Abstract

Young men who have sex with men (YMSM) are the only group in which rates of new HIV infections are increasing in the United States. Alcohol and drug use have been linked to HIV risk, but evidence suggests that these associations may change across development and by relationship type. Data were taken from an analytic sample of 114 YMSM enrolled in a longitudinal study of lesbian, gay, bisexual and transgender youth with 4 years of participant follow-up. For the sample as a whole, alcohol use before sex was not associated with sexual risk, but drug use before sex was positively associated with sexual risk. A positive association between alcohol use and sexual risk emerged across development, and this association was stronger in serious relationships relative to casual sex partners. The positive association between drug use before sex and sexual risk decreased across development and was stronger in serious relationships. We discuss the need for addressing substance use before sex in dyadic interventions with YMSM.