Tobacco and alcohol co-use among people with HIV (PWH) in Nairobi, Kenya

Abstract

Introduction: Although the majority of people living with HIV (PWH) in the world reside in sub-Saharan Africa, little is known about the syndemic of tobacco and alcohol use among PWH in that region. The purpose of this study was to describe tobacco and alcohol co-use behaviors among PWH in Nairobi, Kenya.

Methods:  Between June and November 2021, 50 PWH with concurrent tobacco and alcohol use in Nairobi were assessed with a structured interview. Women were intentionally oversampled in order to constitute 50% of the group. Participants completed structured interviews administered by trained research assistants using standardized, culturally appropriate, tobacco and alcohol use questionnaires.

Results:  Fifty PWH completed the study. All identified as African with a mean age of 40.3 years. All participants were engaged in HIV care and were receiving antiretroviral therapy (ART). Mean cigarettes smoked per day was 8.2, and 57% reported moderate/high cigarette dependence. The mean alcohol use disorder identification test (AUDIT) score was 18.6, and 84% reported drinking amounts in the hazardous range. Preferred alcoholic beverages were clear spirits (48%), beer (32%), and changaa (12%), a traditional home-brewed liquor made from millet, corn, or sorghum.  Cigarette dependence was not significantly associated with higher AUDIT score in any of the two linear regression models that were tested. In Model 1 younger age (β = -0.37, p = 0.002) and higher depression score (β = 0.49, p = 0.02), and in Model 2, younger age (β = -0.31, p = 0.01) and higher anxiety score (β = 1.05, p = 0.003) were significantly associated with higher AUDIT scores.

Conclusions:  Tobacco and alcohol co-use in PWH in Nairobi, Kenya is common. This syndemic may require culturally appropriate and tailored treatment approaches, especially those targeting younger health strata and those with comorbid mental illness, to improve health outcomes.