Hazardous alcohol use, sexual behavior, and recent and undiagnosed HIV across 11 Eastern and Southern African countries.

OBJECTIVES

Quantify hazardous alcohol prevalence among individuals at risk of acquiring HIV and its association with sexual behaviors, and recent and undiagnosed HIV in 11 Eastern and Southern African countries.

DESIGN

Secondary analysis of 16 nationally-representative household surveys (2015-2023).

METHODS

We included sexually active individuals aged ≥15 years. Alcohol use patterns were classified using the AUDIT-C (non-drinkers; low-risk drinkers; hazardous non-binge drinkers; hazardous binge drinkers). Outcomes included sexual risk behaviors, recent HIV infection, and undiagnosed HIV infection. Survey-weighted alcohol use prevalence and logistic regression were estimated by gender, adjusting for sociodemographic covariates. We estimated the proportion of recent and undiagnosed infections arising from excess risks associated with alcohol use patterns.

RESULTS

Analyses included 251,931 participants. Across countries, 5.8%-21.1% reported hazardous binge drinking, and 3.7%-15.7% reported hazardous non-binge drinking, with large gender differences. Sexual risk behaviors increased with drinking severity among men and women. Alcohol use was associated with higher odds of undiagnosed HIV infection; adjusted odds ratios ranged from 1.32 (1.16-1.50) for low-risk drinkers to 1.52 (1.34-1.72) for hazardous binge drinkers among men, and 1.28 (1.13-1.46) to 1.55 (1.31-1.82) among women. Removing alcohol-associated excess risk reduced undiagnosed HIV by 15.1% (10.9%-19.4%) among men and 5.8% (4.0%-7.9%) among women. Estimates for recent infections followed a similar pattern but with larger uncertainty.

CONCLUSIONS

Hazardous alcohol use was associated with HIV risk in Eastern and Southern Africa. Reaching individuals with hazardous alcohol use with effective HIV prevention could reduce risk, and interventions to reduce alcohol use among heavy drinking populations may improve overall health, including HIV-related outcomes.