This is one of few studies evaluating patterns and predictors of alcohol misuse in a sample of young Black MSM in NYC. Our findings showed a high prevalence of past-year and 3-month binge drinking among young Black MSM, which are in line with findings from the 2017 National HIV Behavioral Surveillance Report (Centers for Disease Control and Prevention, 2019) indicating that the prevalence of binge drinking during the 30 days before the interview were 45.0% and 31.9% among HIV-negative and HIV-positive MSM in general, and 47.0% among MSM in NYC. This suggests a need for targeted interventions and support programs to address alcohol misuse in this specific population. In addition, our findings are twice compared to 21.5% of Americans aged 12 and older who reported binge drinking in the past month in 2023 (Substance Abuse and Mental Health Services Administration, 2023) due to differences in age and study population. Previous studies indicated that older MSM are more likely to report alcohol use and alcohol misuse (Bhambhani et al., 2021; Liu et al., 2016). Another study conducted in San Francisco documented that nearly 25.0% and 19.3% were weekly and at least weekly binge drinkers (Santos et al., 2018) which were much higher than the respective rates in our study. This could be attributable to different sampling strategies: Santos et al. used respondent-driven sampling to recruit MSM, while our study relied primarily on online advertising, face-to-face outreach, and referrals by study participants (Frye et al., 2021), which could generate more diverse study populations. Future studies need to consider different sampling strategies to recruit a diversity of MSM to be representative for estimating alcohol use.

Notably, our findings highlighted the higher risk of alcohol misuse among young Black MSM in NYC compared with the adult population in New York State overall and other urban settings. The respective past-year and three-month prevalence rates of alcohol misuse in our study were 33.2% and 28.0%, much higher than 16.7% of adults in New York State who reported heavy drinking and excessive alcohol use in the past 30 days (New York State Department of Health, 2020). While our study measured alcohol misuse among MSM in the past year and past three months, the New York State report focused on alcohol misuse among adults in the past 30 days. Alcohol misuse is a key factor for HIV and STI infection among MSM because intoxication could in part interfere with the use of prevention methods (e.g., condoms; Liu et al., 2016; Wray et al., 2019). These findings emphasize the importance of raising awareness of alcohol misuse and implementing alcohol risk reduction programs in this vulnerable and hard-to-reach population.

In both bivariate and multivariable analyses, internalized homophobia was not statistically associated with alcohol misuse. Previous findings revealed that MSM might use alcohol as a strategy to cope with homosexual stigma or violence due to sexual orientation (Bruce et al., 2008; Wolitski et al., 2007). For example, the odds of binge drinking among those with high internalization of negative societal attitudes were 2.1 times higher compared to those with low self-stigma (Peacock et al., 2015). Furthermore, in our study, we assessed internalized homophobia using six questions with excellent internal consistency. It is necessary to further validate the scale we used to measure internalized stigma and evaluate the association between internalized homophobia and alcohol misuse with a large enough sample size. In addition, we found no statistical association between having positive screening for depression and alcohol misuse. In this study, PHQ-2 was used to screen for major depression, and internalized stigma was evaluated based on six single questions. Hence, further studies should use the full version of depression evaluation (e.g., PHQ-9) following a positive screening using PHQ-2 and stigma scales (e.g., Mayfield’s 23-item internalized homonegativity scale; Peacock et al., 2015) to assess the association with alcohol misuse.

Stevens et al. reported that alcohol was the most widely used substance among MSM with chemsex-related drug use (Íncera-Fernández et al., 2021). In our study, using drugs within two hours before or during sex increased the probability of alcohol misuse to 1.76 times; however, after controlling for demographic characteristics, chemsex was no longer a significant factor. This could be attributable to the broader definition of chemsex in our study which encompassed individuals using various substances such as marijuana, powder/crack cocaine, methamphetamine, and club drugs within two hours before or during anal sex, regardless of their role (top or bottom). In contrast, chemsex often refers to the use of methamphetamine in North America (Flores-Aranda et al., 2019). Although there is no agreement on the definition of chemsex which varies based on the cultural and geographical contexts (Flores-Aranda et al., 2019), it is well noted that chemsex among MSM is associated with significant physical, biomedical, and psychosocial harm (Stevens et al., 2020). Hence, more research is needed to examine the association between chemsex and alcohol misuse among MSM as well as develop psychosocial and behavioral interventions to support MSM with a history of chemsex that is positively associated with alcohol misuse.

In both crude and adjusted models, marijuana was significantly associated with the past 3-month and past-year alcohol misuse. A prospective study among American adults showed that marijuana smokers were five times more likely to develop an alcohol use problem, compared with those who had not used marijuana (23% vs. 5%, respectively; Weinberger et al., 2016). More importantly, Alcohol use and marijuana use during sex contribute to an increased risk of unprotected sex among MSM (Mackesy-Amiti & Ouellet, 2010). Specifically, the likelihood of participating in unprotected anal intercourse was approximately three times greater during sexual encounters involving both cannabis and alcohol compared with those without any substance consumption. (Firkey et al., 2021). These findings underscore the urgency for additional research aimed at unraveling the underlying mechanisms and designing effective interventions to support individuals grappling with concurrent substance use issues.

Our study revealed that young Black MSM with multiple casual male sex partners had a higher likelihood of misusing alcohol, which is similar to the findings of a study conducted among MSM in San Francisco (Santos et al., 2018). Again, these findings highlight the need to develop MSM-specific interventions that jointly address alcohol misuse and HIV risks. More importantly, we found that young Black MSM with a history of marijuana use and hard drug use were more likely to report alcohol misuse. These findings were consistent with prior studies indicating that using illicit drugs was positively associated with alcohol misuse (Liu et al., 2016). Santos et al. indicated that methamphetamine and cocaine were positively associated with hazardous drinking in bivariate analysis, although the authors used a different version of the alcohol use disorders identification test (i.e., full AUDIT; Santos et al., 2018). It is noted that existing studies, even with the general population, recommended differently gendered cutoffs for alcohol misuse with both the short and the full version of AUDIT based on the achievement of sensitivity and specificity (Moehring et al., 2019; Villarosa-Hurlocker et al., 2020). Alcohol use screening tools are necessary, therefore, that distinguish between sex- and gender-related characteristics which, in turn, could propose optimal screening cut-offs for alcohol misuse in this hard-to-reach population.

This study has several limitations. The original study focused on evaluating the efficacy of an intervention to increase HIV self-testing among young Black MSM and transwomen (Frye et al., 2021). This study with a small sample size targeting young Black MSM was not representative of the MSM community in NYC, although we implemented divergent sampling strategies (e.g., online advertising, in-person outreach, etc.) to recruit the best diverse pool of young Black MSM. In addition, the main outcomes of interest are self-reported which could suffer from the social desirability bias. Therefore, we presented the prevalence and correlates of both past-year and past 3-month alcohol misuse and concluded that there remain generally similar results regarding determinants of alcohol misuse. Finally, as discussed earlier, we used short versions of depression symptom severity as well as internalized stigma toward homosexuality which, in turn, might be unable to capture the covariates of interest. Future studies should implement the full versions of these scales to assess the association with alcohol misuse.