JMIR Publications

ABSTRACT

Background:

Trauma is common among young men who have sex with men (YMSM) and young transgender women (YTW) and is linked to increased substance use and HIV risk. However, it remains unclear whether alcohol and other drug (AOD) use influences the relationship between trauma exposure and condomless sex in these populations.

Objective:

This study examined whether substance use amplifies or attenuates the association between trauma and condomless sexual behaviors among YMSM and YTW.

Methods:

This was a secondary analysis of data from a randomized controlled trial evaluating an electronic screening and intervention to reduce AODs among YMSM and YTW. Participants (N = 450) aged 16–26 completed validated assessments of trauma exposure, polysubstance use, binge drinking, and sexual risk behaviors between December 2016 and October 2020. The primary outcome was the number of condomless sex acts while under the influence of AODs in the past 3 months. Negative binomial regressions assessed whether AODs moderated the relationship between trauma and condomless sex while under the influence of AODs.

Results:

Higher trauma exposure was independently associated with increased condomless sex while under the influence of AODs (p =0.008). Binge drinking significantly moderated this relationship, associating trauma and sexual risk (p <.001). Conversely, cannabis use attenuated the trauma–risk relationship (p =0.002). Stimulant use was associated with increased sexual risk but did not moderate the trauma-risk relationship.

Conclusions:

Binge drinking may exacerbate trauma-related sexual risk behaviors among YMSM and YTW, whereas cannabis use may buffer these effects. Trauma-informed, substance-specific, and culturally tailored interventions are needed to reduce Human Immunodeficiency Virus risk among sexual and gender minoritized youth.