# Alcohol Outlet Density, HIV Treatment Outcomes, and Polysubstance Use among Women: A Mixed-Methods Approach

> **NIH NIH R36** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2024 · $49,386

## Abstract

PROJECT SUMMARY
 There are 1.2 million people with HIV in the United States, of whom nearly one-fifth are women. Nearly
half of women with HIV (WWH) consumed alcohol in the past month, a proportion two to three times greater
than in the general female population. Among adults, alcohol consumption is increasing among women but not
men. Data from the Women’s Interagency HIV Study indicate that between 12-24% of WWH report unhealthy
alcohol use, defined as >7 drinks/week or >3 drinks/occasion. In addition, studies have documented that
polysubstance use—concurrent use of alcohol and at least one other substance (e.g., tobacco, stimulants,
cocaine, opioids)—is increasingly common among WWH. It is critical to focus on WWH because the
consequences of alcohol consumption for women are greater than those of men at lower levels and shorter
duration of alcohol use. WWH tend to have poorer ART adherence and viral suppression than men with HIV.
Among WWH that receive ART, excessive alcohol use has been found to result in decreased ART adherence
and viral load increases in a dose-response fashion. As a modifiable influence on HIV care continuum targets,
alcohol and polysubstance use vulnerability appears to have greater impacts on HIV and clinical outcomes
among WWH than among men with HIV. Thus, to achieve more sustainable and equitable reductions in
excessive alcohol and polysubstance use, it is important to identify upstream factors within neighborhoods that
can be targeted to achieve significant population health gains among WWH. Recent research has highlighted
the significance of environmental factors influencing substance use and health outcomes for WWH. Therefore,
it is important to explore potential community environmental factors such as the density of alcohol outlets given
that some of the most important determinants of alcohol and polysubstance use are at the community level.
 The specific aims of this proposal are to: (1) Longitudinally quantify both the direct and indirect effects
of alcohol outlet density on alcohol consumption and polysubstance use, and HIV care continuum outcomes
(engagement with care, being on ART, ART adherence, and viral load suppression) among WWH, and assess
whether associations differ by race/ethnicity, and (2) Explore, using semi-structured in-depth interviews, the
experiences and perceptions of WWH about how alcohol outlets influence their alcohol and polysubstance use
behaviors and HIV care. This work is innovative because it will be the first study to investigate the longitudinal
association between alcohol outlet density and HIV care continuum outcomes in the United States. This
proposal is significant because it focuses on how disproportionate exposure to alcohol outlets may adversely
play a role in the racial health disparities seen among WWH. The long-term goal of this research is to inform
the implementation of evidence-based alcohol policies to improve the health of WWH.

## Key facts

- **NIH application ID:** 11006421
- **Project number:** 1R36DA061663-01
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Jih-Cheng Yeh
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $49,386
- **Award type:** 1
- **Project period:** 2024-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11006421

## Citation

> US National Institutes of Health, RePORTER application 11006421, Alcohol Outlet Density, HIV Treatment Outcomes, and Polysubstance Use among Women: A Mixed-Methods Approach (1R36DA061663-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/11006421. Licensed CC0.

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