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

Introduction. Although the majority of PWH in the world reside in sub-Saharan Africa, little is known about the syndemic of tobacco and alcohol use 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–November 2021, 50 PWH with concurrent tobacco and alcohol use in Nairobi, Kenya were cross-sectionally assessed with a structured interview. Women were intentionally oversampled in order to constitute 50% of the participant group. Participants completed structured interviews by trained research assistants using standardized, culturally appropriate, tobacco use and alcohol use questionnaires. Results. Fifty PWH completed the study. All participants identified as African with a mean age of 40.3 years. Half of the sample were men, half were women, and all participants were engaged in HIV care and were receiving antiretroviral therapy (ART). Mean cigarettes smoked per day was 8.2, and 57% percent 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. Younger age, higher depression score, and higher anxiety score 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.