{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:40:43Z","timestamp":1792820443104,"version":"4.5.0"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u250024 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\u25001.90), condomless sex (OR=1.25; 95% CI: 1.07\u25001.47), and condom counselling (OR=1.32; 95% CI: 1.14\u25001.53). 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.<\/jats:p>","DOI":"10.1371\/journal.pone.0341299","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:24:25Z","timestamp":1779125065000},"page":"e0341299","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cWe do anything to get alcohol\u201d: 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"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5471-5819","authenticated-orcid":true,"given":"Kate","family":"Bergh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-8152","authenticated-orcid":true,"given":"Zoe","family":"Duby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-8757","authenticated-orcid":true,"given":"Jeroen","family":"De Man","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabila","family":"Ebrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2136-6533","authenticated-orcid":true,"given":"Carl","family":"Lombard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5535-2458","authenticated-orcid":true,"given":"Petal Petersen","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Jonas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"pone.0341299.ref001","author":"O Shisana","year":"2022"},{"key":"pone.0341299.ref002","author":"World Health Organization","year":"2024"},{"key":"pone.0341299.ref003","doi-asserted-by":"crossref","first-page":"606050","DOI":"10.3389\/fpubh.2021.606050","article-title":"Assessing Intertemporal Socioeconomic Inequalities in Alcohol Consumption in South Africa","volume":"9","author":"M Fontes Marx","year":"2021","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0341299.ref004","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1186\/s12879-023-08470-y","article-title":"An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa","volume":"23","author":"LF Johnson","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0341299.ref005","doi-asserted-by":"crossref","first-page":"2282","DOI":"10.1186\/s12889-023-17188-0","article-title":"Binge drinking and condom negotiation behaviours among adolescent girls and young women living in Cape Town, South Africa: sexual control and perceived personal power","volume":"23","author":"SE Singer","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0341299.ref006","article-title":"Adolescent binge drinking: development context and opportunities for prevention","volume":"39","author":"T Chung","year":"2015","journal-title":"Alcohol Res"},{"issue":"10036","key":"pone.0341299.ref007","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/S0140-6736(16)00648-6","article-title":"Global burden of diseases, injuries, and risk factors for young people\u2019s health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"387","author":"AH Mokdad","year":"2016","journal-title":"Lancet"},{"key":"pone.0341299.ref008","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/acer.13985","article-title":"Alcohol and Women: A Brief Overview","volume":"43","author":"ME McCaul","year":"2019","journal-title":"Alcohol Clin Exp Res"},{"issue":"1","key":"pone.0341299.ref009","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/JAN.0000000000000388","article-title":"Adolescent Girls and Alcohol Use: Increasing Concern During the COVID-19 Pandemic","volume":"32","author":"TS Smith","year":"2021","journal-title":"J Addict Nurs"},{"key":"pone.0341299.ref010","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1348\/135910709X476558","article-title":"Young adults\u2019 social drinking as explained by an augmented theory of planned behaviour: the roles of prototypes, willingness, and gender","volume":"15","author":"F Zimmermann","year":"2010","journal-title":"Br J Health Psychol"},{"issue":"4","key":"pone.0341299.ref011","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1007\/s12187-022-09913-9","article-title":"Youths\u2019 Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study","volume":"15","author":"C Carels","year":"2022","journal-title":"Child Indic Res"},{"key":"pone.0341299.ref012","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3109\/10826084.2013.819365","article-title":"Drinking in the Context of Life Stressors: A Multidimensional Coping Strategy Among South African Women","volume":"49","author":"KW Choi","year":"2014","journal-title":"Subst Use Misuse"},{"key":"pone.0341299.ref013","doi-asserted-by":"crossref","first-page":"1491114","DOI":"10.1080\/16549716.2018.1491114","article-title":"Social support factors associated with psychological resilience among women survivors of intimate partner violence in Gauteng, South Africa","volume":"11","author":"MT Machisa","year":"2018","journal-title":"Glob Health Action"},{"issue":"8","key":"pone.0341299.ref014","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.socscimed.2012.06.020","article-title":"Gender-based violence and HIV sexual risk behavior: alcohol use and mental health problems as mediators among women in drinking venues, Cape Town","volume":"75","author":"EV Pitpitan","year":"2012","journal-title":"Soc Sci Med"},{"key":"pone.0341299.ref015","doi-asserted-by":"crossref","first-page":"112637","DOI":"10.1016\/j.socscimed.2019.112637","article-title":"Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa","volume":"295","author":"AM Hatcher","year":"2022","journal-title":"Soc Sci Med"},{"issue":"10","key":"pone.0341299.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0204956","article-title":"Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model","volume":"13","author":"A Gibbs","year":"2018","journal-title":"PLoS One"},{"issue":"10","key":"pone.0341299.ref017","doi-asserted-by":"crossref","first-page":"3238","DOI":"10.1007\/s10461-021-03291-z","article-title":"From Survival to Glamour: Motivations for Engaging in Transactional Sex and Relationships Among Adolescent Girls and Young Women in South Africa","volume":"25","author":"Z Duby","year":"2021","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0341299.ref018","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11121-006-0061-2","article-title":"Alcohol use and sexual risks for HIV\/AIDS in sub-Saharan Africa: systematic review of empirical findings","volume":"8","author":"SC Kalichman","year":"2007","journal-title":"Prev Sci"},{"key":"pone.0341299.ref019","article-title":"Reducing HIV Risks in the Places Where People Drink: Prevention Interventions in Alcohol Venues","author":"EV Pitpitan","year":"2016","journal-title":"AIDS Behav"},{"key":"pone.0341299.ref020","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1525\/maq.2003.17.4.423","article-title":"Syndemics and public health: reconceptualizing disease in bio\u2010social context","volume":"17","author":"M Singer","year":"2003","journal-title":"Med Anthropol Q"},{"key":"pone.0341299.ref021","article-title":"A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic","volume":"24","author":"M Singer","year":"1996","journal-title":"Free Inquiry"},{"issue":"7","key":"pone.0341299.ref022","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1089\/jwh.2010.2328","article-title":"Substance abuse, violence, and HIV in women: a literature review of the syndemic","volume":"20","author":"JP Meyer","year":"2011","journal-title":"J Womens Health (Larchmt)"},{"issue":"1","key":"pone.0341299.ref023","doi-asserted-by":"crossref","first-page":"18083","DOI":"10.1038\/s41598-022-20230-7","article-title":"Syndemics of intimate partner violence among women in HIV endemic South Africa: geospatial analysis of nationally representative data","volume":"12","author":"A Tomita","year":"2022","journal-title":"Sci Rep"},{"key":"pone.0341299.ref024","doi-asserted-by":"crossref","DOI":"10.1177\/08862605221084738","article-title":"A Prospective Analysis of the Interrelationship between Physical Intimate Partner Violence and Alcohol Use: A Post-Hoc Analysis of Young Women Involved in the Stepping Stones and Creating Futures Trial in South Africa","volume":"38","author":"A Gibbs","year":"2023","journal-title":"J Interpers Violence"},{"key":"pone.0341299.ref025","author":"The Global Fund","year":"2025"},{"key":"pone.0341299.ref026","author":"S Woldesenbet","year":"2021"},{"key":"pone.0341299.ref027","author":"S Woldesenbet","year":"2020"},{"key":"pone.0341299.ref028","author":"Stats-SA","year":"2016"},{"issue":"1","key":"pone.0341299.ref029","doi-asserted-by":"crossref","first-page":"2221377","DOI":"10.1080\/25787489.2023.2221377","article-title":"A prediction risk score for HIV among adolescent girls and young women in South Africa: identifying those in need of HIV pre-exposure prophylaxis","volume":"24","author":"RC Moyo","year":"2023","journal-title":"HIV Res Clin Pract"},{"key":"pone.0341299.ref030","first-page":"21","article-title":"Fast Clustering Algorithm to Cluster Very Large Categorical Data Sets in Data Mining.","volume-title":"KDD: Techniques and Applications","author":"ZA. Huang","year":"1997"},{"issue":"1","key":"pone.0341299.ref031","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1186\/s12889-022-13445-w","article-title":"Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability","volume":"22","author":"C Mathews","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0341299.ref032","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The AUDIT Alcohol Consumption Questions (AUDIT-C) An Effective Brief Screening Test for Problem Drinking","volume":"158","author":"K Bush","year":"1998","journal-title":"Arch Intern Med"},{"issue":"7","key":"pone.0341299.ref033","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1001\/archinte.163.7.821","article-title":"Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population","volume":"163","author":"KA Bradley","year":"2003","journal-title":"Arch Intern Med"},{"key":"pone.0341299.ref034","author":"National Department of Health, Statistics South Africa, South African Medical Research Council, ICF","year":"2016"},{"issue":"3","key":"pone.0341299.ref035","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1037\/0022-006X.73.3.539","article-title":"Mental illness and\/or mental health? Investigating axioms of the complete state model of health","volume":"73","author":"CLM Keyes","year":"2005","journal-title":"J Consult Clin Psychol"},{"issue":"3","key":"pone.0341299.ref036","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/cpp.572","article-title":"Evaluation of the mental health continuum-short form (MHC-SF) in setswana-speaking South Africans","volume":"15","author":"CLM Keyes","year":"2008","journal-title":"Clin Psychol Psychother"},{"key":"pone.0341299.ref037","author":"R Core Team","year":"2024"},{"key":"pone.0341299.ref038","doi-asserted-by":"crossref","DOI":"10.1002\/9780470580066","volume-title":"Complex surveys: a guide to analysis using R","author":"T Lumley","year":"2010"},{"key":"pone.0341299.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v045.i07","article-title":"Amelia II: A Program for Missing Data","volume":"45","author":"J Honaker","year":"2011","journal-title":"J Stat Softw"},{"key":"pone.0341299.ref040","author":"K Hlahla","year":"2024"},{"key":"pone.0341299.ref041","volume-title":"Correlates of adherence to oral pre-exposure prophylaxis (PrEP) and the dapivirine ring among adolescent girls and young women (AGYW) participating in the MTN-034\/REACH trial. International Association of Providers of AIDS Care (IAPAC) Adherence 2023 Conference","author":"K Ngure","year":"2022"},{"issue":"6","key":"pone.0341299.ref042","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-080993","article-title":"Prevalence of substance and hazardous alcohol use and their association with risky sexual behaviour among youth: findings from a population-based survey in Zimbabwe","volume":"14","author":"K Hlahla","year":"2024","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0341299.ref043","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1186\/s12889-024-19250-x","article-title":"Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda","volume":"24","author":"H Kalungi","year":"2024","journal-title":"BMC Public Health"},{"key":"pone.0341299.ref044","author":"MIET AFRICA","year":"2021"},{"issue":"4","key":"pone.0341299.ref045","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1177\/0081246320946298","article-title":"Factors influencing alcohol use among female in-school adolescents in the Western Cape, South Africa","volume":"50","author":"TJ Hlomani-Nyawasha","year":"2020","journal-title":"South African J Psychol"},{"key":"pone.0341299.ref046","doi-asserted-by":"crossref","unstructured":"Duby Z, Williams PP, Bergh K, Jonas K, Kuo C, Mathews C. \u201cI drink for vibes\u201d: Applying social theories to understand alcohol use amongst South African Adolescent Girls and Young Women and work towards solutions. [Unpublished]. 2025.","DOI":"10.4314\/ajdas.v24i1.4"},{"key":"pone.0341299.ref047","article-title":"Determinants of HIV infection among adolescent girls and young women aged 15-24 years in South Africa: A 2012 population-based national household survey","author":"M Mabaso","year":"2018","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0341299.ref048","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1186\/s13104-018-3646-5","article-title":"Association between alcohol use and HIV status: findings from Zambia and Zimbabwe","volume":"11","author":"G Musuka","year":"2018","journal-title":"BMC Res Notes"},{"issue":"2","key":"pone.0341299.ref049","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017955","article-title":"HIV\/AIDS mortality attributable to alcohol use in South Africa: a comparative risk assessment by socioeconomic status","volume":"8","author":"C Probst","year":"2018","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0341299.ref050","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1186\/s12889-022-13394-4","article-title":"Determining HIV risk for Adolescent Girls and Young Women (AGYW) in relationships with \u201cBlessers\u201d and age-disparate partners: a cross-sectional survey in four districts in South Africa","volume":"22","author":"G George","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0341299.ref051","doi-asserted-by":"crossref","first-page":"117144","DOI":"10.1016\/j.socscimed.2024.117144","article-title":"Couples, alcohol use and experience of intimate partner violence among young women in urban informal settlements in Durban, South Africa: A mixed methods study","volume":"356","author":"A Gibbs","year":"2024","journal-title":"Soc Sci Med"},{"key":"pone.0341299.ref052","author":"RE Edwards","year":"2020"},{"key":"pone.0341299.ref053","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10461-018-2250-y","article-title":"Alcohol availability, marketing, and sexual health risk amongst urban and rural youth in South Africa","volume":"23","author":"L Letsela","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0341299.ref054","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmmh.2023.100273","article-title":"A latent class analysis of young women\u2019s co-occurring health risks in urban informal settlements in Durban, South Africa","volume":"4","author":"LJ Brown","year":"2023","journal-title":"SSM - Mental Health"},{"issue":"7","key":"pone.0341299.ref055","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.socscimed.2011.12.022","article-title":"\u201cBecause he has bought for her, he wants to sleep with her\u201d: alcohol as a currency for sexual exchange in South African drinking venues","volume":"74","author":"MH Watt","year":"2012","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0341299.ref056","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7196\/SAMJ.2020.v111i1.14520","article-title":"Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa","volume":"111","author":"CP Bonner","year":"2020","journal-title":"S Afr Med J"},{"issue":"1","key":"pone.0341299.ref057","first-page":"112","article-title":"Accuracy and Utility of the AUDIT-C with Adolescent Girls and Young Women (AGYW) Who Engage in HIV Risk Behaviors in South Africa","volume":"20","author":"T Kline","year":"2019","journal-title":"J Appl Meas"},{"key":"pone.0341299.ref058","doi-asserted-by":"crossref","first-page":"1290427","DOI":"10.1080\/16549716.2017.1290427","article-title":"A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours","volume":"10","author":"A Gibbs","year":"2017","journal-title":"Glob Health Action"},{"key":"pone.0341299.ref059","doi-asserted-by":"crossref","unstructured":"Bergh K, Jonas K, Toska E, Abdullah F, Nomtopi B, Mathews C, et al. I will take PrEP because that\u2019s what will help me not to get infected with HIV: Barriers to and facilitators of PrEP and condom use amongst adolescent girls and young women enrolled in a school-based combination HIV prevention programme in South Africa. Unpublished. 2025.","DOI":"10.3389\/fpubh.2025.1616261"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:24:33Z","timestamp":1779125073000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341299"}},"subtitle":[],"editor":[{"given":"Habil","family":"Otanga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":59,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0341299","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}