Abstract
Our qualitative study explores meaning making and motivation for preexposure prophylaxis (PrEP) adherence and engagement among gay, bisexual, and other sexual minoritized men (GBSMM) who misuse alcohol. Nineteen interviews with 10 participants who screened positive for harmful alcohol consumption (Alcohol Use Disorders Identification Test scores > 8) indicated that PrEP meaning making contributes to mental well-being, serving as a stabilizing ritual. Motivation for engagement included a commitment to proactive health management and personal and community safety. In the analysis, meaning making and motivation converged through themes of (a) identity affirmation, (b) accountability for self-care, (c) peace of mind, and (d) agency. Complementary themes included relationship dynamics and strategies for adherence. Participants' alcohol use was also explored, examining its intersections with the themes and understandings of PrEP and social well-being. Recommendations include integrating motivational enhancements into the care continuum to increase PrEP adherence and engagement with clinical care and community support among patients misusing alcohol.