The Lived Experiences of Unhealthy Alcohol Use among Young People with HIV in Southwestern Uganda

Unhealthy alcohol use among adolescents and young adults living with HIV (AYAH), is common and poses risks to their health and social wellbeing. However, research that explores comorbid unhealthy drinking and HIV among AYAH is limited in Uganda. We conducted semi-structured in-depth interviews with 14 AYAH who self-reported current alcohol use, recruited from the adolescent immunosuppression (ISS) clinic of Mbarara Regional Referral Hospital in Southwestern Uganda. We explored AYAH's lived experiences with unhealthy alcohol use within the context of HIV. We tape-recorded the interviews, transcribed them verbatim, and used thematic analysis to uncover themes. Five themes emerged relating to AYAH's experiences with unhealthy alcohol use: (1) self-control: AYAH perceived that they had self-determination in the initiation, use, and termination of their drinking. (2) Purpose and meaning: Drinking served the purpose of arousing emotions like happiness, bringing pride, and helping AYAH make friends. (3) Parental monitoring: Parents and caregivers disapproved of excessive drinking leading AYAH to sometimes tell lies to get al.cohol. (4) Use experience: Following alcohol consumption, AYAH experienced effects of intoxication, withdrawal, and sometimes blackouts but these were expected. (5) Disconnection: AYAH with unhealthy drinking attracted a negative image for self and family, as well as HIV-related stigma. The themes improve our understanding of AYAH's alcohol experiences and provide a basis for designing adolescent HIV clinic-level interventions. Interventions should address AYAH's alcohol expectations, re-orient their purpose and meaning to healthier habits, mobilize parental supervision, and provide judgment-free care, delivered by their usual care providers.