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September 10, 2025Open Access

Alcohol Consumption and Health Outcomes Among Men in a Rural HIV-Endemic Cohort in South Africa

Key Points

Hazardous alcohol use was not linked to HIV prevalence or mortality among rural South African men.
Among 5,771 men, 10% met the criteria for hazardous alcohol use and 28% reported any alcohol use recently.
Poisson regression models assessed HIV outcomes, while Cox models evaluated mortality over a median of 3.4 years.
Findings highlight the lack of impact of hazardous alcohol use on care retention and short-term mortality rates.

Abstract

Background In South Africa, men experience lower HIV care engagement and retention than women. Men who consume alcohol face greater barriers to care and may represent a population with significant unmet health needs. We investigated associations between alcohol consumption, HIV clinical outcomes, and all-cause mortality among men in rural South Africa. Methods We analyzed data from men in a population-based health screening in KwaZulu-Natal linked to longitudinal clinical and mortality data. Our primary exposure was hazardous alcohol use, defined as an AUDIT-C score ≥4. Our primary outcomes were: living with HIV, awareness of HIV positive status, virologic suppression (3), healthcare access (clinic visit

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