4. Discussion
depressive, depression, depressive symptoms
This study is one of the few that investigate the mediating role of depressive symptoms on the relationship between HQoL and alcohol use among male PLWH who consume alcohol. Our findings support the hypothesis that a reduction in depressive symptoms mediates the effect of improvement in HRQoL on a reduction of alcohol use. Specifically, the results show that improvements in HRQoL in the intervention arm resulted in a reduction in depression, which in turn led to decreased alcohol consumption. This effect was not observed in the control arm. The intervention arm of this study involved a multilevel approach to address several factors, including alcohol use, depressive symptoms, healthy living, and ART adherence. This was achieved through individual counseling, group interventions, and collective action. Both individual counseling and group interventions included a significant component that addressed depressive symptoms, stress, healthy living, and relationships as well as an alcohol risk-reduction module. The collective action intervention focused on identifying key structural problems affecting PLWH and planning and conducting action to address structural changes. In contrast, the control group received only standard care from the ART center, without the additional multilevel interventions provided to the intervention group. The study’s results have significant public health implications and suggest that reducing alcohol use among male PLWH who consume alcohol may require a combination of interventions at different levels that address HRQoL and depressive symptoms as well as other factors concurrently.