Elevated risk of alcohol use disorder in Japanese men living with HIV: Psychosocial determinants and protective role of sense of coherence

Background: Men living with HIV face elevated risks for alcohol use disorder (AUD), yet few studies have examined sociodemographic and psychosocial correlates of AUD risk in Asian populations. Sense of coherence (SOC), reflecting the ability to cope with stress, may serve as a protective factor against AUD. This study investigated factors associated with AUD risk among men living with HIV in Japan. Methods: This cross-sectional study analyzed data from the third HIV Futures Japan nationwide survey (November 2019-July 2020). Of 908 respondents, 883 biologically male participants who completed alcohol use disorder screening were analyzed. AUD status was classified as low-risk drinking, at-risk drinker, or suspected AUD. Multinomial logistic regression examined sociodemographic and psychosocial predictors. Results: Among participants, 46.8% were classified as low-risk drinking, 44.7% as at-risk drinkers, and 8.5% as suspected AUD. Compared with the low-risk drinking group, heterosexual orientation (OR: 0.38, 95% CI: 0.17-0.86), higher education (OR: 0.63, 95% CI: 0.43-0.90), and older age (OR: 0.98, 95% CI: 0.96-1.00) were associated with lower odds of at-risk drinking. No sociodemographic factors associated with suspected AUD. In the fully adjusted psychosocial model, higher SOC was associated with lower odds of both at-risk drinking (OR: 0.98, 95% CI: 0.96-0.99) and suspected AUD (OR: 0.96, 95% CI: 0.93-0.98). Conclusions: The prevalence of suspected AUD among men living with HIV in Japan (8.5%) was substantially higher than in the general Japanese population (0.5%). SOC emerges as a robust protective factor, suggesting that interventions strengthening SOC may help mitigate AUD risk in this vulnerable population.