# Sexualized alcohol and drug use among men who have sex with men and the PrEP retention in Thailand. > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/sexualized-substance-use-prep-retention-barriers-msm/ > **Published:** 2026-04-27T20:24:54-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T10:00:35-04:00 > **Clinical Summary:** Study reveals sexualized substance use creates specific barriers to PrEP retention among men who have sex with men, highlighting need for targeted interventions --- CED Clinical Relevance  #66Notable Clinical Interest Evidence Brief | CED ClinicSexualized [substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/) among Thai men who have sex with men was associated with reduced PrEP retention in a clinic-based cohort study. PrepMsm[Substance Use](https://cedclinic.com/stroke-risk-assessment-substance-use/)Hiv PreventionAdherence Sexualized substance use among Thai men who have sex with men was associated with reduced PrEP retention in a clinic-based cohort study. What This Study Teaches Us This study demonstrates that substance use specifically in sexual contexts creates distinct barriers to HIV prevention adherence beyond general substance use patterns. The syndemic framework linking substance use, [mental health](https://cedclinic.com/cannabis-psychiatric-research-findings-depression-anxiety/) symptoms, and trauma experiences provides a useful clinical lens for understanding multiple co-occurring health risks in this population. Why This Matters PrEP retention is critical for HIV prevention effectiveness, and this study identifies a specific behavioral pattern that clinicians should screen for when prescribing PrEP to MSM patients. Understanding that sexualized substance use creates unique adherence challenges can inform targeted retention strategies and counseling approaches. Study Snapshot Study Type Mixed-methods cohort study Population 100 Thai men who have sex with men recruited from community clinic Intervention Assessment of sexualized alcohol use (SAU) and sexualized drug use (SDU) Comparator MSM without sexualized substance use Primary Outcome PrEP retention rates Key Finding Sexualized substance use associated with reduced PrEP retention Journal Drug and Alcohol Dependence Reports Year 2024 Clinical Bottom Line Clinicians prescribing PrEP to MSM should specifically assess for substance use in sexual contexts, not just general substance use patterns. Patients reporting sexualized alcohol or drug use may benefit from enhanced retention support and monitoring. What This Paper Does Not Show The study does not establish causation between sexualized substance use and PrEP discontinuation, nor does it demonstrate that addressing substance use improves retention. The mechanisms linking sexualized substance use to poor retention remain unclear from this analysis. Where This Paper Deserves Skepticism The study is limited to one clinic setting in Thailand, potentially limiting generalizability to other populations or healthcare systems. Self-reported substance use and sexual behaviors may be subject to recall bias or social desirability bias, and the cross-sectional design limits causal inference. Dr. Caplan's Take This study highlights something I see regularly in practice – patients who use substances specifically around sexual activity face different adherence challenges than those with general [substance use disorders](https://cedclinic.com/cannabinoid-clinical-trials-mental-disorders-evidence-2/). The syndemic approach makes clinical sense, but I need more guidance on practical interventions that actually improve retention in this population. What a Careful Reader Should Take Away Sexualized substance use represents a distinct clinical pattern that warrants specific attention in PrEP care. While this study identifies an important association, clinicians should focus on enhanced monitoring and support for these patients while awaiting evidence on effective intervention strategies. Join the Conversation Have a question about how this applies to your situation? [Ask Dr. Caplan →](https://benjamincaplan.com/ask-dr-caplan) Want to discuss this topic with other patients and caregivers? [Join the forum discussion →](https://cedclinic.com/interact/discussion-forums/forum/cannabis-industry/) Have thoughts on this? Share it: [X Share on X](https://twitter.com/intent/tweet?text=Just%20read%20this%20on%20CEDclinic.com%3A%20Sexualized%20alcohol%20and%20drug%20use%20among%20men%20who%20have%20sex%20with%20men%20and%20the%20PrEP%20retention%20in%20Thailand.%20%40drcaplan&url=https%3A%2F%2Fcedclinic.com%2Fsexualized-substance-use-prep-retention-barriers-msm%2F)[in Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fcedclinic.com%2Fsexualized-substance-use-prep-retention-barriers-msm%2F)[🦅 Share on BlueSky](https://bsky.app/intent/compose?text=Just%20read%20this%3A%20Sexualized%20alcohol%20and%20drug%20use%20among%20men%20who%20have%20sex%20with%20men%20and%20the%20PrEP%20retention%20in%20Thailand.%20via%20%40drcaplan.bsky.social%20https%3A%2F%2Fcedclinic.com%2Fsexualized-substance-use-prep-retention-barriers-msm%2F)[📷 Follow on Instagram](https://www.instagram.com/drbenjamincaplan)[📝 Read more on Substack](https://doctorapprovedcannabis.substack.com/)[🔔 Subscribe via RSS](https://cedclinic.com/feed/) Table of Contents - [FAQ](#FAQ)[What is sexualized substance use and how does it affect PrEP adherence?](#What_is_sexualized_substance_use_and_how_does_it_affect_PrEP_adherence) - [Should clinicians screen for substance use when prescribing PrEP to MSM patients?](#Should_clinicians_screen_for_substance_use_when_prescribing_PrEP_to_MSM_patients) - [What is a psychosocial syndemic and why is it relevant to PrEP care?](#What_is_a_psychosocial_syndemic_and_why_is_it_relevant_to_PrEP_care) - [How can mobile health interventions help MSM patients on PrEP who use substances?](#How_can_mobile_health_interventions_help_MSM_patients_on_PrEP_who_use_substances) - [What additional support should be offered to MSM patients who report sexualized substance use?](#What_additional_support_should_be_offered_to_MSM_patients_who_report_sexualized_substance_use) - [Related](#Related) ## FAQ #### What is sexualized substance use and how does it affect PrEP adherence? Sexualized substance use involves using alcohol or drugs in sexual contexts, which can impair judgment and decision-making around safe sex practices. This study found that sexualized substance use among Thai MSM was associated with reduced PrEP retention, potentially compromising HIV prevention effectiveness. #### Should clinicians screen for substance use when prescribing PrEP to MSM patients? Yes, routine screening for both alcohol and drug use in sexual contexts should be part of comprehensive PrEP care. Early identification allows for targeted interventions and closer monitoring of PrEP adherence in high-risk patients. #### What is a psychosocial syndemic and why is it relevant to PrEP care? A psychosocial syndemic refers to co-occurring conditions like substance use, depression, anxiety, and trauma that interact synergistically to worsen health outcomes. Understanding these interconnected factors helps clinicians provide more comprehensive care and identify patients at higher risk for poor PrEP retention. #### How can mobile health interventions help MSM patients on PrEP who use substances? Mobile health interventions can provide accessible, discreet support for [medication adherence](https://cedclinic.com/new-york-medical-cannabis-tax-repeal/), substance use monitoring, and [mental health](https://cedclinic.com/cannabis-psychiatric-research-findings-depression-anxiety/) resources. The study explored acceptability of these digital tools as adjuncts to traditional clinical care for improving PrEP retention. #### What additional support should be offered to MSM patients who report sexualized substance use? Patients should receive integrated care addressing both substance use and HIV prevention, including counseling on [harm reduction](https://cedclinic.com/can-you-mix-weed-and-alcohol/) strategies and more frequent follow-up visits. Referral to substance abuse treatment and mental health services may be necessary for comprehensive care. [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. 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