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Beliefs About Toxic Interactions Between Alcohol and PrEP Predict Less Initiation and More Discontinuation: Results
Brian Mustanski1,2, Daniel T Ryan3, Ross Baiers3
1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. brian@northwestern.edu.
AIDS and Behavior
|May 27, 2026
Summary
Beliefs about alcohol and HIV medication toxicity deter PrEP use among young men who have sex with men (YMSM). Addressing these beliefs may improve PrEP uptake and persistence for HIV prevention.
Area of Science:
- Public Health
- Epidemiology
- Behavioral Science
Background:
- Young men who have sex with men (YMSM) face high HIV incidence and low PrEP coverage.
- Concerns about alcohol-HIV medication interactions may hinder PrEP adherence, a belief potentially common among YMSM due to elevated hazardous drinking rates.
Purpose of the Study:
- To investigate the impact of alcohol-interactive toxicity beliefs on PrEP uptake and discontinuation among HIV-negative YMSM.
- To identify barriers to effective HIV prevention strategies in this population.
Main Methods:
- Longitudinal analysis of 478 HIV-negative YMSM (mean age 23.0).
- Examined direct effects of alcohol consumption and toxicity beliefs, and their interaction, on PrEP uptake and discontinuation over six months.
- Data collected from a racially and ethnically diverse sample.
Main Results:
- A majority of YMSM (58%) held at least one alcohol-related toxicity belief.
- These beliefs were associated with reduced PrEP uptake among non-users.
- YMSM reporting both higher alcohol consumption and toxicity beliefs were more likely to discontinue PrEP.
Conclusions:
- Alcohol-interactive toxicity beliefs are prevalent among YMSM and act as a significant barrier to PrEP uptake and consistent use.
- Interventions targeting these beliefs, through education and counseling, could enhance PrEP effectiveness for HIV prevention.
- Addressing these misconceptions is crucial for optimizing HIV prevention efforts in YMSM populations with high alcohol use.
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