By San Francisco AIDS Foundation
Why do we drink, what does it do for us, when is it a problem, and what can we do to drink in a way that’s good for us? San Francisco community members gathered at the San Francisco LGBT Community Center on November 4 to discuss these salient questions and the role that alcohol plays in our lives at “Real Talk: Can You Party Smart?” a public forum hosted by San Francisco AIDS Foundation.
Michael Siever, PhD, founder of The Stonewall Project and Magnet, moderated the event. Panelists included Hunter Rose, an HIV testing provider at SFAF and former bar-back at bars in the Castro; Anibal Mejia, a harm reduction drinker and behavioral health services provider at the Mission Neighborhood Resource Center; Carlton Paul, a long-time bartender at SOMA’s gay cruise bar Powerhouse; Sean Allen Murray, a community member in recovery; and Patt Denning, PhD, a service provider and harm reduction expert. Many community members also joined in the open dialogue to share their thoughts and experiences related to alcohol.
By Jennifer Cocohoba, PharmD, AAHIVE
People living with HIV—in addition to people taking medication for other conditions—may wonder how alcohol affects their health and how it might interact with their medications. Here, I’ll highlight some things to look out for if you’re taking medications and plan on drinking, so that you can raise your glass in celebration with friends, family, and loved ones without worry.
About half of American adults report drinking on a regular basis—which we know can be beneficial if it’s done in moderation. Observational studies have pointed to benefits such as lowered risk of cardiovascular disease and better brain functioning in later years. On the other hand, excessive drinking increases risk of liver disease, high blood pressure, diabetes, stroke and many other health conditions.
For most people, having some alcohol is usually okay, but heavy drinking can be harmful. And we define heavy drinking as, for women, having three or more drinks per day, or more than seven drinks per week. For men, heavy drinking means having four or more drinks per day or more than 14 drinks per week. Binge drinking—when a larger quantity of alcohol is consumed in a short period of time—can also be harmful.
But what about drinking when you’re taking medications? Is moderation still the key?
In February of 2013, Caleb (not his real name) had hit a breaking point. Crystal meth wasn’t exactly creating dramatic negative consequences in his life—he was still successfully employed—but he wanted to quit and was struggling not to use. He turned to Stonewall, San Francisco AIDS Foundation’s substance use treatment program, in addition to joining Crystal Meth Anonymous (CMA), for help with his meth problem.
CMA, a 12-step program, prescribes complete abstinence from all substances, not just meth. Members are asked to stop drinking alcohol and using other substances since they could trigger meth use, leading to relapse. For about a year, Caleb stopped using alcohol—in addition to meth—completely, even though his alcohol use was not his primary concern.
Caleb, during his period of sobriety, quickly realized the extent to which—as a gay man living in San Francisco—alcohol permeated his social world. “Gays definitely drink a lot. I don’t know if it’s just gay men—or anyone living in San Francisco—but if I wanted to drink socially every day, I could. Without any problem. And I live in the Castro so the bars are nearby.”
“HIV researchers have called alcohol the ‘forgotten drug’ in the HIV epidemic,” explains Sarah Woolf-King, PhD, MPH. “It’s so ubiquitous and normative, people tend to forget that when it’s overused or misused, it can still have significant negative consequences.”
Woolf-King, Assistant Professor at the University of California, San Francisco, has devoted the past decade of her research career investigating the role of alcohol in sexual decision making and HIV transmission—with an eye on ultimately being able to help people be healthier and make safer choices when they drink.
She explained that, without a doubt, alcohol has played some part in contributing to the HIV epidemic. “The association between alcohol, sex without condoms, and HIV transmission is ubiquitous. In nearly every country, in every subpopulation where it has been studied, people who use alcohol are more likely to be HIV positive, and they’re more likely to have unprotected sex,” notes Woolf-King.
But, alcohol doesn’t always equate to unprotected sex—alcohol’s causal role is more nuanced. The relationship between alcohol and unprotected sex is moderated by other factors, such as how long a person has been with their current sex partner. Alcohol is more likely to influence a person’s decision to have unprotected sex if he or she is with a first time—versus longer term—sexual partner. People with longer-term partners are more likely to have established sexual routines, and thus more likely to do the same thing whether or not they’ve been drinking.