Cannabis and Alcohol Co-Use And HIV Biomedical Intervention Engagement Among Black Sexual/Gender Minority People: A Day-Level Analysis

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INTRODUCTION: Cannabis and alcohol are the most frequently used substances among Black sexual/gender minority people, and co-use of these substances is surging. Little work exists on the association of cannabis/alcohol co-use with HIV prevention and care engagement in this population. The authors examined daily associations of cannabis/alcohol co-use with pre-exposure prophylaxis and antiretroviral medications use, in the context of hazardous alcohol and cannabis use, among Black sexual/gender minority. METHODS: Daily use of cannabis, alcohol, and pre-exposure prophylaxis/antiretroviral medication was assessed through 14-day ecologic momentary assessment in the Neighborhoods and Networks Part 2 cohort study of Black sexual/gender minority in Chicago (2022-2024). Generalized estimating equations models were used to examine day-level associations between cannabis/alcohol co-use and following-day pre-exposure prophylaxis/antiretroviral medication use. RESULTS: Across 5,729 days for 521 participants with ≥1 ecologic momentary assessment responses, cannabis/alcohol co-use, cannabis-only use, alcohol-only use, and no substance use occurred on 19.8%, 36.5%, 6.3%, and 34.9% days, respectively. Among participants who reported hazardous alcohol use (Alcohol Use Disorders Identification test≥8), on cannabis-only days, participants were more likely to report following-day pre-exposure prophylaxis/antiretroviral medication use (adjusted RR=1.54; 95% CI=1.00, 2.38). Among participants with no hazardous alcohol use, alcohol-only use day was associated with greater following-day pre-exposure prophylaxis/antiretroviral medication use (adjusted RR=1.34; 95% CI=1.02, 1.76). Cannabis/alcohol co-use was not associated with pre-exposure prophylaxis/antiretroviral medication use, regardless of hazardous alcohol or cannabis use status. CONCLUSIONS: Heterogeneity exists regarding the associations between cannabis/alcohol co-use and pre-exposure prophylaxis/antiretroviral medication use among Black sexual/gender minority, depending on individuals' hazardous alcohol use status. Future research should collect fine-grained contextual data on cannabis/alcohol co-use to examine the mechanisms through which co-use influences HIV care engagement.

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