; men). Conclusions The present study showed that alcohol use contributed considerably to the socioeconomic differences in HIV/AIDS mortality. Targeting HIV infection under the influence of alcohol is a promising strategy for interventions to reduce the HIV/AIDS burden and related socioeconomic differences in South Africa.

[1]  Mohammad Hossein Khosravi,et al.  Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, Lancet.

[2]  Eyal Oren,et al.  Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, Lancet.

[3]  H. Ross,et al.  Lifestyle and Income-related Inequality in Health in South Africa , 2017, International Journal for Equity in Health.

[4]  J. Rehm,et al.  Coverage of alcohol consumption by national surveys in South Africa , 2017, Addiction.

[5]  J. Rehm,et al.  Alcohol Use, Socioeconomic Status and Risk of HIV Infections , 2017, AIDS and Behavior.

[6]  E. Roth,et al.  Public Drinking Venues as Risk Environments: Commercial Sex, Alcohol and Violence in a Large Informal Settlement in Nairobi, Kenya , 2017, Human ecology.

[7]  N. Sewankambo,et al.  Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda , 2017, PloS one.

[8]  J. Rehm,et al.  Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect , 2017, Population Health Metrics.

[9]  E. Williams,et al.  Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions. , 2016, Alcoholism, clinical and experimental research.

[10]  J. Rehm,et al.  Socio‐economic differences in HIV/AIDS mortality in South Africa , 2016, Tropical medicine & international health : TM & IH.

[11]  Edward A. Smith,et al.  Girls Just Want to Know Where to Have Fun: Preventing Substance Use Initiation in an Under-Resourced Community in South Africa Through HealthWise , 2016, Prevention Science.

[12]  J. Josse,et al.  missMDA: A Package for Handling Missing Values in Multivariate Data Analysis , 2016 .

[13]  D. Celentano,et al.  Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey , 2016, AIDS care.

[14]  Saul Johnson,et al.  Alcohol Use and Transactional Sex among Women in South Africa: Results from a Nationally Representative Survey , 2015, PloS one.

[15]  S. Kalichman,et al.  Reducing HIV Risks in the Places Where People Drink: Prevention Interventions in Alcohol Venues , 2015, AIDS and Behavior.

[16]  Blair T. Johnson,et al.  Alcohol Use Predicts Sexual Decision-Making: A Systematic Review and Meta-Analysis of the Experimental Literature , 2015, AIDS and Behavior.

[17]  J. Rehm,et al.  Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis. , 2014, International journal of epidemiology.

[18]  S. Clark,et al.  The Unfolding Counter-Transition in Rural South Africa: Mortality and Cause of Death, 1994–2009 , 2014, PloS one.

[19]  K. Carey,et al.  Exploring the Relationships Among Food Insecurity, Alcohol Use, and Sexual Risk Taking Among Men and Women Living in South African Townships , 2014, The Journal of Primary Prevention.

[20]  Edward A. Smith,et al.  The dynamic association between healthy leisure and substance use in South African adolescents: a state and trait perspective , 2014, World leisure journal.

[21]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[22]  D. Labadarios,et al.  South African National HIV Prevalence, Incidence and Behaviour Survey, 2012 , 2014 .

[23]  S. Kalichman,et al.  The relationship between attending alcohol serving venues nearby versus distant to one’s residence and sexual risk taking in a South African township , 2014, Journal of Behavioral Medicine.

[24]  N. Taffa,et al.  Socio-economic inequality and HIV in South Africa , 2013, BMC Public Health.

[25]  S. Clark,et al.  Profile: Agincourt Health and Socio-demographic Surveillance System , 2012, International journal of epidemiology.

[26]  J. Amin,et al.  Differences in Lipid Measurements by Antiretroviral Regimen Exposure in Cohorts from Asia and Australia , 2012, AIDS research and treatment.

[27]  Mardge H. Cohen,et al.  Structural determinants of food insufficiency, low dietary diversity and BMI: a cross-sectional study of HIV-infected and HIV-negative Rwandan women , 2012, BMJ Open.

[28]  G. Gmel,et al.  Determining the best population-level alcohol consumption model and its impact on estimates of alcohol-attributable harms , 2012, Population Health Metrics.

[29]  S. Shade,et al.  Towards Elimination of Mother-to-Child Transmission of HIV: The Impact of a Rapid Results Initiative in Nyanza Province, Kenya , 2012, AIDS research and treatment.

[30]  C. Parry,et al.  Alcohol Consumption, Progression of Disease and Other Comorbidities, and Responses to Antiretroviral Medication in People Living with HIV , 2012, AIDS research and treatment.

[31]  M. Leibbrandt,et al.  Describing and decomposing post-apartheid income inequality in South Africa , 2012 .

[32]  A. Kavanagh,et al.  Individual and household‐level socioeconomic position is associated with harmful alcohol consumption behaviours among adults , 2011, Australian and New Zealand journal of public health.

[33]  J. Rehm,et al.  Estimating uncertainty of alcohol-attributable fractions for infectious and chronic diseases , 2011, BMC medical research methodology.

[34]  K. Peltzer,et al.  Alcohol use and problem drinking in South Africa: findings from a national population-based survey. , 2011, African journal of psychiatry.

[35]  L. Johnston,et al.  “Taking Care of Business”: Alcohol as Currency in Transactional Sexual Relationships Among Players in Cape Town, South Africa , 2011, Qualitative health research.

[36]  F. Altice,et al.  A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. , 2010, Drug and alcohol dependence.

[37]  B. Grant,et al.  Statistical modeling of volume of alcohol exposure for epidemiological studies of population health: the US example , 2010, Population health metrics.

[38]  J. Rehm,et al.  Causal considerations on alcohol and HIV/AIDS--a systematic review. , 2010, Alcohol and alcoholism.

[39]  J. Rehm,et al.  Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis , 2010, International Journal of Public Health.

[40]  M. Newell,et al.  Coming home to die? the association between migration and mortality in rural South Africa , 2009, BMC public health.

[41]  Till Bärnighausen,et al.  Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey , 2007, International journal of epidemiology.

[42]  T. Bärnighausen,et al.  Mortality levels and trends by HIV serostatus in rural South Africa , 2007, AIDS.

[43]  H. Bang,et al.  The Association Between HIV Infection and Alcohol Use: A Systematic Review and Meta-Analysis of African Studies , 2007, Sexually transmitted diseases.

[44]  R. Jewkes,et al.  Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence. , 2007, Social science & medicine.

[45]  Alan D. Lopez,et al.  Setting international standards for verbal autopsy. , 2007, Bulletin of the World Health Organization.

[46]  S. Kaufmann,et al.  Malnutrition and Infection: Complex Mechanisms and Global Impacts , 2007, PLoS medicine.

[47]  G. Gmel,et al.  Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action 'Gender, Culture and Alcohol Problems: a Multi-national Study'. , 2006, Alcohol and alcoholism (Oxford, Oxfordshire). Supplement.

[48]  N. Sewankambo,et al.  Alcohol use before sex and HIV acquisition: a longitudinal study in Rakai, Uganda , 2006, AIDS.

[49]  Peter Byass,et al.  Refining a probabilistic model for interpreting verbal autopsy data , 2006, Scandinavian journal of public health.

[50]  C. Parry.  South Africa: alcohol today. , 2005, Addiction.

[51]  R. Jewkes,et al.  Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. , 2004, Social science & medicine.

[52]  N. Steyn,et al.  Nutritional status and food security in Sub-Saharan Africa: Predictions for 2020. , 2000, Asia Pacific journal of clinical nutrition.

[53]  Rafael Lozano,et al.  AGE STANDARDIZATION OF RATES: A NEW WHO STANDARD , 2000 .

[54]  Alan D. Lopez,et al.  The global burden of disease: a comprehensive assessment of mortality and disability from diseases injuries and risk factors in 1990 and projected to 2020. , 1996 .

[55]  C. Murray,et al.  The global burden of disease in 1990: summary results, sensitivity analysis and future directions. , 1994, Bulletin of the World Health Organization.

[56]  Dean T. Jamison,et al.  World development report 1993 : investing in health , 1993 .

[57]  BOMBAY CALCUrIA,et al.  World development report 1993--investing in health. , 1993, Communicable disease report. CDR weekly.

[58]  John P. Allen,et al.  Measuring Alcohol Consumption , 1992, Humana Press.

[59]  M. S. Patel,et al.  An introduction to meta-analysis. , 1989, Health Policy.

[60]  Henri Begleiter,et al.  The Effects of Alcohol on the Central Nervous System in Humans , 1972 .

[61]  T. Gross,et al.  For Personal Use. Only Reproduce with Permission from Elsevier Ltd Public Health Inequalities in Health between and within Countries: Poverty and Inequality Social Determinants of Health Inequalities , 2022 .