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=41.2). Participants completed measures of unhealthy alcohol use [alcohol-related problems, heavy drinking days, drinks per week, drinking to manage pain (yes/no)], pain severity, and pain management care experiences. An analysis of variance examined differences in pain severity by pain management experience. Regression analyses examined the associations of pain severity and pain management experience with unhealthy alcohol use. Pain severity was significantly associated with drinking to manage pain and heavy drinking days, but not drinks per week or alcohol-related problems. MSM with HIV who were dissatisfied with pain care reported significantly greater pain severity compared to those who were satisfied or managing pain on their own. Compared to satisfaction, dissatisfaction with pain care was also associated with significantly higher odds of drinking to manage pain, although the inclusion of pain severity attenuated this association. Results highlight pain severity as a key factor related to pain management experience and unhealthy alcohol use among MSM with HIV. Future studies should prioritize pain-alcohol integrated intervention development.