Alcohol Misuse and Illicit Drug Use Among Occupational Groups at High Risk of HIV in Sub-Saharan Africa: A Systematic Review

  • Monica O. KuteesaEmail author
  • Janet Seeley
  • Helen A. Weiss
  • Sarah Cook
  • Anatoli Kamali
  • Emily L. Webb
Original Paper


Key occupational groups in sub-Saharan Africa (SSA) are at increased risk of HIV, and may be at increased risk of substance use. In January 2018, we systematically searched for studies reporting prevalence of, and risk factors for alcohol misuse or illicit drug use and their association with HIV incidence or prevalence among fisherfolk, uniformed personnel, truckers, miners, motorcycle taxi riders and sex workers in SSA. Seventy-one studies published between 1983 and 2017 were included: 35 reported on alcohol misuse (19 using AUDIT, 5 using CAGE) and 44 on illicit drug use (eight reported both). Median prevalence of alcohol misuse based on AUDIT/CAGE was 32.8% (IQR 20.8–48.5%). Prevalence of illicit drug use ranged from 0.1% (95% CI: 0.0–0.2%) for injection drug use to 97.1% (95% CI: 85.1–99.9%) for khat (among uniformed personnel). Among papers examining associations between substance use and HIV incidence (n = 3) or prevalence (n = 14), nine papers (53%) reported a significant positive association (2 with incidence, 7 with prevalence). Harm reduction interventions in occupational settings are urgently required to prevent new HIV infections.


Alcohol misuse Illicit drug use HIV Key populations Sub-Saharan Africa 



We sincerely thank Matt Price M.D for constructive criticism of the manuscript.

Authors’ Contributions

All authors have made substantial contributions to the work reported in the manuscript. MOK devised the project, MOK, JAS, AK, HAW, SC, and EW contributed to the design of the research, MOK and EW to the data extraction and analysis of the results and to the writing of the manuscript. JAS, AK, HAW, and SC discussed the results and contributed to the manuscript.


This research was jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. E Webb and H Weiss received funding from MRC Grant Reference MR/K012126/1.

Compliance with Ethical Standards

The review protocol was registered at: ( CRD42016053495).

Conflict of interest

The authors have declared that no competing interests exist.

Supplementary material

10461_2019_2483_MOESM1_ESM.docx (46 kb)
Supplementary material 1 (DOCX 46 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.MRC/UVRI and LSHTM Uganda Research UnitEntebbeUganda
  2. 2.Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
  3. 3.Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
  4. 4.MRC Tropical Epidemiology GroupLondon School of Hygiene and Tropical MedicineLondonUK
  5. 5.Department of Non-Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
  6. 6.International AIDS Vaccine Initiative (IAVI)NairobiKenya

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