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Background  In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people.    Methods  Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators.    Results  The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use,  13%  vs.  24%, p <  0.01 ; current illicit drug use,  7%  vs.  15%, p <  0.01 ; current alcohol and illicit drug use comorbidity,  4  vs.  11%, p <  0.01 . Past-year prevalence estimates for  hazardous  substance use were generally low among young people in this setting  (< 10%)  with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not  hazardous  substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use.    Conclusions  At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.    Supplementary Information  The online version contains supplementary material available at 10.1186/s13011-021-00422-6.

substance abuse treatment, prevention, and policy

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators