Recreational ART Use among Individuals Living with HIV/AIDS in South Africa: Examining Longitudinal ART Initiation and Viral Suppression.

•South Africa has a high prevalence of HIV and co-occurring substance use.•There is speculation of recreational ART use which may compromise HIV treatment.•We tested how recreational ART and other substance use affect HIV cascade outcomes.•Recreational ART use was infrequent and not associated with HIV care outcomes.•Binge drinking and drug use predicted lower ART initiation and viral non-suppression.