Unhealthy alcohol use is prevalent among people with HIV, particularly among men who have sex with men (MSM). Pain frequently co-occurs with unhealthy alcohol use and is associated with suboptimal HIV care outcomes. The present study examined the effects of pain severity and experiences with pain management care (i.e., satisfied, dissatisfied, managing pain on own) on alcohol use. Participants were MSM with HIV reporting heavy alcohol use and pain in the past 30 days who were enrolled in a clinical trial targeting alcohol use (N = 125, 78.4% White, M