Pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition among men who have sex with men (MSM). However, little is known about unhealthy substance use among MSM initiating PrEP in real-world settings. Unhealthy substance use is a risk factor for HIV acquisition and non-adherence to treatment, and may also impact PrEP use. MSM who were prescribed PrEP from 2015 to 2017 at clinics in Providence, Rhode Island and New Haven, Connecticut were recruited to participate in a prospective observational study. Structured clinical assessments were used to assess demographics, HIV risk behaviors, and unhealthy alcohol (alcohol use disorders identification test [AUDIT]-C scores ≥ 4) and drug use (use of any drugs in the past 3 months). Bivariate and multivariate analyses were performed to determine demographics and behaviors associated with unhealthy alcohol and drug use. Among 172 MSM initiating PrEP, 64% were white and 40% were 25–34 years old. Participants reported a median of 3 (IQR 2–7) sexual partners in the last 3 months; 20% reported an HIV positive partner. Unhealthy alcohol and any drug use were reported by 54 and 57%, respectively, and 76% reported at least one of the two. The majority of drug use reported was marijuana and poppers (41 and 26% of participants, respectively). Relative to those without unhealthy alcohol use, unhealthy alcohol use was independently associated with any drug use (adjusted odds ratio [AOR] = 2.57, 95% CI 1.32–5.01). Frequent drug use was associated with younger age (< 25 years, AOR 4.27, 95% CI 1.51–12.09). Unhealthy alcohol use is common among MSM taking PrEP. Drug use other than marijuana and poppers was uncommon among our cohort. Further efforts may be needed to understand the influence of unhealthy alcohol and other substance use on PrEP outcomes and to engage MSM who use drugs for PrEP.
Pre-exposure prophylaxis Alcohol Implementation Men who have sex with men HIV
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Support for study authors: PAC is supported by the National Institute Health (R01MH114657). EJE was supported as a Yale Drug Abuse, Addiction and HIV Research Scholars (DAHRS) Program during the conduct of this work (K12DA033312).
This study was funded by Lifespan/Tufts/Brown Center for AIDS Research (Grant No. P30AI042853) and the Yale Center for Interdisciplinary Research on AIDS (Grant No. 5P30MH62294) and also National Institutes of Health (Grant Nos. R34DA042648, R34MH110369, R34MH109371, R21MH113431, R21MH109360) and National Institutes of Health (US) (Grant No. K12DA033312).
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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