Abstract
INTRODUCTION: Hazardous alcohol use is prevalent among people with HIV, with women disproportionately experiencing adverse alcohol-related outcomes in HIV care. This study aimed to qualitatively explore factors contributing to the onset, escalation, and continuation of hazardous drinking among women with HIV. METHODS: Women with HIV and hazardous drinking patterns were recruited from the WHAT-IF? Study, a randomized trial evaluating the efficacy of naltrexone for alcohol reduction. Participants completed 60-minute semi-structured interviews. Interview transcripts were analyzed using thematic analysis methods. RESULTS: Twenty women (mean age 49.3 years; 85% Black) participated. Common themes identified by the participants as influencing their drinking onset and escalation were early exposure and normalization, and the impact of use among family and friends. Emotion and coping were identified as essential motivators in drinking escalation, as well as drug use (using alcohol and drugs together or using alcohol instead of drugs). These factors also contributed to the persistence of hazardous drinking, alongside participants' perceived health benefits of alcohol. While not common, some participants talked about a history of trying to reduce or stop drinking; they reported that their mental health and family and friends were instrumental in encouraging sobriety or continued alcohol use. CONCLUSION: Women with HIV identified emotional and social factors as primary drivers of hazardous drinking across their lifespan. Interventions that address coping strategies and enhance social support may be beneficial in reducing alcohol use in this population.