JMIR Publications

ABSTRACT

Background:

Across populations, risky drinking has been demonstrated to increase HIV risk behaviors. This is of special concern for sexually minoritized cisgender men and transgender (SMMT) young adults (aged 18-34), who report greater incidence of hazardous drinking (as defined by AUDIT-C criteria) and HIV compared to their heterosexual and/or cisgender peers.

Objective:

This study examined 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 SMMT individuals. Results were used to inform development of an alcohol reduction intervention for this population.

Methods:

A qualitative study was conducted with data collected via four focus groups and one in-depth interview among young adult SMMT individuals in the United States from April-June 2023 (n=22). Participants were grouped according to SMMT identity: 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 SMMT 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 SMMT individuals and hazardous use of alcohol was used as a means of escape and coping.

Conclusions:

Alcohol use among SMMT 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 SMMT young adults as they encounter stressors in real-time.