Alcohol outlet density, HIV treatment outcomes, and substance use among women: a quantitative and qualitative approach
Embargo Date
2027-08-22
OA Version
Citation
Abstract
This dissertation examines the role of alcohol outlet density in shaping alcohol consumption, illicit drug use, and HIV care outcomes among women living with HIV (WLWH). Utilizing both a quantitative and qualitative approach, it integrates longitudinal quantitative analysis with qualitative interviews to explore how neighborhood-level alcohol outlet density impacts HIV treatment engagement, adherence to antiretroviral therapy (ART), and viral load suppression. Chapter 2 focuses on the relationship between off-premise alcohol outlets (liquor stores) and alcohol consumption, finding that higher liquor store density is associated with increased alcohol use and reduced viral suppression. Chapter 3 extends this analysis to on-premise outlets (bars, pubs, nightclubs, and cocktail lounges), linking their density to higher levels of illicit drug use and reduced medication adherence. Chapter 4 presents qualitative findings from in-depth interviews with WLWH, shedding light on the experiences and perceptions of how alcohol outlets contribute to substance use and undermine HIV care, particularly in neighborhoods marked by economic and racial disadvantage. These findings underscore the compounded effects of alcohol outlet density in neighborhoods that are already burdened by structural inequities such as poverty, racial segregation, and limited access to healthcare. The dissertation concludes by offering policy recommendations aimed at reducing alcohol-related harms through targeted interventions at the neighborhood level, such as regulating alcohol outlet density and implementing community-based programs to improve HIV care outcomes for WLWH. This research highlights the importance of addressing environmental factors in the fight to improve health outcomes for marginalized populations, especially among WLWH.
Description
2025