People living with HIV in rural communities may face different barriers to taking proper care of themselves

People who live with HIV in rural areas are less likely to keep up with their treatment schedules if they are problem drinkers, say Tulane University researchers. Overall, about one in three HIV positive people surveyed by the researchers reported skipping at least one dose of their medications in the past week.

Tulane epidemiologists analyzed data from 273 patient interviews at eight rural clinics across Louisiana.

"Cities are generally thought to be the areas hit the hardest by the AIDS epidemic, but HIV/AIDS is also a problem in rural areas," says lead author Hamish Mohammed, a graduate student at the Tulane University School of Public Health and Tropical Medicine. "People living with HIV in rural communities may face different barriers to taking proper care of themselves. Our analysis suggests that they could benefit from programs to address chronic alcohol drinking."

Highly active antiretroviral therapy, introduced in 1996, has been shown to improve the quality and length of life and to decrease the rates of hospitalization and infection in people with HIV, Mohammed says. However, the therapy regimen has significant side effects and requires a complicated dosing schedule. Both factors make it difficult for people to keep up with the treatment as they are required. Failing to take the medications as prescribed result in faster progression to full-blown AIDS as well as the growth of drug-resistant strains of HIV.

Problem drinkers were defined using the CAGE index as people who answered yes to two or more of the following questions: “In the past month did you ever feel (1) that you should cut down on your drinking? (2) people annoyed you by criticizing your drinking? (3) bad or guilty about your drinking? And (4) have a drink first thing in the morning to steady your nerves or rid yourself of a hangover?”

More than one in 10 participants (12.8 percent) were problem drinkers. Respondents reported a similar rate of binge drinking (12.8 percent) and illicit drug use (16.8 percent), while nearly half (49.8 percent) reported signs of depression. Problem drinking remained the strongest predictor of at least one missed dose of medication.

The study was published in a recent issue of the journal AIDS Patient Care and STDs. The co-authors included Lyn Kieltyka, Gwangi Richardson-Alston, Manya Magnus, Janet Rice and principal investigator Patricia Kissinger, all of Tulane University School of Public Health and Tropical Medicine.