Structural characteristics of alcohol venues are associated with testing positive for HIV in rural Kwazulu-Natal, South Africa

The HIV epidemic in South Africa is one of the largest globally, with a 20% prevalence among adults. The South African National Strategic Plan recognizes the need to address social and structural barriers to HIV prevention, as well as behavioral drivers, including alcohol abuse. Nested within a rural community-based HIV testing initiative, including at alcohol venues (AVs), we explored whether structural features of AVs were associated with HIV seropositivity. Of the 488 individuals tested at 46 AVs, 43 (8.8%) were seropositive. The majority of AVs were rural, unregistered, informal, lacked a liquor license, well-maintained, single rooms with lighting, make-shift seating, and adjacent outdoor space. Sound systems, bathrooms and preventative health signage were less common. In this cross-sectional analysis, community members were more likely to be identified as living with HIV at shebeens that were in town (<i>p</i> = 0.006), well-maintained (<i>p</i> = 0.008), had bathrooms (<i>p</i> = 0.004), and were monitored by security (<i>p</i> = 0.047). Multivariable regression analysis identified indoor bathrooms as an independent correlate of living with HIV (Adjusted Odds Ratio: 0.52, CI 95% 0.30-0.90). While many structural characteristics were static, several were potentially modifiable. Understanding how AV characteristics are associated with testing positive for HIV may inform community-based interventions that can address HIV risk.