The Importance of Context: Neighborhood Drinking Norms and Heavy Drinking Among HIV Patients

Heavy drinking has harmful consequences among individuals with HIV, including delayed HIV testing and treatment, reduced medication adherence, and organ damage.1 Better understanding factors underlying heavy drinking among those with HIV may inform intervention. Several studies show that individual characteristics (eg, drinking motives, depression) are associated with drinking levels among HIV patients.2–7 However, epidemiologic research as a whole has increasingly highlighted the importance of group-level factors in substance use, including neighborhood poverty,8,9 laws,10–12 alcohol outlet density,13–17 neighborhood sociocultural characteristics,18,19 and community drinking norms.20,21 For example, the New York Social Environment Study (NYSES) found that neighborhood-level drinking norms were associated with individual-level drinking.20 Specifically, acceptability of any drinking was particularly associated with moderate drinking, whereas acceptability of drunkenness was particularly associated with heavy drinking.20 Although neighborhood-level factors are assumed to play a role in drinking among individuals with HIV,22 to our knowledge, these associations have yet to be tested. Drinking norms may be particularly relevant for HIV patients, as HIV patients report social motives to drink,5 and such content could be incorporated into drinking-reduction interventions. Thus, we examined the association of neighborhood-level drinking norms with individual-level drinking among individuals with HIV. Based on prior work,20 we hypothesized that more permissive neighborhood-level norms regarding any drinking would be associated with greater drinking quantity and frequency, and that more permissive neighborhood-level norms regarding drunkenness would be associated with greater maximum drinks consumed and binge drinking frequency.