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Results Among 226 HIV-negative Black MSM, the majority (60%) were 25+ years of age. Most of the substance use behaviors, were not significantly associated with PrEP initiation or adherence. However, stimulant use before/during CAI was significantly associated with lower odds of PrEP adherence (Adjusted odds ratio=0.21, 95% confidence interval=0.07, 0.61; p= less then 0.01). Conclusions These findings suggest that PrEP adherence is feasible among Black MSM who use substances. However, Black MSM who engage in stimulant use before/during C