Published in PLOS One on 2026-05-18, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kate Bergh, Zoe Duby, Jeroen De Man, Nabila Ebrahim, Caroline Kuo, Carl Lombard, Petal Petersen Williams, Kim Jonas
Source: PLOS One • DOI 10.1371/journal.pone.0341299
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Despite national declines in HIV prevalence, adolescent girls and young women (AGYW) in South Africa continue to face a disproportionate burden of HIV infection. The syndemic theory provides a framework for understanding how interconnected epidemics such as alcohol use disorders, violence and HIV cluster together and reinforce each other. Using this theory, we aimed to test and explore the relationship between alcohol use and HIV risk and infection amongst AGYW in high HIV-burdened communities in South Africa. Data for this study were drawn from a mixed methods impact evaluation of a combination HIV prevention programme implemented across eight provinces in South Africa. A household survey was conducted among AGYW aged 15─24 years in the 12 intervention sub-districts selected by the Global Fund and 12 matching comparison sub-districts. Dried blood spot specimens were collected to test for HIV; alcohol use and sexual behaviours were reported through a self-completed electronic questionnaire. Generalised linear regression models were used to assess the relationship between alcohol use and HIV risk and infection as well as sexual risk behaviours and hazardous drinking. A subsample of 68 AGYW participated in qualitative in-depth interviews. Interview transcripts were translated into English and analysed using thematic analysis. Of the 5025 survey participants, 10% were living with HIV, and 35% engaged in hazardous drinking. No significant association was found between alcohol use and HIV risk or infection. However, a positive association was found between hazardous drinking and sexual violence (OR=1.51; 95% CI: 1.20─1.90), condomless sex (OR=1.25; 95% CI: 1.07─1.47), and condom counselling (OR=1.32; 95% CI: 1.14─1.53). Qualitative interview participants described how AGYW sought alcohol from older men, knowing that sex would be expected in exchange. This put them in high-risk situations where sexual violence was a concern and negotiating condom use became more challenging. These findings highlight the need for interventions that educate AGYW on the harmful effects of binge drinking and provide safer, healthier alternatives for recreation, particularly in low-resourced communities.
Introduction
South Africa has the largest HIV epidemic in the world [1]. Although HIV prevalence has declined from 14.0% in 2017 to 12.7% in 2022, adolescent girls and young women (AGYW) aged 15─24 years are the population at highest risk of HIV infection in the country [1]. HIV prevalence among AGYW was approximately double that of their male counterparts (6.9% versus 3.5%) in 2022 [1]. Thus, AGYW are a population with a critical need for HIV prevention and treatment interventions.
According to the World Health Organization (WHO), alcohol consumption per capita, defined as litres of pure alcohol consumed per persons aged 15 years and older in one year, was considerably higher in South Africa (8.8) compared to the global average (5.5) and the African regional average (4.5) in 2019 [2]. In South Africa, alcohol consumption per capita is higher among individuals aged 15 and older who have a higher socio-economic status (SES), while binge drinking, defined as current drinkers who consume five or more standard drinks on one occasion, is more prevalent among individuals with a lower SES [3]. Binge drinking in South Africa is a widespread and socially normalised behaviour, with 54% of male drinkers and 35% of female drinkers reporting such behaviour in 2021 [4]. The highest levels of binge drinking occur among people aged 18─35 years with research suggesting that binge drinking may even be underestimated among adolescents as they reach the same blood alcohol concentration as adults sooner given their smaller body size [3,5,6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kate Bergh, Zoe Duby, Jeroen De Man, Nabila Ebrahim, Caroline Kuo, Carl Lombard, Petal Petersen Williams, Kim Jonas. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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