Abstract Background Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultural and geographical differences exist regarding alcohol use. In this study, we compare the alcohol use and hazardous drinking in Belgian (BE) and South African (SA) university students. Methods An online survey assessing alcohol use among university students in South Africa (University of KwaZulu-Natal) and Belgium (University of Antwerp) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). For male students a cut-off point of 5 was used for hazardous drinking and for female students a score of 4. In total, 499 students were included in the study (250 BE and 249 SA students). A comparative analysis between both universities was performed for men and women separately with a Pearson chi-square test or Mann-Whitney U test. Furthermore, the association between hazardous drinking and several exposure variables was explored using multivariable logistic regression analysis. Results A significant higher amount of male (94.8%) as well as female (92.4%) BE students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) SA students (p < 0.001). Additionally, a significant higher amount of BE students were hazardous drinkers, compared to the SA students (p < 0.001). Multivariate analysis showed that male BE students were approximately five times more likely to be hazardous drinkers than male SA students (OR = 5.057, 95% CI 1.378-18.556; p = 0.015). Female BE students were over twice more likely to be hazardous drinkers than female SA students (OR = 2.371, 95% CI 0.846-6.644; p = 0.099). Conclusions BE students drink significantly more alcohol and a significant higher proportion of BE students were hazardous drinkers compared to SA students. Qualitative research in both groups has been conducted to get more insight into the reasons of these differences and will also be presented at the Conference. Key messages ...