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

Charlotte Probst; Charles D H Parry; Jürgen Rehm

doi:10.1136/bmjopen-2017-017955

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

BMJ Open. 2018 Feb 21;8(2):e017955. doi: 10.1136/bmjopen-2017-017955.

Authors

Charlotte Probst^{1

2}, Charles D H Parry^{3

4}, Jürgen Rehm^{1

2

5

6

7}

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
² Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.
³ Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁴ Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa.
⁵ Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁶ Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.
⁷ Department of Psychiatry, University of Toronto, Toronto, Canada.

Abstract

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.

Keywords: AIDS; HIV; South Africa; alcohol; burden of disease; inequalities; socioeconomic status.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Acquired Immunodeficiency Syndrome / mortality*
Adolescent
Adult
Age Distribution
Alcohol Drinking / epidemiology*
Cohort Studies
Condoms / statistics & numerical data
Female
Humans
Male
Middle Aged
Risk Assessment
Sex Distribution
Social Class*
South Africa / epidemiology
Survival Analysis
Young Adult