Evidence shows that engaging in sexualized drug use (SDU) can be associated with sexual health problems and poor mental health. However, the prevalence of drug-related problems associated with SDU remains unclear. Our study aimed to examine the prevalence and associated factors of drug-related problems and drug dependence in a sample of gay, bisexual, and other men who have sex with men living with HIV (HIV + GBMSM). We included 101 HIV + GBMSM who had engaged in SDU in the last year. Participants completed an online survey featuring a validated questionnaire (the DUDIT test) to assess the risk of drug-related problems and drug dependence. Univariate and multivariate analyses were conducted to explore variables associated with drug-related problems. 80% of our sample had symptoms suggestive of drug-related problems, with 5% showing likely drug dependence. Additionally, 10% had suffered an overdose with loss of consciousness, 9% experienced suicidal thoughts associated with SDU, and approximately 20% had sexual difficulties during sober sex since using drugs for sex. Multivariate analysis identified that recent drug use (less than 15 days prior), polydrug use, and depressive symptoms are independent predictors of drug-related problems. Our study revealed a high prevalence of drug-related problems among HIV + GBMSM engaged in SDU. The factors associated with drug-related problems identified in our study can serve as key markers in clinical settings where HIV + GBMSM receive care. These indicators can help detect community members most at risk and facilitate the provision of resources and interventions to prevent SDU-related harm.