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. 2025 Nov;86(6):885-893.
doi: 10.15288/jsad.24-00172. Epub 2025 Mar 20.

How Cannabis and Alcohol Use Influence Sexual Behavior Among Men Who Have Sex With Men (MSM): An Ecological Momentary Assessment Study

Maria J Bustamante  1 , Tibor P Palfai  1 , Jeffrey S Simons  2 , Stephen A Maisto  3 , Brooke Z Beckius  2 , Kawon Kim  2
Affiliations

How Cannabis and Alcohol Use Influence Sexual Behavior Among Men Who Have Sex With Men (MSM): An Ecological Momentary Assessment Study

Maria J Bustamante et al. J Stud Alcohol Drugs. 2025 Nov.

Abstract

Objective: Heavy drinking is common among men who have sex with men (MSM) and significantly increases HIV acquisition risk. MSM who report heavy drinking also report higher cannabis use, which has also been associated with sexual behaviors known to elevate HIV transmission risk. Despite evidence of associations at the between-subjects level, the effects of alcohol and cannabis use on sexual risk behavior among MSM who engage in heavy drinking are largely unknown. The current study used ecological momentary assessment to examine the between- and within-subject associations of heavy drinking, cannabis use, and sexual behavior.

Method: This is a secondary data analysis of a study on alcohol intoxication and sexual decision making that included 115 MSM who reported cannabis use and were not using pre-exposure prophylaxis (PrEP) at baseline. Participants reported daily alcohol and cannabis use and sexual activities over 6 weeks. Multilevel multinomial regression was used to evaluate how alcohol and cannabis use were associated with sexual behaviors.

Results: Higher alcohol use was associated with higher rates of intercourse at the between-persons level and a higher likelihood of all sexual behaviors at the event level. In contrast, cannabis use at the between-person level was associated with an increased rate of condomless anal intercourse relative to both anal intercourse with a condom as well as no sex. At the within-person level, cannabis was associated with an increased likelihood of anal sex with or without a condom relative to no sex.

Conclusions: Cannabis and alcohol may have independent effects on sexual risk behavior among MSM. Interventions addressing sexual health among MSM who engage in heavy drinking should also consider the additive risks of cannabis use.

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Figures

Figure 1.
Figure 1.
Marginal within-person effects of cannabis use (upper panel) and drinking (lower panel) on sexual behavior. CI = confidence interval.
Figure 1.
Figure 1.
Marginal within-person effects of cannabis use (upper panel) and drinking (lower panel) on sexual behavior. CI = confidence interval.
See this image and copyright information in PMC

References

    1. Boone MR, Cook SH, & Wilson P (2013). Substance use and sexual risk behavior in HIV-positive men who have sex with men: An episode-level analysis. AIDS and Behavior, 17(5), 1883–1887. 10.1007/s10461-012-0167-4 - DOI - PubMed
    1. Bourne A, & Weatherburn P (2017). Substance use among men who have sex with men: Patterns, motivations, impacts and intervention development need. Sexually Transmitted Infections, 93(5), 342–346. 10.1136/sextrans-2016-052674 - DOI - PubMed
    1. Cahalan D, Cisin IH, & Crossley HM (1969). American drinking practices: A national study of drinking behavior and attitudes. Monographs of the Rutgers Center of Alcohol Studies, 6, 260.
    1. Colfax G, Vittinghoff E, Husnik MJ, McKirnan D, Buchbinder S, Koblin B, Celum C, Chesney M, Huang Y, Mayer K, Bozeman S, Judson FN, Bryant KJ, & Coates TJ (2004). Substance use and sexual risk: A participant- and episode-level analysis among a cohort of men who have sex with men. American Journal of Epidemiology, 159(10), 1002–1012. 10.1093/aje/kwh135 - DOI - PubMed
    1. Drumright LN, Little SJ, Strathdee SA, Slymen DJ, Araneta MRG, Malcarne VL, Daar ES, & Gorbach PM (2006). Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. Journal of Acquired Immune Deficiency Syndromes, 43(3), 344–350. 10.1097/01.qai.0000230530.02212.86 - DOI - PubMed