New research suggests binge drinking could be putting young women at far greater risk than many realise.
Binge drinking is defined as consuming five or more drinks in one sitting, and according to the data, over a third of female drinkers in South Africa admit they do it.
At the same time, South Africa remains home to the world's largest HIV epidemic and young women aged 15 to 24 are among the hardest hit.
Research by the South African Medical Research Council (SAMRC) found that binge drinking increases exposure to situations that make getting infected more likely.
Key Findings
High Prevalence: Nearly one in three young women surveyed consumed alcohol, with almost half classified as hazardous drinkers and about a quarter identified as binge drinkers.
Age and Environment: The highest levels of alcohol consumption were specifically recorded in the 20 to 24 age group, with urban centers like Cape Town and Tshwane seeing the most concerning rates.
Socioeconomic Drivers: Factors such as easy access to cheap alcohol, targeted marketing, and unemployment act as major catalysts for excessive drinking.
Vulnerability: Researchers emphasized that excessive alcohol use decreases safe-sex negotiation power, heightening these women's vulnerability to HIV and other risky behaviors.
Study Context
The research, which surveyed over 4,000 adolescent girls and young women (AGYW), aged 15 to 24.
I spoke to Dr. Zoe Duby, a socio-behavioural public health researcher and qualitative social scientist with over 20 years’ experience in sexual and reproductive health, HIV prevention, health equity, mental health and wellbeing in sub-Saharan Africa.
Duby is a Senior Scientist in the Health Systems Research Unit at the South African Medical Research Council (SAMRC) and a Research Associate with the University of Cape Town’s School of Public Health.
With a PhD in Public Health and an MPhil in HIV in Society, Duby brings strong academic grounding to work that prioritises research translation, ensuring that evidence informs practice, policy and real-world impact. Her qualitative research focuses on unpacking sensitive behaviours, complex social contexts, and the intersections of gender, sexuality, health care access and health rights. Based in Cape Town, South Africa, she is passionate about promoting health equity, challenging discriminatory norms and breaking the silence around harmful taboos.
How bad is the situation in Cape Town where men buy alcohol and pressure vulnerable women into condomless sex?
What the research shows is deeply concerning, but it is also important to say this is not simply a story about individual girls making "bad choices." In our data, 10% of the 5,025 survey participants were living with HIV and 35% were engaging in hazardous drinking, and the qualitative interviews showed that some young women actively sought alcohol from older men knowing sex would be expected in return. That means alcohol is not only a substance; in some contexts it becomes part of a transactional power dynamic where older men use alcohol as a currency with which to 'buy' sex.
Protecting young women therefore has to happen at several levels at once. They need safer social spaces, better access to prevention technologies, and honest education about consent and coercion, but communities also need stronger accountability for the gender norms and values that normalise these exchanges. If we only tell girls to "be careful," we miss the fact that the environment is structured in ways that make them vulnerable.
Messaging to these girls about the dangers of drinking alcohol and compromising themselves?
The message should be honest and open, but never blaming. The studies show that alcohol use among adolescent girls and young women is often normalised, socially rewarded, and tied to sociability, belonging, and "vibes," which means it is not enough to issue moral warnings and preach total "abstinence". At the same time, the risks are real: alcohol can lower inhibitions, make it harder to leave unsafe situations, and make condom negotiation more difficult.
So the best message is: know that drinking can place you in situations where your safety, consent, and control are reduced, especially when older men are involved or when sex is expected in exchange for alcohol. We also need to make an effort to make non-drinking and being sober and in control "cool". But it should also make clear that the burden of safety should never rest only on girls; the people pressuring them and the systems normalising this behaviour must also be challenged. Prevention messaging works best when it is practical, respectful, and rooted in the realities young women already face.
How do we get these girls to stay in treatment and live healthy lifestyles without seeming judgemental?
The first step is to remove blame and shame from the interaction. Young women are far more likely to stay in care when they feel respected, understood, and not blamed for the circumstances that shaped their risk. The broader research base on AGYW in South Africa shows that stigma, fear of judgement, and difficult social environments often shape whether young women disclose, return to care, or keep up with treatment.
What helps is a supportive, youth-friendly, and non-punitive service model. That means counselling that focuses on what the young woman needs now: adherence support, mental health support, protection from violence, and practical help with transport, follow-up, and disclosure where needed. If services sound judgemental and blaming, girls may disappear; if they sound caring and confidential, they are more likely to stay engaged.
How do we make alcohol producers protect vulnerable girls?
The evidence suggests that alcohol marketing is not a neutral backdrop; it helps shape the very normalisation that makes drinking appear fashionable, expected, and socially necessary. Young women in the study described alcohol as part of social life, and other South African youth research has shown that alcohol outlet density and advertising can intensify exposure to risky settings and sexual violence. In that sense, producers and marketers are part of the environment that sustains harm.
That is why self-regulation alone is not enough. Government needs stronger controls on advertising, tighter enforcement of age restrictions, and restrictions on alcohol promotion around schools, youth spaces, and digital platforms. Public messaging also has to offer an alternative: it should make non-drinking, safe socialising, and refusal of transactional pressure feel normal and desirable rather than isolating.
How does government policy help our young girls?
Government policy matters because the problem is structural, not just behavioural. Our research shows that alcohol availability, social norms, gendered power, and HIV risk are tightly linked, which means HIV prevention has to work alongside alcohol policy, violence prevention, and youth services. The National Department of Health can help by integrating HIV prevention with alcohol screening, Gender Based Violence response, sexual and reproductive health services, and youth-friendly care.
But the National Health Department alone cannot solve this. A real response requires coordination with education, social development, police, and local government to reduce alcohol exposure, strengthen protection from exploitation, and create safer community environments. The most important insight from our research is that the issue is not just whether young women know the risks; it is whether the systems around them make safe choices possible.
I spoke to Tolulope Adenekan, a public health researcher and research hub operations officer at the INFORM Africa Research Hub, Institute of Human Virology Nigeria (IHVN), Abuja. Her work focuses on HIV, implementation science, qualitative research, and strengthening health systems.
My reasons for speaking to Adenekan in Abuja Nigeria, was to compare the different cities in different countries to get a sense of how substance abuse and the vulnerabilities it brings to young girls, particularly.
Adenekan’s MSc research evaluated adherence to antiretroviral therapy (ART) among adolescents and young people living with HIV receiving care in selected health facilities in Abuja Municipal Area Council (AMAC), the Capital City in Nigeria.
Adenekan’s areas of interest include HIV prevention and treatment, ART adherence, maternal and adolescent health, infectious diseases, implementation science, and research operations. Tolulope Adenekan enjoys translating research into practical information that supports better health programmes and informed decision-making.
Adenekan is a member of the Royal Society of Tropical Medicine and Hygiene (FRSTMH), a member of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), a Board Member of Like Minds Health Support Initiative, and a Certified Data Protection Officer accredited by the Nigeria Data Protection Commission (NDPC).
Adenekan has supported NIH-funded public health research and welcomes opportunities to share evidence-based insights with the media.
How bad is this situation in Nigeria?
Bad enough. The picture you painted is not peculiar to South Africa. In Nigeria we are debating sachet ban, but I don’t think that’s the real issue. Roughly a quarter of Nigerian women fall into what researchers call harmful drinking, and the number of harmful drinkers nationally nearly doubled between 1995 and 2015. Growing up, alcohol used to be older men affair here in Nigeria, but that has changed, especially in cities, where it's cheap, everywhere, and marketed hard at young people, which includes young women.
You know more than the drinking itself, The World Health Organisation has said for years that alcohol is one of the clearest drivers of unsafe sex and HIV risk, and the reason isn't complicated, a few drinks in, a young woman's ability to insist on a condom, or to just walk away from a man making her uncomfortable, drops. And there's very often an older man with money somewhere in that picture. Research done here in Nigeria, across several states, keeps turning up transactional relationships between adolescent girls and older men as a real driver of HIV risk, this is a pattern.
Just to be clear, the blame is not on her. I get uneasy whenever the conversation focuses only on what she should have done differently. The laws we have, the Child's Rights Act, the Violence Against Persons Prohibition Act, cover some of this, but not all of it. They don't apply uniformly across states, and honestly, they weren't built with "she drank on her own" scenarios clearly in mind. That's a gap worth naming, not papering over. Pair stronger, more consistent enforcement with real economic alternatives, because a lot of these girls aren't doing this for fun, they're doing it to survive. You can't preach your way out of poverty, and no girl should have to choose between her safety and her next meal.
Messaging on the dangers of drinking alcohol and compromising themselves?
I believe the conversation should be honest, respectful, and free of judgment. From my work with young people, they often switch off when they feel they are being lectured.
Instead of simply saying "don't drink," we should explain how alcohol affects judgment and decision-making, increasing the risk of sexual violence, unintended pregnancy, HIV, other sexually transmitted infections, road traffic injuries, and poor mental health, none of this is about her character, It's about what alcohol does to judgment generally, and about partners who know that and use it. We should also remind them that protecting their health and future is not a sign of weakness but of strength.
How do we help these girls stay on treatment and live healthy lives without being judgmental?
The first thing is to remove blame from the discussion, tell her the truth without being judgemental. Introduce her to HIV counseling centre, where she will learn about the great advances in HIV treatment. A girl who adheres to treatment can test undetectable and untransmitable, she can live long, healthy and productive lives. At the counseling centres, health care workers should offer support and youth friendly services to these women, which include introducing them to the peer support groups.
Targeted marketing, how do we encourage alcohol producers and marketers to be more responsible?
Consistency with enforcements. In Nigeria, The National Agency for Food and Drug Administration and Control (NAFDAC) has been enforcing a ban on alcohol sold in sachets and sub-200ml bottles precisely because that packaging is what makes alcohol cheap and disposable on a teenager's budget, and a National Alcohol Control Bill covering marketing and production, not just packaging, passed second reading in the House of Representatives this past May. Advertising already carries some restrictions; NAFDAC and Advertising Regulatory Council of Nigeria require "drink responsibly" disclaimers and keep alcohol ads out of children's programming. But, the honest answer is none of this holds unless enforcement stays consistent, the sachet ban alone has been delayed and re-delayed for years under industry pushback. Marketing rules only mean something with independent monitoring behind them. Nobody polices their own bottom line.
How can government policy help?
The Health Department's real job in Nigeria is integration, not another standalone campaign. Alcohol screening and counselling belong inside the services girls already use, adolescent clinics, antenatal care, HIV testing and treatment, not off in their own silo, and the frontline workers need training to actually ask the right questions and catch risky drinking early.
None of this is a single-agency job. It needs government, health workers, schools, parents, community and religious leaders, and young women themselves coming together.
One more thing worth saying: the UCT research is useful precisely because it broke the numbers down by age and urban setting. We don't have that resolution of data here yet. A generic "drink less" campaign won't touch a problem this specific, and until our data matches theirs, our policy keeps aiming a little to the left of the actual target.
How bad the challenge of binge drinking or drug abuse among learners?
17 year old Nomathemba Dlamini*, not her real name, to protect her identity as she is in Grade 11 in a Johannesburg school in Cosmo City, South Africa.
She started experimenting with alcohol and dagga (dagga (Afrikaans pronunciation: [ˈdaχa]) is a word used in certain areas of Southern Africa to describe cannabis flower. The term, dating to the 1660s, derives from the word daxa in the Khoekhoe language used to describe the plant as well as various species of Leonotis. The leaves of specifically the Leonotis leonurus resemble the cannabis leaf and are known locally as wild dagga) about 2 years ago, when she moved to Johannesburg from Mpumalanga province so she can get a better school with better results over the years. The harsh reality is that at home, her father works in Pretoria and is only home over the weekend.
This has left the 3 children (2 girls and 1 boy, as siblings, including Nomathemba) to take care of themselves with no adult supervision during the week.
She is repeating Grade 11 in 2026 because she did not write her final examinations in 2025 due to a meltdown she suffered from heavy drinking and dagga, which landed her in hospital. She did not write her mid-year examinations in 2026 because she landed in hospital again this year.
The doctors have threatened to put her in rehab if she is taken to hospital again.
The doctors and health-workers have insisted that the father hire a helper to help take care of the children during the week when the father is at work, something he can afford.
She admits to sleeping with an older boy because she had no transport back home from a party, she did use protection according to her. She has never done an HIV test, as she has not seen the need thus far.
This work was produced with the assistance of a grant provided by the Wits Centre of Journalism at the University of the Witwatersrand. The opinions held are of the author.