ArticleAnnals of behavioral medicine : a publication of the Society of Behavioral Medicine2026
Efficacy on the rocks: how hazardous drinking contextualizes the path from internalized heterosexism to antiretroviral adherence via adherence self-efficacy.
Article in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundYoung Black sexual minority men living with HIV (YBSMM+) in the US South face a confluence of structural and psychosocial barriers that impact antiretroviral therapy (ART) adherence. Internalized heterosexism and hazardous drinking have emerged as significant yet understudied factors influencing adherence self-efficacy, a known determinant of sustained ART adherence. PURPOSE: This study examined the relationships among internalized heterosexism, adherence self-efficacy, and ART adherence in a sample of YBSMM+, with a particular focus on the moderating role of hazardous drinking.
methodsUtilizing cross-sectional survey data from a community-based sample of YBSMM+ in the US South, we conducted moderated mediation analyses to assess the direct and indirect effects of internalized heterosexism on ART adherence via adherence self-efficacy, as well as whether hazardous drinking moderates the direct effect of internalized heterosexism on adherence self-efficacy.
resultsFindings indicated that higher levels of internalized heterosexism were associated with lower adherence self-efficacy, which in turn predicted lower ART adherence. Adherence self-efficacy significantly mediated the relationship between internalized heterosexism and ART adherence, replicating prior research. Moreover, participants who reported hazardous drinking evidenced a stronger inverse association between internalized heterosexism and adherence self-efficacy than those who did not report hazardous drinking.
conclusionsThe results underscore the complex interplay among internalized heterosexism, adherence self-efficacy, and hazardous drinking in shaping ART adherence among YBSMM+. Interventions targeting adherence self-efficacy and addressing hazardous drinking, while also directly addressing internalized stigma, may help buffer the harmful effects of these factors and support improved HIV health outcomes in this population.
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