Abstract
The HIV epidemic in South Africa is among the largest in the world with a prevalence of 20% 2 among adults. The South African National Strategic Plan recognizes the need to address social 3 and structural barriers to HIV prevention, as well as behavioral drivers, including alcohol abuse. 4 Nested within a rural community-based HIV testing initiative, including testing at alcohol venues 5 (AV), we explored whether structural features of AVs were associated with testing positive for 6 HIV. Of the 488 individuals tested at 46 AVs, 43 (8.8%) were seropositive. The majority of AVs 7 were rural, un-registered, informal, lacked a liquor license, well-maintained, single rooms with 8 lighting, make-shift seating, and adjacent to outdoor space. Sound systems, bathrooms and 9 preventative health signage were less common. In this cross-sectional analysis, community 10 members were more likely to be identified as living with HIV at shebeens that were in town 11 (p=0.006), well- maintained (p=0.008), had bathrooms (p=0.004), and were monitored by 12 security guards (p=0.047). Multivariable regression analysis identified indoor bathrooms as an 13 independent correlate of living with HIV (Adjusted Odds Ratio: 0.52, CI 95% 0.30-0.90). While 14 many of the structural characteristics were static, several were potentially modifiable. 15 Understanding how AV characteristics are associated with testing positive for HIV may inform 16 community-based interventions that can address HIV risk.