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

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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 (<40 copies/mL), advanced HIV disease (CD4 count<200 cells/mm 3 ), healthcare access (clinic visit <12 months), and all-cause mortality. Poisson regression models were used for HIV outcomes and clinic follow-up; Cox proportional hazard models were used for mortality. Models were adjusted for clinical and demographic confounders. In sensitivity analyses, alcohol use was redefined as any use in the past 12 months. Results Among 5,771 men (median age 36.2 years, SD 18.9), 10% met criteria for hazardous alcohol use with 28% reporting any alcohol use in the past 12 months. Hazardous alcohol use was not associated with HIV prevalence (aPR 0.96 95%CI 0.83-1.12, p=0.63), awareness of HIV diagnosis (aPR 1.25, 95%CI 0.88–1.77, p=0.22), virologic suppression (aPR 0.92, 95%CI 0.82–1.03, p=0.14), or advanced HIV disease (aPR 0.71, 95%CI 0.40–1.26, p=0.24). Clinic retention was low overall (56% hazardous alcohol vs. 63% no/low-risk alcohol, p=0.092) and similar between groups in adjusted models. Over a median 3.4 years, 7.3% of men with HIV died, with no differences by hazardous alcohol use. Results were similar when considering any alcohol use as the exposure. Conclusions Hazardous alcohol use among rural South Africa men was not associated with HIV prevalence, HIV clinical outcomes, retention in care, or short-term mortality.

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