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Effects of Gender and Alcohol Use on US Veterans with HIV Female veterans have poorer HIV outcomes than male veterans, and alcohol use hurts HIV outcomes regardless of gender.

While many people might not think that HIV is a large problem in the United States, at the end of 2015 over 1.1 million Americans were living with HIV. Of these people living with HIV in the United States, 75% are men.  However, more women have contracted HIV in recent years, and women are also more susceptible to HIV than men within a heterosexual relationship context. Women may also be more vulnerable than men to alcohol use, which can then affect their HIV-related care and health. Researchers realized this could be a huge issue, and studied this using a subset of military veterans. They specifically used military veterans because the United States Veterans Health Administration (VA) is the nation’s largest health care system and the largest provider of HIV care. Within the VA health care system, researchers studied veterans living with HIV to see if there are differences by gender with how they receive HIV care, and if gender changes the association between HIV care and alcohol use.

All patients aged 25-84 who had been diagnosed with HIV, had been screened for alcohol use, and were using VA health care between February 2008 and September 2014 were included in this study. The HIV care outcomes that they used were: 1) Did the patients get enrolled in HIV care, 2) Were they on medication to treat their HIV, and 3) Were they virally suppressed (was the HIV medication working enough to have the virus at a very low level in the patient’s blood).

In total, there were 33, 224 veterans included in the study, 971 women and 32, 253 men. Sixty-four percent were over 50 years old, and almost half of the study did not drink at all. On average, the women in this study were younger than the men, more likely to be black, more likely to have mental health disorders, and drank less than men.

Unfortunately, women in this study were less likely to be enrolled in HIV care or prescribed HIV medication, and were virally suppressed compared to the men in the study. Also, if women were very heavy drinkers, they were less likely to be on HIV medication and be virally suppressed compared to women who didn’t drink. If men were moderate or heavy drinkers, they also were less likely to be in HIV care, be on medication, and be virally suppressed compared to men who were non-drinkers. At every level of alcohol use, women had worse outcomes (less likely to be in HIV care, be on HIV medication, and be virally suppressed) compared to men.

Overall, this study showed that moderate or heavy alcohol use can negatively affect a person’s HIV care, no matter their gender. However, it seems as though women need some extra help, especially those female veterans, to make sure they get on HIV care and stay on care so they can be healthy and not transmit HIV to others. Moving forward, specific interventions geared towards women with HIV would be very helpful, especially if these interventions also targeted those with mental health disorders and high alcohol use.

Article Information

Edited By: Mary Sabuda
Source: Gender and Alcohol Use: Influences on HIV Care Continuum in a National Cohort of Patients with HIV
Publication Date: July 12, 2018

Paper Author(s): Theresa E. MATSON, Kathleen A. MCGINNIS, Anna D. RUBINSKY, Madeline C. FROST, Maggie CZARNOGORSKI, Kendall J. BRYANT, E. Jennifer EDELMAN, Derek D. SATRE, Sheryl L. CATZ, Kara M. BENSLEY, David A. FIELLIN, Amy C. JUSTICE, Emily C. WILLIAMS

Paper Institution(s): Veteran Affairs (VA) Puget Sound Health Care System, Kaiser Permanente Washington Health Services Research Institute; VA Connecticut Healthcare System; University of California, San Francisco; VA San Francisco Healthcare System; Department of Veterans Affairs; National Institute on Alcohol Abuse and Alcoholism; Yale Schools of Medicine and Public Health; Kaiser Permanente Northern California; University of California at Davis; University of California, Berkeley; University of Washington