Investigating the Impact of Alcohol Use on PrEP Adherence and the Burden of HIV and Other Sexually Transmitted Infections: An Umbrella Review
1Department of Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK; ORCID:https://
orcid.org/0000-0002-9152-8753
2Department of Mathematics, University of Louisville, United States; ORCID:https://orcid.org/0009-0004-4967-9306
3Department of Chemistry, University of Louisville, United States; ORCID: https://orcid.org/0009-0001-6196-8790
4Department of Pathology, University of Louisville, United States; ORCID:https://orcid.org/0009-0002-4720-0993
5Department of Internal Medicine, Mirpur General Hospital, Dhaka, Bangladesh; ORCID:https://orcid.org/0009-0006
2027-7543
Citation: Md Rakibul Hasan, Akidul Haque, et al., “Investigating the Impact of Alcohol Use on PrEP Adherence and
the Burden of HIV and Other Sexually Transmitted Infections: An Umbrella Review”, American Research Journal of
Biosciences, Vol 10, no. 1, 2025, pp. 1-20.
Abstract
Background: Despite the proven efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV infection, adherence
remains inconsistent, particularly among individuals with alcohol use and intersecting psychosocial or structural
challenges. This umbrella review synthesized evidence on how alcohol consumption influences PrEP adherence,
discontinuation, and related HIV and sexually transmitted infection (STI) outcomes, with emphasis on population
specific and severity-related dimensions. Methods: Following PRISMA and AMSTAR-2 standards for umbrella reviews,
a systematic search was conducted across MEDLINE, Embase, Cochrane Library, PsycINFO, Scopus, and Web of Science
for peer-reviewed systematic reviews and meta-analyses published between January 2006 and June 2025. Twenty-two
reviews met the inclusion criteria. Screening and data extraction were performed in Covidence and REDCap, with overlap
quantified by Corrected Covered Area. Quantitative credibility, heterogeneity, and risk-of-bias metrics guided evidence
weighting. Results: Across pooled analyses, adherence above 70 % reduced HIV acquisition risk by roughly 75 % (RR ≈
0.25 – 0.30), while adherence below 60 % yielded negligible protection (RR ≈ 0.95). Hazardous drinking was associated
with a 25 – 35 % reduction in adherence and 2-fold higher odds of discontinuation. Baseline STI prevalence among
PrEP users averaged 24 %, with incidence near 72 per 100 person-years, indicating overlapping vulnerability. Provider
barriers included low PrEP familiarity (≈ 60 %) and limited prescribing confidence (< 35 %). Transgender and gender
diverse populations showed PrEP use under 10 %, constrained by stigma, cost, and perceived hormone interactions.
Conclusion: Alcohol use and co-occurring psychosocial stressors substantially erode PrEP adherence and continuity,
amplifying HIV and STI risks despite pharmacologic efficacy. Integrating alcohol-reduction counseling, mental-health
support, and long-acting PrEP delivery within gender-affirming, low-barrier systems is critical to sustain prevention
gains and reduce inequities.
