Formative Research to Identify Contributors to Risky Drinking and Adapt an Alcohol Reduction Intervention Among Young Adults Vulnerable to HIV: Qualitative Focus Group Study

Background: Across populations, risky drinking has been demonstrated to increase HIV risk behaviors. This is of special concern for sexually minoritized cisgender men and gender-diverse young adults (aged 18‐34 years), who report greater incidence of hazardous drinking (as defined by the Alcohol Use Disorders Identification Test - Consumption criteria) and HIV compared to their heterosexual and/or cisgender peers. Objective: This study aimed to examine alcohol perceptions, patterns of use, and the role that anti-LGBTQ+ (lesbian, gay, bisexual, transgender, queer) policies and discrimination played in alcohol risk behaviors for sexually minoritized cisgender men and gender-diverse individuals. Results were used to inform the development of an alcohol reduction intervention for this population. Method: A qualitative study was conducted with data collected via 4 focus groups among young adult sexually minoritized cisgender men and gender-diverse individuals in the United States from April to June 2023 (N=21). Participants were grouped according to identity as cisgender men, transgender men, transgender women, and nonbinary individuals. Transcripts were analyzed using codebook thematic analysis. Results: Alcohol use was described as a way to navigate belonging, social connection, and identity expression within LGBTQ+ contexts. Alcohol was viewed as a mainstay of LGBTQ+ spaces, with many using it as a social lubricant and coping mechanism for LGBTQ+-related stress, as well as for relaxation and having fun. Drinking intensity was often tied to an individual’s comfort with their evolving sexually minoritized cisgender men and gender-diverse identity, with drinking being higher in earlier stages of exploration. The consequences of drinking discussed by participants included impaired decision-making and negative effects on mental and physical health. Anti-LGBTQ+ laws and policies were seen as contributing to the further stigmatization of sexually minoritized cisgender men and gender-diverse individuals, and hazardous use of alcohol was used as a means of escape and coping. Conclusions: Alcohol use among sexually minoritized cisgender men and gender-diverse individuals is an important aspect of negotiating identity within different social settings and coping with stigma. Findings have valuable implications for tailoring alcohol reduction interventions for sexually minoritized cisgender men and gender-diverse young adults as they encounter stressors in real time.