Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infecti

The gap

Consensus across the literature

Supporting evidence — 3 representative gaps

• “We do anything to get alcohol”: A mixed methods approach to explore the intersections between alcohol use and HIV risk and infection amongst adolescent girls and young women from high HIV-burdened communities in South Africa (2026) · doi

  Limitations of this study are firstly that some of the variables in the current HIV risk score were not significantly associ- ated with the score. Although the positive and negative predictive values for the score were relatively high when it was applied to the baseline survey data for the My Journey Programme, HIV prevalence in the HERStory3 survey data used PLOS One | https://doi.org/10.1371/journal.pone.0341299 May 18, 2026 13 / 18 for this study was lower (10.0% vs. 12.4%), reducing the number of HIV-positive cases and decreasing statistical power [29]. However, DBS-confirmed HIV status was also used as an outcome in this study to examine the relationship between HIV and alcohol use. Secondly, we were unable to test the direction of the relationships between alcohol use, HIV risk and infection, and sexual risk behaviour because the data is from a cross-sectional study. Nevertheless, our regression models support existing evidence of the association between hazardous drinking and sexual risk behaviour, where the bidirectionality of these relationships has previously been explored. Thirdly, we found no association between hazardous drinking and mental health, suggesting that AGYW may have different motivations for drinking compared to older women, thus the direction of the relationship remains unclear for this population. Fourthly, while both the electronic survey and qualitative interviews may be subject to social desirability bias, steps were taken to minimise this, including a comprehen- sive informed consent process. Participants were informed that there were no immediate benefits to them for participation in the survey or interview and that their information would be kept anonymous and confidential. Fifthly, the AUDIT-C score has not been validated among AGYW in low-resourced settings and there is inconsistency in the literature regarding whether a cutoff of 2 or more, or 3 or more, should be used to identify hazardous drinking among women [33,57]. We tested Model 3 using both cutoff points and found no statistically significant differences in the results. Finally, sub-districts and sites within the intervention and comparison arms were purposefully selected to optimise the programme effect in this non-randomised comparison. Systematic random sampling was used to select households within the selected sites, but at higher levels, sites and sub-districts were not selected based on a random sampling technique. As such, we cannot claim our sub-districts nor study participants to be representative for the general South African AGYW population. This must be considered when interpreting the descriptive statistics and prevalence estimates. However, we believe that after controlling for key covariates, the identified associations correspond to a general trend relevant to the target population of AGYW in high HIV-burdened communities.

  Keywords: risk score survey used drinking agyw hazardous population districts sites selected positive high programme prevalence
• HIV Risk Perceptions and First Sexual Intercourse Among Youth in Cape Town South Africa (2007) · doi

  Health behavior models posit that the perceived level of risk of HIV infection is associated with the level of HIV risk behavior; however, there has been limited research in Sub-Saharan Africa on factors associated with perceived risk or on the relationship between perceived risk and risk behaviors.

  Keywords: risk perceived behavior level associated health models posit infection there limited saharan africa factors relationship
• Alcohol Use Among Female Sex Workers and Male Clients: An Integrative Review of Global Literature (2010) · doi

  Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive.

  Keywords: health alcohol associated adverse physical illicit drug mental problems victimization sexual violence associations sexually transmitted