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Among people living with HIV, research indicates that medication adherence is lower among people who believe that alcohol and HIV medications interact to produce toxic effects. Rates of hazardous drinking are elevated among YMSM, suggesting such beliefs may be common. The goal of these analyses was to examine how alcohol-interactive toxicity beliefs impacts PrEP uptake and discontinuation in a sample of 478 HIV-negative YMSM. This sample had a mean age of 23.0 (SD\u2009=\u20092.8) and was racially and ethnically diverse (24.1% Black; 29.9% White; 36.2% Hispanic\/Latino). Longitudinal models examined the direct effects of alcohol consumption and toxicity beliefs, as well as their interaction, on PrEP uptake and discontinuation six months later. Most YMSM endorsed at least one toxicity belief (58%). Among baseline non-PrEP-users, toxicity beliefs were associated with lower PrEP uptake (aHR\u2009=\u20090.76; 95% CI: 0.61\u20130.95). Among current PrEP users, YMSM with both higher alcohol consumption and toxicity beliefs were those most likely to discontinue PrEP six months later. This study provides new evidence that the prevalence of alcohol-related interactive toxicity beliefs among YMSM are substantial and represent a barrier to effective HIV prevention. Given PrEP efficacy depends on consistent use, discontinuation during periods of HIV risk undermines prevention goals. Interventions addressing alcohol-related toxicity beliefs\u2014through education, counseling, and tailored messaging\u2014may optimize PrEP uptake and persistence, particularly among populations with high alcohol use.<\/jats:p>","DOI":"10.1007\/s10461-026-05185-4","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:48:13Z","timestamp":1779886093000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beliefs About Toxic Interactions Between Alcohol and PrEP Predict Less Initiation and More Discontinuation: Results from the RADAR Cohort Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9222-5116","authenticated-orcid":false,"given":"Brian","family":"Mustanski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Baiers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Newcomb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"5185_CR1","unstructured":"Centers for Disease Control and Prevention. 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Mustanski is an Associate Editor of the journal and played not editorial role in the review or acceptance of this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Northwestern University IRB. Informed consent was obtained from all individual participants included in the study, which included an agreement for data to be reported in journal publications.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}}]}}