Preexposure prophylaxis initiation and alcohol-related sexual risk among young men who have sex with men.

OBJECTIVE

Human immunodeficiency virus (HIV) infection is a significant public health concern, particularly among young men who have sex with men (YMSM). Preexposure prophylaxis (PrEP) is highly effective in preventing HIV infection. However, PrEP does not protect against other sexually transmitted infections. Previous studies have shown unintended consequences following PrEP initiation, including increased sexual risk behaviors. Problematic alcohol use, to which YMSM are particularly vulnerable, may also play a role in increasing sexual risk. The present study examines the prospective relationship between PrEP initiation and alcohol-related sexual behaviors among YMSM.

METHOD: One hundred thirty-nine YMSM (Mage = 21.22) were enrolled in a longitudinal study examining PrEP initiation and alcohol-related sexual risk over 18 months. Participants completed a baseline assessment and follow-up assessments every 6 months. Data collection took place between 2016 and 2020.

RESULTS

PrEP initiation was modeled at Time 1, Time 2, Time 3, and Time 4. Alcohol-related sexual risk behaviors were measured at Time 1 and Time 4. The trajectory of PrEP initiation was used to predict latent change in alcohol-related sexual behaviors. Consistent with our hypothesis, a combined latent change score and latent trajectory model revealed a positive association between PrEP initiation and alcohol-related sexual behaviors between baseline and 18-month follow-up.

CONCLUSION

These results are consistent with research identifying a potentially high-risk period following PrEP initiation among a vulnerable group (YMSM), with implications for risk assessment and interventions targeting alcohol-related sexual behaviors among YMSM. Findings may aid in reducing adverse sexual outcomes among YMSM who initiate PrEP and ultimately contribute to the minimization of sexual health disparities among YMSM. (PsycInfo Database Record (c) 2026 APA, all rights reserved).