Stigma about going alcohol-free prevents HIV patients from making healthy decisions

Study in Vietnam reveals fears of isolation, ridicule — even changes in business relationships


  • Denise Blough
October 26, 2020
Ho Chi Minh City, Vietnam

People normally stigmatize harmful health behaviors like drug use or overeating, but healthy actions can lead to stigma too, suggests a new study co-led by epidemiology professor Kathryn Lancaster and epidemiology PhD student Angie Hetrick.

The study, published in PLOS ONE, shows that HIV patients living in Vietnam experience stigma toward abstaining from alcohol, and that feelings of shame and embarrassment when refusing drinks is higher for those who typically drink a lot.

“People living with HIV are often encouraged to reduce or eliminate their alcohol use, which can weaken the effectiveness of HIV treatment and lead to missed doses and worsening of infection,” Lancaster said. “We were concerned that in places like Vietnam, where alcohol use is a cultural norm and many people are living with HIV, reducing alcohol use could be challenging.”

Based on interviews with HIV patients, Lancaster, Hetrick and their collaborators from Vietnam and around the U.S. developed a scale to measure alcohol abstinence stigma, which was used to survey more than 1,300 people with HIV from seven clinics in Thai Nguyen, Vietnam.

They found that internalized, experienced and anticipated stigma from alcohol abstinence was most pronounced for HIV patients with the highest level of alcohol use, which was measured using the Alcohol Use Disorders Identification Test. These patients had increased concerns about facing isolation, ridicule and even suffering business relationships if they abstained from alcohol, Hetrick said.

“Part of working in the Vietnamese culture isn’t just going to the office 9-5, it’s going out with your colleagues after work or even as part of work events and drinking with them,” Hetrick said, noting similarities to the U.S. “Alcohol is part of the career life, the social life, weddings, funerals — it can be a cultural expectation.”

Awareness of and education about this type of stigma will be critical to designing effective support programs and policy efforts for alcohol reduction among HIV patients, Lancaster said. 

“There is a lot of opportunity now that we have a tool to measure this type of stigma to examine it in other settings where alcohol use is common,” she said. “Perhaps in the U.S. or on college campuses, where alcohol use is something that can define your social life, this could be an opportunity to measure that more systematically.”

Other authors of this study include Vivian F. Go, Tran Viet Ha and Teerada Sripaipan of University of North Carolina - Chapel Hill; Geetanjali Chander, David Dowdy, Constantine Frangakis, Heidi E. Hutton and Carl A. Latkin of Johns Hopkins University; and Bui Xuan Quynh of the University of North Carolina Project in Hanoi, Vietnam.


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