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Alcohol Use and High-Risk Sexual Behavior Among Men Who Have Sex With Men: The Effects of Consumption Level and Partner Type

  • September 2004
  • Health Psychology 23(5):525-32
DOI:10.1037/0278-6133.23.5.525
Authors:
Peter A Vanable at Syracuse University
Peter A Vanable
David J Mckirnan at University of Illinois at Chicago
David J Mckirnan
Susan Buchbinder at UCSF University of California, San Francisco
Susan Buchbinder
Bradford N Bartholow at U.S. Department of Health and Human Services
Bradford N Bartholow
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Abstract

Alcohol use may increase HIV sexual risk behavior, although findings have varied across study populations and methods. Using event-level data from 1,712 seronegative men who have sex with men, the authors tested the hypothesis that social context would moderate the effect of alcohol consumption on unprotected anal sex (UAS). For encounters involving a primary partner, rates of UAS did not vary as a function of alcohol use. However, consumption of 4 or more drinks tripled the likelihood of UAS for episodes involving a nonprimary partner. Thus, the effects of alcohol vary according to the context in which it is used. Interventions to reduce substance-related risk should be tailored to the demands of maintaining sexual safety with nonprimary partners.
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Alcohol Use and High-Risk Sexual Behavior Among Men Who Have Sex
With Men: The Effects of Consumption Level and Partner Type
Peter A. Vanable
Syracuse University David J. McKirnan
University of Illinois at Chicago
Susan P. Buchbinder
San Francisco Department of Public Health Bradford N. Bartholow
Centers for Disease Control and Prevention
John M. Douglas Jr. and Franklyn N. Judson
Denver Public Health Department Kathleen M. MacQueen
Centers for Disease Control and Prevention
Alcohol use may increase HIV sexual risk behavior, although findings have varied across study
populations and methods. Using event-level data from 1,712 seronegative men who have sex with men,
the authors tested the hypothesis that social context would moderate the effect of alcohol consumption
on unprotected anal sex (UAS). For encounters involving a primary partner, rates of UAS did not vary
as a function of alcohol use. However, consumption of 4 or more drinks tripled the likelihood of UAS
for episodes involving a nonprimary partner. Thus, the effects of alcohol vary according to the context
in which it is used. Interventions to reduce substance-related risk should be tailored to the demands of
maintaining sexual safety with nonprimary partners.
Key words: HIV, AIDS, alcohol use, sexual risk behavior, partner type, social context, gay men
Improved treatments for HIV have led to declines in AIDS-
related morbidity and mortality and tangible improvements in
quality of life for many people living with HIV. However, new
cases of HIV—estimated at 40,000 per year in the United States—
have remained constant in recent years (Karon, Fleming, Steketee,
& De Cock, 2001), indicating that additional prevention efforts are
necessary to reduce transmission risk behaviors among men and
women at greatest risk for HIV. Trends in HIV epidemiology
among men who have sex with men (MSM) are of particular
concern. MSM account for 42% of all new infections in the United
States—more than any other group (Centers for Disease Control
and Prevention, 2001)—and recent findings point to an alarming
resurgence of high-risk sexual behavior, sexually transmitted dis-
eases (STDs), and new HIV infections among MSM (Ekstrand,
Stall, Paul, Osmond, & Coates, 1999; Katz et al., 2002; Vanable,
Ostrow, McKirnan, Taywaditep, & Hope, 2000; Wolitski, Valdis-
erri, Denning, & Levine, 2001). Further, a recent probability
sample of MSM residing in four major urban epicenters (Catania
et al., 2001) found an HIV prevalence rate of 17% among all MSM
and extremely high rates among MSM who are African American
(29%), who are heavy drug users (32%), or who are less well
educated (37%). Ongoing surveillance demonstrates a need for a
renewed focus on intervention-oriented research to stem the tide of
new infections among MSM.
Alcohol use proximal to sexual activity has been identified as a
potential contributor to risky sexual behavior among MSM and
other at-risk populations. Several studies have pointed to a modest
association between substance use and seroconversion among
MSM (Buchbinder et al., 1996; Chesney, Barrett, & Stall, 1998;
Gilbart et al., 2000; Penkower et al., 1991). Further, global asso-
ciation studies that examined the relationship between general
drinking patterns (i.e., average quantity and frequency of alcohol
use) and risky sexual behavior consistently have pointed to higher
rates of sexual risk behavior among people who also report heavy
drinking (Stall & Purcell, 2000). However, event-level studies
involving MSM (Gillmore et al., 2002; Weatherburn et al., 1993)
and other at-risk populations (Scheidt & Windle, 1996; Weinhardt,
Carey, Carey, Maisto, & Gordon, 2001) have not consistently
detected an association between alcohol consumption prior to
Peter A. Vanable, Department of Psychology and Center for Health and
Behavior, Syracuse University; David J. McKirnan, Department of Psy-
chology, University of Illinois at Chicago; Susan P. Buchbinder, San
Francisco Department of Public Health; Bradford N. Bartholow and Kath-
leen M. MacQueen, Centers for Disease Control and Prevention (CDC),
Atlanta, Georgia; John M. Douglas Jr. and Franklyn N. Judson, Denver
Public Health Department, Denver, Colorado.
Kathleen M. MacQueen is now at Family Health International, Durham,
North Carolina.
This study was supported by CDC Cooperative Agreements U64/
CCU802715, U64/CCU502714, and U64/CCU900523 and was funded by
the CDC and the National Institute for Allergies and Infectious Diseases.
We gratefully acknowledge the important contributions to this study made
by Julie Doetsch, Kelly Kay, Paul O’Mally, and Kent Penley. Thanks are
also extended to Michael Carey, Rae Littlewood, Stephen Maisto, and
Joshua Smyth for their helpful comments on an earlier version of this
article.
Correspondence concerning this article should be addressed to Peter A.
Vanable, Department of Psychology, Syracuse University, 430 Huntington
Hall, Syracuse, NY 13244-2340. E-mail: pvanable@psych.syr.edu
Health Psychology Copyright 2004 by the American Psychological Association
2004, Vol. 23, No. 5, 525–532 0278-6133/04/$12.00 DOI: 10.1037/0278-6133.23.5.525
525
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
... A number of other situational factors linked to sexual decision-making have also been proposed in the HIV prevention literature, including partner familiarity (or lack thereof) [40,54] and sexual arousal [15,53,[55][56][57][58][59]. Partner familiarity is a complex construct that has often been defined by asking participants to rate how well they know a partner using Likert-like scale items, or to characterize partners in categorical terms such as primary (whether monogamous or non-monogamous), casual, or anonymous [36,60,61]. ...
... Research is needed to determine whether study participants would be willing and/or able to pause might be less acceptable for individuals with higher average daily levels of sexual arousal. These between-subjects findings accord with past research into contextual influences on sexual decision-making, which have identified both sexual arousal [15,53,[55][56][57][58][59] and partner familiarity [40,54] as important influences on decision-making processes. ...
Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study
Article
Full-text available
  • Sep 2023
  • AIDS BEHAV
Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.
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... A situation factor that has long been identified as an important moderator of alcohol's relation to condomless sex is sexual partner relationship (Cooper, 2010;Vanable et al., 2004). "Partner relationship" in the alcohol-sexual behaviors literature typically has been operationalized by the participant rating how well he/she knows a sexual partner. ...
... Alcohol intoxication may also provide a context in which it is more likely that communication about sexual practices with an unfamiliar partner is less effective or does not happen at all (Cooper, 2010). In fact, in one of the few studies of alcohol's relation to condomless sex in MSM and partner type, Vanable et al.'s (2004) cross-sectional survey showed that alcohol was not related to use of a condom with a primary partner, but that at a moderate dose or higher (4 drinks or more) alcohol was associated with condomless sex with a casual partner. The current study is the first to provide longitudinal, event-level data on alcohol intoxication, partner familiarity, and sexual behaviors in MSM, which allows the examination of partner relationship and alcohol intoxication in combination as within-person contextual factors associated with sexual behaviors. ...
Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men
Article
Full-text available
  • Oct 2021
  • ARCH SEX BEHAV
The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21–50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant’s own or study-provided mobile phone. Individual differences variables were measured by participants’ completing questionnaires measuring effortful control and urgency, and the participant’s self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol’s effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol’s effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.
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... These criteria are based on establishing associations between alcohol use and condomless sex. [39][40][41][42][43][44][45][46] Those eligible were given the option to enter their contact information in a separate survey, for the study coordinator to contact them by phone for enrollment. Each participant received a link to an informed consent document. ...
... [3] Further, alcohol use and mental health difficulties are associated with sexual risk, forming a syndemic (i.e., synergistic epidemic) that threatens the health of YGBM. [44][45][46] [17,66] The intervention was found to be highly acceptable to the Romanian YGBM community. ...
An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context (Preprint)
Preprint
  • Oct 2017
BACKGROUND Young gay and bisexual men (YGBM) in some Eastern European countries, such as Romania, face high stigma and discrimination, including in health care. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. OBJECTIVE This study aimed to adapt and pilot test, in Romania, a preliminarily efficacious mobile health (mHealth) HIV-prevention intervention, created in the United States, to reduce HIV risk among YGBM. METHODS After an intervention formative phase, we enrolled 43 YGBM, mean age 23.2 (SD 3.6) years, who reported condomless sex with a male partner and at least 5 days of heavy drinking in the past 3 months. These YGBM completed up to eight 60-minute text-based counseling sessions grounded in motivational interviewing and cognitive behavioral skills training with trained counselors on a private study mobile platform. We conducted one-group pre-post intervention assessments of sexual (eg, HIV-risk behavior), behavioral (eg, alcohol use), and mental health (eg, depression) outcomes to evaluate the intervention impact. RESULTS From baseline to follow-up, participants reported significant (1) increases in HIV-related knowledge (mean 4.6 vs mean 4.8; P=.001) and recent HIV testing (mean 2.8 vs mean 3.3; P=.05); (2) reductions in the number of days of heavy alcohol consumption (mean 12.8 vs mean 6.9; P=.005), and (3) increases in the self-efficacy of condom use (mean 3.3 vs mean 4.0; P=.01). Participants reported significant reductions in anxiety (mean 1.4 vs mean 1.0; P=.02) and depression (mean 1.5 vs mean 1.0; P=.003). The intervention yielded high acceptability and feasibility: 86% (38/44) of participants who began the intervention completed the minimum dose of 5 sessions, with an average of 7.1 sessions completed; evaluation interviews indicated that participation was rewarding and an “eye-opener” about HIV risk reduction, healthy identity development, and partner communication. CONCLUSIONS This first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicates preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination across various similar settings pending future efficacy testing in a large trial, especially in contexts where stigma keeps YGBM out of reach of affirmative health interventions.
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... Behavioral and psychosocial barriers may hinder PrEPtaking efforts [18,19]; with the consumption of alcohol and/or substances, as well as the experience of mental health concerns such as depression, potentially serving as considerable challenges. The prevalence of these barriers tends to be higher among GBMSM, including GBMSM who have been prescribed PrEP, compared to the general population [20][21][22][23][24][25]; which in part may derive from a range of unique stressors and socio-contextual factors that GBMSM experience (e.g., [26]). However, while alcohol, substance use, and mental health issues have all been significantly associated with poorer adherence to antiretroviral therapy (ART) among GBMSM who are living with HIV [27,28], the associations between these issues and adherence specifically to PrEP have been somewhat less consistent. ...
Perceived influence of alcohol consumption, substance use, and mental health on PrEP adherence and condom use among PrEP-prescribed gay, bisexual, and other men-who-have-sex-with-men: a qualitative investigation
Article
Full-text available
Background Gay, bisexual, and other men-who-have-sex-with-men (GBMSM) continue to be disproportionately affected by Human Immunodeficiency Virus (HIV). Although HIV pre-exposure prophylaxis (PrEP) offers an effective means of reducing incident HIV among this population, the HIV-preventive success of oral-based PrEP is contingent upon regimen adherence. Elevated rates of alcohol-, substance use-, and mental health-related issues among GBMSM potentially hinder PrEP-taking efforts, however the evidence for this remains mixed. Accordingly, the present study entailed a comprehensive qualitative investigation to explore PrEP-prescribed GBMSM’s perceptions surrounding the influence of alcohol, substance use, and mental health on PrEP adherence. Methods PrEP-prescribed GBMSM (age ≥ 18 years; prescribed PrEP for ≥ 3 months) were recruited from two PrEP-delivery clinics in Toronto, Canada for focus groups as part of the formative phase of an alcohol-, substance use-, and mental health-focused randomized controlled intervention trial. Focus group discussions qualitatively explored perceived strengths and barriers associated with adherence to PrEP treatment; with an emphasis on alcohol, substance use, and mental health concerns. Condom use among PrEP-prescribed GBMSM within the context of these concerns was also discussed. Results A total of five focus groups involving 35 GBMSM were conducted (4–10/group; mean age = 42.4; white = 71.4%). Although participants themselves generally reported successfully adhering to their PrEP regimens—resulting from a strong, underlying motivation for self-care—they recognized the detrimental impact that alcohol, substance use, and mental health had on adherence among their peers. In this regard, alcohol and substances were perceived as detracting from adherence only when consumption was excessive or temporally linked to PrEP dosing. Pronounced mental health issues (e.g., severe depression) were also seen as hindering adherence, although these effects were nuanced and perceived as person-dependent. Alcohol and substances were linked to condomless sex, regardless of PrEP use, and PrEP was therefore viewed as an HIV-protective ‘safety net.’ Conclusions Overall, findings suggest that PrEP adherence can often be successfully achieved in the presence of alcohol-, substance use-, and mental health-related issues. Augmenting self-care, and addressing pronounced addictions- and mental health-related concerns, may enhance PrEP treatment among GBMSM.
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... Another opportunity for targeted counseling could be found for participants with a history of alcohol misuse, which was a predictor of ineffective protection in the present study. In high-income countries, MSM are disproportionately affected by alcohol-related issues [45][46][47][48], including MSM on PrEP [49,50]. Causal links between alcohol abuse and HIV risk have been shown in the literature [51][52][53][54] and could also affect PrEP adherence. ...
Rate and Predictors of Ineffective HIV Protection in African Men Who Have Sex with Men Taking Pre-Exposure Prophylaxis
Article
Full-text available
  • Apr 2022
  • AIDS BEHAV
We investigated the rate and predictors of ineffective HIV protection in men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) in a prospective cohort study from November 2017 to November 2020 in Mali, Côte d’Ivoire, Burkina Faso, and Togo. MSM had to be 18 years or older and at high risk of HIV infection to participate. They also received a comprehensive sexual health prevention package, including PrEP, in community-based clinics as part of the cohort study. Using socio-behavioral/clinical data, HIV protection during their most recent anal intercourse with a male partner was categorized as effective or ineffective (i.e., incorrect PrEP adherence and no condom use). Seventeen percent (500/2839) of intercourses were ineffectively protected for the 520 study participants. Predictors of ineffective HIV protection included being an event-driven user with financial difficulties, having a high alcohol misuse score, and not being a member of a community association. PrEP programs in West Africa must be tailored to socially vulnerable MSM who struggle to adopt PrEP.
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... Compared to the general population, alcohol-related issues have been shown to be disproportionately elevated among populations of gbMSM [22][23][24][25] as well as individuals who have been prescribed PrEP [26,27]. Notably, such issues may be particularly detrimental to adherence. ...
Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure Prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men
Article
Full-text available
Abstract Background Although HIV pre-exposure prophylaxis (PrEP) substantially diminishes the likelihood of HIV acquisition, poor adherence can decrease the HIV-protective benefits of PrEP. The present investigation sought to identify the extent to which alcohol consumption, substance use, and depression were linked to PrEP nonadherence among gay, bisexual, and other men-who-have-sex-with-men (gbMSM). Methods gbMSM (age ≥ 18, prescribed PrEP for ≥3 months) were recruited from two clinics in Toronto, Canada for an e-survey assessing demographics; PrEP nonadherence (4-day PrEP-focused ACTG assessment); hazardous and harmful alcohol use (AUDIT scores of 8–15 and 16+, respectively); moderate/high risk substance use (NIDA M-ASSIST scores > 4); depression (CESD-10 scores ≥10); and other PrEP-relevant factors. The primary outcome, PrEP nonadherence, entailed missing one or more PrEP doses over the past 4 days. A linear-by-linear test of association assessed whether increasing severity of alcohol use (i.e., based on AUDIT categories) was linked to a greater occurrence of PrEP nonadherence. Univariate logistic regression was employed to determine factors associated with PrEP nonadherence, and factors demonstrating univariate associations at the p
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... MSM make up only 2% of the population yet accounted for 70% of all new HIV infections in the United States in 2017 (CDC, 2019). MSM are more likely than other populations to have risky unprotected sex while under the influence of alcohol (Irwin, Morgenstern, Parsons, Wainberg, & Labouvie, 2006), particularly with nonprimary "casual" partners (Vanable et al., 2004). Research in these and other vulnerable populations may help to identify unique and targetable risk factors relevant to sexual health risk. ...
Sexual Discounting: A Systematic Review of Discounting Processes and Sexual Behavior
Article
Full-text available
  • Oct 2020
Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic review examines delay and probability discounting in human sexual behavior through synthesis of 50 peer-reviewed, original research articles. Sixteen studies focusing exclusively on monetary delay discounting found small effect size positive correlations with sexual risk behaviors. Eleven studies examined delay or probability discounting of sexual behavior itself using tasks that varied duration, frequency, or quality of sex to determine value. Results show delay and uncertainty of sex causes systematic decreases in value. These studies also show consistent medium effect size relationships between sexual discounting measures and sexual health and substance use, supporting utility above and beyond monetary discounting. Twenty-three studies have modeled clinically relevant decision-making, examining effects of delay until condom availability and STI contraction probability on condom use. Observational and experimental designs found condom-use discounting is elevated in high-risk substance use populations, is sensitive to context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetary discounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine, alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimal effect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewed studies robustly support that sexual behavior is highly dependent on delay and probability discounting, and that these processes strongly contribute to sexual risk. Future research should exploit these systematic relationships to design behavioral and pharmacological approaches to decrease sexual risk behavior.
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Syndemic Profiles and Sexual Minority Men’s HIV-Risk Behavior: A Latent Class Analysis
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Full-text available
  • Oct 2021
  • ARCH SEX BEHAV
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Predictors of health behaviors during a college national championship sports event: A daily diary study
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  • Aug 2020
Objective Few studies have examined relations between college sporting events and maladaptive health behaviors among non-athlete college students. Participants: 97 college students. Methods: Completed nightly surveys (alcohol, eating, physical activity, sexual risk taking, smoking) for 11 days around a National Championship game. Results: Baseline stress and rumination was related to worse health behavior; mindfulness was related to better health behavior. Hierarchical linear modeling showed that all maladaptive health behaviors significantly increased the day of the sporting event compared to individuals’ baseline levels. Rumination significantly predicted a spike in alcohol use and sexual risk taking behavior on the day of the Championship game. Conclusions: Risk factors for maladaptive health behaviors include stress and rumination, while mindfulness is protective. Interventions may work to make sports events on campus safer for students (e.g., condoms, reminder emails, mindfulness interventions for at risk groups); more research is needed.
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  • Mar 2000
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Individual and Situational Markers of Condom Use and Sex With Nonprimary Partners Among Alcoholic Inpatients: Findings From the ATRISK Study
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Alcohol Myopia
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Full-text available
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This article explains how alcohol makes social responses more extreme, enhances important self-evaluations, and relieves anxiety and depression, effects that underlie both the social destructiveness of alcohol and the reinforcing effects that make it an addictive substance. The theories are based on alcohol’s impairment of perception and thought—the myopia it causes—rather than on the ability of alcohol’s pharmacology to directly cause specific reactions or on expectations associated with alcohol’s use. Three conclusions are offered (a) Alcohol makes social behaviors more extreme by blocking a form of response conflict. (b) The same process can inflate self-evaluations. (c) Alcohol myopia, in combination with distracting activity, can reliably reduce anxiety and depression in all drinkers by making it difficult to allocate attention to the thoughts that provoke these states. These theories are discussed in terms of their significance for the prevention and treatment of alcohol abuse.
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Does Alcohol Lead to Sexual Risk Behavior? Findings from Event-Level Research
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Full-text available
  • Feb 2000
  • Annu Rev Sex Res
The belief that alcohol use leads to sexual risk behavior is nearly ubiquitous. To determine if this belief is warranted, we identify theory and research regarding the alcohol, risky-sex link. We focus our review on studies that use the event-level methodology because this approach provides a particularly sensitive but stringent test of the situational alcohol, risky-sex connection. Overall, the data from available event-level studies indicate that people who use condoms when they are sober also tend to use them when drinking; people who fail to use condoms when drinking probably also fail to use them when sober. We recognize several empirical exceptions to this rule and provide suggestions for future research.
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The Relation of Alcohol Use to HIV-Risk Sexual Behavior Among Adults With a Severe and Persistent Mental Illness
Article
Full-text available
  • Feb 2001
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Personality and Cognitive Factors Influencing Substance Use and Sexual Risk for HIV Infection Among Gay and Bisexual Men
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Substance use reliably predicts sexual risk behavior, and sensation-seeking personality characteristics have been found to covary with these associations. In a study of 289 gay and bisexual men attending a large gay pride event, the authors examined the role of substance use sexual outcome expectancies in explaining associations between sensation seeking, substance use, and risky sex. Consistent with previous research, alcohol and other drugs were associated with sexual behavior. However, path analyses showed that sensation seeking accounted for variance in sexual behavior over and above substance use before sex and that sensation seeking predicted substance use expectancies that in turn predicted substance use before sex. It was concluded that altering substance use outcome expectancies may be an important strategy for HIV risk reduction for individuals high in sensation seeking. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Assessing sexual behavior with self-report is essential to research on a variety of health topics, including pregnancy and infertility, sexually transmitted infections, and sexual health and functioning. Recent methodological research has provided new insights regarding the accuracy of self-reports of sexual behavior. We review these studies, paying particular attention to a promising new development: the use of computer-assisted assessments. The collection of sexual risk behavior data with computers has increased dramatically in recent years, but little is known about the accuracy of such assessments. We summarize the evidence, discuss methodological issues that arise in studies evaluating the accuracy of self-reports, and offer recommendations for future research.
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Does alcohol lead to sexual risk behavior? Findings from event-level research
Article
  • Jan 2000
  • Annu Rev Sex Res
The belief that alcohol use leads to sexual risk behavior is nearly ubiquitous. To determine if this belief is warranted, we identify theory and research regarding the alcohol, risky-sex link. We focus our review on studies that use the event-level methodology because this approach provides a particularly sensitive but stringent test of the situational alcohol, risky-sex connection. Overall, the data from available event-level studies indicate that people who use condoms when they are sober also tend to use them when drinking; people who fail to use condoms when drinking probably also fail to use them when sober. We recognize several empirical exceptions to this rule and provide suggestions for future research.
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Sexual negotiation in the AIDS era
Article
  • Feb 1997
Objective: To test the safety of the ‘negotiated safety’ strategy — the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions. Method: Data from a recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice, their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables. Results: The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection. Conclusions: The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.
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Alcohol and increased behavioral risk for AIDS
Article
  • Jan 1992
  • Alcohol Health Res World
Reviews research examining the relationship between alcohol use and sexual behavior. The issue of sexual risk-taking behavior (SRTB) and alcohol is addressed, with a review of laboratory studies. Findings are interpreted in terms of 2 major theoretical models proposed to account for alcohol's effect on social behavior. Survey research is discussed that examines the content of individually held beliefs about alcohol's effect on sexual behavior and the relationship between naturally occurring drinking behavior and sexual behaviors, particularly risky ones. An interpretation is offered of the relationship between drinking and SRTB; the commonsense idea that a behavior must be inhibited before it can be disinhibited is presented. Implications of this perspective for future research and for intervention efforts to prevent SRTB are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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