In the past few days, the medical world has been rocked by a major study finding that, contrary to popular opinion and some previous research, not even one drink a day is good for people. And it has already been established that even minimal drinking is more harmful for HIV-positive folks (including undetectable ones) than for folks in general, conferring a higher risk of death, heart disease, and cancer.
Now, that's not to say that if you're HIV positive, you should never have another drink. But what if you're consuming more than 14 drinks a week -- or even more than five drinks per isolated binge?
That's exactly the kind of "heavy drinking" HIV-positive gay and bi men (or MSM, "men who sleep with men") that Brown University-led researchers were looking for at Boston's venerable LGBTQ Fenway Health center for a study. The 180 men recruited were divided into two groups. The members of one group were asked (in person) to fill out detailed questionnaires about their recent drinking, treatment adherence, and safe-sex histories -- but they received no further intervention. The other group's members not only filled out these forms but also had a sit-down with a well-trained expert to talk about their results -- and then participated in follow-up chats after two weeks (over the phone) and three and six months (in person).
Over the course of the following year, the men in the forms-only group reduced their drinking on average about 25%. "It got people thinking and talking about their drinking and sometimes saying, 'Wow, I'm drinking more heavily than I thought,'" says lead author Christopher Kahler, Ph.D., scientific director at the Brown University Alcohol Research Center on HIV.
But the results for the group that additionally received "motivational interviewing" were far more dramatic: The average number of drinks per week dropped from 16 to seven -- and the number of heavy drinking days per month dropped from five to one. Rates of condomless sex with non-steady partners also dropped more than they did among the non-intervention group. "A lot of that happened naturally when they cut out those heavy drinking nights," says Kahler.
What happened in the interventions to make them so effective? According to Kahler, it started with counselors saying that it was entirely up to participants to do what they wanted going forward, regardless of what they wrote on their forms. Then, participants were asked about a typical week of their drinking: what they liked about it or derived from it, such as sexual disinhibition or relaxation, but also, what were the downsides?
"Many said they felt they weren't doing as much with their lives as they could be in terms of work, relationships, or exercise," says Kahler. Asked their goals for the next one to five years, "many said they realized that alcohol didn't fit into them."
Participants were then told where their drinking level fell compared with data based on drinking among gay and bi men. "A lot of guys said, 'You mean that out of 100 guys, I'm drinking more than all but five of them?'" says Kahler. "That would really shock them, make them say, 'Wow.'"
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Kahler guesses that the intervention yielded high results because heavy drinking "had been in the back of [participants'] minds, and this was the little push they needed." He says, "They thought, 'I don't really want to be known as the 95th percentile guy.' And then, they made a series of small changes, like not going out on a particular night to a particular place with particular guys, or not needing a bottle of wine in their house for themselves alone because they ended up drinking the whole thing. These small decisions added up."
A few participants realized they could not curb their drinking alone and were given help connecting to outside programs, says Kahler.
But, overall, he says, "The study suggests that having a conversation with follow-up with a well-trained, empathetic counselor about alcohol use can help people think through their drinking and make some degree of change that's likely to help them health-wise. They don't have to call themselves an alcoholic or say they have an alcohol problem."
Kahler says that the next phase of the study, recruiting HIV-positive MSM in Boston and Miami, will see whether the same approach can work via videoconferences. If it does, that would mean that one or two counselors in one city could potentially connect with participants in countless cities nationwide.