Prevalence of alcohol use, associated risk factors, and the impact on the HIV care cascade among adolescent girls and young women in South Africa: Findings from the HERStory Study

Background. High rates of hazardous and binge drinking patterns have been identified among adolescent girls and young women (AGYW) in South Africa. AGYW also bear the highest burden of HIV/AIDS in the country, placing them at increased risk of negative outcomes for both HIV and alcohol. Objectives. To estimate the prevalence of alcohol use and describe the patterns of use for AGYW enrolled in the HERStory Study. Secondary aims included identifying covariates of alcohol consumption and examining the impact of alcohol use patterns on the HIV care continuum. Methods. We included all 4 377 AGYW (aged 15 - 24 years) enrolled in the HERStory baseline survey from six high HIV-risk districts. Alcohol consumption was assessed using the abbreviated Alcohol Use Disorders Identification Test, the AUDIT-C screening tool, with a score of ≥2 indicating hazardous drinking, while binge drinking was defined as consuming ≥6 drinks on one occasion at least monthly. Results. Among participants, the median (interquartile range) age was 19 (17 - 21) years; 57.2% attended school, 82% were of low socioeconomic status and 66.3% self-reported as HIV negative. The prevalence of alcohol use was 32.2% and was highest among women aged 20 - 24 years (36.1%) and among those living in the Cape Town and Tshwane districts (52.8% and 51.6%, respectively). Of the 1 394 participants who reported ever drinking, 50.6% reported hazardous drinking and 22.7% binge drinking. Hazardous drinking was associated with residence in Cape Town district (odds ratio (OR) 2.25) and absence from school (OR 1.42) in univariate analyses. The odds of binge drinking were 2 - 7 times greater in all districts compared with King Cetshwayo in univariate analyses, and remained significant in the multivariate analysis. No association was found between hazardous or binge drinking and HIV care outcomes. Conclusion. The prevalence of alcohol use was elevated in the population of young women aged 20 - 24 years. Hazardous and binge drinking patterns were common in most districts and among those not attending school. Efforts to address the risk of drinking in this age group could focus on increased screening of AGYW for alcohol use, and supporting school attendance and after-school activities.