Interaction Effects of Neighborhood Disadvantage and Individual Social Support on Frequency of Alcohol Use in Youth Living with HIV

Youth living with HIV (YLH) experience multiple disease‐related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual‐ and neighborhood‐level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood‐specific data were compiled from the 2010 U.S. Census Bureau and matched with individual‐level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non‐Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross‐level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed. Highlights Youth living with HIV (YLH) experience multiple disease‐related stresses. Both social and physical contexts may influence the interplay of alcohol use in YLH. Drug use, being male, non‐Black, and age were positively associated with frequency of alcohol use. Higher levels of social support were associated with less frequent alcohol use. The link between alcohol use and support was weaker in areas with lower socioeconomic disadvantage.