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AIDS Behav. 2018 Aug 25. doi: 10.1007/s10461-018-2260-9. [Epub ahead of print]

Prevalence and Correlates of Unhealthy Alcohol and Drug Use Among Men Who Have Sex with Men Prescribed HIV Pre-exposure Prophylaxis in Real-World Clinical Settings.

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Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Department of Medicine, Yale-New Haven Hospital, New Haven, CT, USA.
Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
Department of Medicine, Brown University, Providence, RI, USA.
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
Health Services Research & Development Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA.
Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.


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.


Alcohol; HIV; Implementation; Men who have sex with men; Pre-exposure prophylaxis


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