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The Unaddressed Needs of Alcohol-Using Couples on Antiretroviral Therapy in Malawi: Formative Research on Multilevel Interventions

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Abstract

Alcohol use among HIV-positive individuals in sub-Saharan Africa directly impacts adherence to antiretroviral therapy and HIV outcomes. Few studies have examined approaches to reduce alcohol use among HIV-affected couples, despite evidence that alcohol use is a couple-level concern. We conducted a qualitative study with 23 alcohol-using couples to identify multilevel barriers and facilitators of alcohol use, and potential intervention options with couples. Data were analyzed at individual and dyadic levels using framework analysis. All couples were married and had at least one partner on ART. Men were the primary alcohol drinkers with few women reporting alcohol use. Most women tried to persuade their partners to reduce their alcohol intake and when unsuccessful, enlisted help from relatives and HIV care providers. Effective couple negotiation around men’s alcohol use was constrained by negative peer influence and men’s desire for friendship to cope with life stressors. Women were primarily concerned about the expense of alcohol and described how alcohol prevented the family from meeting basic needs and investing in the future. Alcohol use was described as a major barrier to ART adherence, but was also viewed as the cause of couple and family violence, extramarital partnerships, food insecurity, and poverty. We conclude that multilevel interventions based on couples’ needs and preferences are urgently needed. Couple-based intervention approaches could include provider-led alcohol counseling with couples, alcohol reduction support groups for couples, couples’ counseling to bolster couple communication and problem-solving around alcohol, and economic-strengthening interventions for couples.

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Acknowledgments

This research was funded by the National Institute of Mental Health (NIMH) under grant K01MH107331 and the National Institute of Allergy and Infectious Diseases under grant P30AI027763 (awards to AAC). AR was funded by the National Institute of Drug Abuse under grant T32DA13911. JYT was funded by the NIMH under grant K01MH106416. JAH was funded by the National Institute of Alcohol Abuse and Alcoholism under grant K24AA022586. The authors would like to thank the tireless efforts of the research staff at Invest in Knowledge in Malawi for data collection.

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Authors and Affiliations

  1. Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA

    Amy A. Conroy & Judy Y. Tan

  2. Department of Medicine, Brown University, Providence, RI, USA

    Allison Ruark

  3. Stacey McKenna, LLC, Fort Collins, CO, USA

    Stacey A. McKenna

  4. Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA

    Lynae A. Darbes

  5. Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Judith A. Hahn

  6. Invest in Knowledge, Zomba, Malawi

    James Mkandawire

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  1. Amy A. Conroy
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Correspondence to Amy A. Conroy.

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Conroy, A.A., Ruark, A., McKenna, S.A. et al. The Unaddressed Needs of Alcohol-Using Couples on Antiretroviral Therapy in Malawi: Formative Research on Multilevel Interventions. AIDS Behav 24, 1599–1611 (2020). https://doi.org/10.1007/s10461-019-02653-y

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