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Protocol for a Controlled Experiment to Identify the Causal Role of Acute Alcohol Consumption in Condomless Sex among HIV-Positive MSM: Study Procedures, Ethical Considerations, and Implications for HIV Prevention

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Abstract

Although alcohol consumption is frequently perceived as a driver of condomless sex and subsequent HIV acquisition, the causal nature of this relationship remains unclear, and little is known about alcohol’s direct versus indirect impact on the sexual risk dynamics of those who are HIV-positive. To address this gap, we present the protocol for an in-progress NIAAA-funded controlled experiment, wherein a sample of HIV-positive men-who-have-sex-with-men (MSM) undergoes an alcohol consumption manipulation (alcohol/placebo/control) and sexual arousal induction (sexually aroused/non-aroused), and then reports intentions to engage in condom-protected and condomless sexual acts with hypothetical sexual partners differing in HIV serostatus (HIV+/HIV−/HIV status unknown), condom use preference (use/don’t use/not stated), and physical attractiveness (attractive/unattractive). Study outcomes will identify alcohol’s impact on HIV-positive MSM’s condomless sex intentions in the context of experimentally-manipulated factors as well as risk-relevant personality traits and alcohol-related expectancies. Detailed experimental procedures, ethical considerations, and potential implications for HIV prevention are discussed.

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References

  1. UNAIDS report on the global AIDS epidemic 2013. UNAIDS 2013. http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf. Accessed 6 July 2015.

  2. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2007. Vol. 19 [inclusive page numbers]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/pdf/statistics_2007_HIV_Surveillance_Report_vol_19.pdf. Accessed 6 July 2015.

  3. Public Health Agency of Canada. HIV and AIDS in Canada. Surveillance Report to December 31, 2008. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada. 2009.

  4. Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS. 2002;16(2):135–49.

    Article  PubMed  Google Scholar 

  5. Kalichman SC. HIV transmission risk behaviors of men and women living with HIV-AIDS: prevalence, predictors, and emerging clinical interventions. Clin Psychol. 2000;7:32–47.

    Google Scholar 

  6. AIDS Epidemic Update. UNAIDS 2009 http://data.unaids.org/pub/Report/2009/JC1700_Epi_Update_2009_en.pdf. Accessed 6 July 2015.

  7. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Cooper ML. Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence. J Stud Alcohol Suppl. 2002;14:101–17.

    Article  PubMed  Google Scholar 

  9. George WH, Stoner SA. Understanding acute alcohol effects on sexual behavior. Annu Rev Sex Res. 2000;11:92–124.

    PubMed  CAS  Google Scholar 

  10. Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS—a systematic review. Alcohol Alcohol. 2010;45(2):159–66.

    Article  PubMed  Google Scholar 

  11. Weinhardt LS, Carey MP. Does alcohol lead to sexual risk behavior? Findings from event-level research. Annu Rev Sex Res. 2000;11:125–57.

    PubMed  CAS  PubMed Central  Google Scholar 

  12. Steele CM, Josephs RA. Alcohol myopia. Its prized and dangerous effects. Am Psychol. 1990;45(8):921–33.

    Article  PubMed  CAS  Google Scholar 

  13. Bryan A, Ray LA, Cooper ML. Alcohol use and protective sexual behaviors among high-risk adolescents. J Stud Alcohol Drugs. 2007;68(3):327–35.

    Article  PubMed  Google Scholar 

  14. Crowe LC, George WH. Alcohol and human sexuality: review and integration. Psychol Bull. 1989;105(3):374–86.

    Article  PubMed  CAS  Google Scholar 

  15. Gordon CM, Carey MP, Carey KB. Effects of a drinking event on behavioral skills and condom attitudes in men: implications for HIV risk from a controlled experiment. Health Psychol. 1997;16(5):490–5.

    Article  PubMed  CAS  Google Scholar 

  16. Hull JG, Bond CF Jr. Social and behavioral consequences of alcohol consumption and expectancy: a meta-analysis. Psychol Bull. 1986;99(3):347–60.

    Article  PubMed  CAS  Google Scholar 

  17. LaBrie J, Earleywine M, Schiffman J, Pedersen E, Marriot C. Effects of alcohol, expectancies, and partner type on condom use in college males: event-level analyses. J Sex Res. 2005;42(3):259–66.

    Article  PubMed  Google Scholar 

  18. Maisto SA, Carey MP, Carey KB, Gordon CM. The effects of alcohol and expectancies on risk perception and behavioral skills relevant to safer sex among heterosexual young adult women. J Stud Alcohol. 2002;63(4):476–85.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Murphy ST, Monahan JL, Miller LC. Inference under the influence: the impact of alcohol and inhibition conflict on women’s sexual decision making. Pers Soc Psychol Bull. 1998;24(5):517–28.

    Article  Google Scholar 

  20. Kalichman SC, Johnson JR, Adair V, Rompa D, Multhauf K, Kelly JA. Sexual sensation seeking: scale development and predicting AIDS-risk behavior among homosexually active men. J Pers Assess. 1994;62(3):385–97.

    Article  PubMed  CAS  Google Scholar 

  21. Kalichman SC, Heckman T, Kelly JA. Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior. Arch Sex Behav. 1996;25(2):141–54.

    Article  PubMed  CAS  Google Scholar 

  22. Kalichman SC, Weinhardt L, DiFonzo K, Austin J, Luke W. Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men. Ann Behav Med. 2002;24(3):229–35.

    Article  PubMed  Google Scholar 

  23. Zuckerman M. Biological expression and biological bases of sensation seeking. New York: Cambridge University Press; 1994.

    Google Scholar 

  24. Benotsch EG, Kalichman SC, Kelly JA. Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: prevalence and predictors of high-risk behaviors. Addict Behav. 1999;24(6):857–68.

    Article  PubMed  CAS  Google Scholar 

  25. Benotsch EG, Kalichman SC, Pinkerton SD. Sexual compulsivity in HIV-positive men and women: prevalence, predictors, and consequences of high-risk behaviors. Sex Addict Compuls. 2001;8(2):83–99.

    Article  Google Scholar 

  26. Kalichman SC, Rompa D. Sexual sensation seeking and Sexual Compulsivity Scales: reliability, validity, and predicting HIV risk behavior. J Pers Assess. 1995;65(3):586–601.

    Article  PubMed  CAS  Google Scholar 

  27. Kalichman SC, Cain D. The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. J Sex Res. 2004;41(3):235–41.

    Article  PubMed  Google Scholar 

  28. Dingle GA, Oei TP. Is alcohol a cofactor of HIV and AIDS? Evidence from immunological and behavioral studies. Psychol Bull. 1997;122(1):56–71.

    Article  PubMed  CAS  Google Scholar 

  29. Fisher JC, Bang H, Kapiga SH. The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis. 2007;34(11):856–63.

    Article  PubMed  Google Scholar 

  30. Stall R, Leigh B. Understanding the relationship between drug or alcohol use and high risk sexual activity for HIV transmission: where do we go from here? Addiction. 1994;89(2):131–4.

    Article  PubMed  CAS  Google Scholar 

  31. Woolf SE, Maisto SA. Alcohol use and risk of HIV infection among men who have sex with men. AIDS Behav. 2009;13(4):757–82.

    Article  PubMed  Google Scholar 

  32. Hendershot CS, George WH. Alcohol and sexuality research in the AIDS era: trends in publication activity, target populations and research design. AIDS Behav. 2007;11(2):217–26.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sheeran P, Orbell S. Do intentions predict condom use? Meta-analysis and examination of six moderator variables. Br J Soc Psychol. 1998;37(Pt 2):231–50.

    Article  PubMed  Google Scholar 

  34. Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychol Bull. 1999;125(1):90–132.

    Article  PubMed  CAS  Google Scholar 

  35. Rehm J, Shield KD, Joharchi N, Shuper P. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107:51–9.

    Article  PubMed  Google Scholar 

  36. Davis KC, Hendershot CS, George WH, Norris J, Heiman JR. Alcohol’s effects on sexual decision making: an integration of alcohol myopia and individual differences. J Stud Alcohol Drugs. 2007;68(6):843–51.

    Article  PubMed  Google Scholar 

  37. Davis KC, George WH, Norris J, et al. Effects of alcohol and blood alcohol concentration limb on sexual risk-taking intentions. J Stud Alcohol Drugs. 2009;70(4):499–507.

    Article  PubMed  PubMed Central  Google Scholar 

  38. George WH, Davis KC, Norris J, et al. Indirect effects of acute alcohol intoxication on sexual risk-taking: the roles of subjective and physiological sexual arousal. Arch Sex Behav. 2009;38(4):498–513.

    Article  PubMed  PubMed Central  Google Scholar 

  39. MacDonald TK, MacDonald G, Zanna MP, Fong GT. Alcohol, sexual arousal, and intentions to use condoms in young men: applying alcohol myopia theory to risky sexual behavior. Health Psychol. 2000;19(3):290–8.

    Article  PubMed  CAS  Google Scholar 

  40. Norris J, Stoner SA, Hessler DM, et al. Cognitive mediation of alcohol’s effects on women’s in-the-moment sexual decision making. Health Psychol. 2009;28(1):20–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Maisto SA, Carey MP, Carey KB, Gordon CM, Schum JL, Lynch KG. The relationship between alcohol and individual differences variables on attitudes and behavioral skills relevant to sexual health among heterosexual young adult men. Arch Sex Behav. 2004;33(6):571–84.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Norris J, Stoner SA, Hessler DM, et al. Influences of sexual sensation seeking, alcohol consumption, and sexual arousal on women’s behavioral intentions related to having unprotected sex. Psychol Addict Behav. 2009;23(1):14–22.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Fromme K, D’Amico EJ, Katz EC. Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation? J Stud Alcohol. 1999;60(1):54–63.

    Article  PubMed  CAS  Google Scholar 

  44. Testa M, Fillmore MT, Norris J, et al. Understanding alcohol expectancy effects: revisiting the placebo condition. Alcohol Clin Exp Res. 2006;30(2):339–48.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Parsons JT, Vicioso KJ, Punzalan JC, Halkitis PN, Kutnick A, Velasquez MM. The impact of alcohol use on the sexual scripts of HIV-positive men who have sex with men. J Sex Res. 2004;41(2):160–72.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Parsons JT, Vicioso K, Kutnick A, Punzalan JC, Halkitis PN, Velasquez MM. Alcohol use and stigmatized sexual practices of HIV seropositive gay and bisexual men. Addict Behav. 2004;29(5):1045–51.

    Article  PubMed  Google Scholar 

  47. Shuper PA, Joharchi N, Rehm J. Personality as a predictor of unprotected sexual behavior among people living with HIV/AIDS: a systematic review. AIDS Behav. 2014;18(2):398–410.

    Article  PubMed  Google Scholar 

  48. Kalichman SC, Rompa D. The Sexual Compulsivity Scale: further development and use with HIV-positive persons. J Pers Assess. 2001;76(3):379–95.

    Article  PubMed  CAS  Google Scholar 

  49. Leigh BC. Alcohol expectancies and reasons for drinking: comments from a study of sexual experiences. Psychol Addict Behav. 1990;4:91–6.

    Article  Google Scholar 

  50. Abbey A, Saenz C, Buck PO. The cumulative effects of acute alcohol consumption, individual differences and situational perceptions on sexual decision making. J Stud Alcohol. 2005;66(1):82–90.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Abbey A, Saenz C, Buck PO, Parkhill MR, Hayman LW Jr. The effects of acute alcohol consumption, cognitive reserve, partner risk, and gender on sexual decision making. J Stud Alcohol. 2006;67(1):113–21.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kruse MI, Fromme K. Influence of physical attractiveness and alcohol on men’s perceptions of potential sexual partners and sexual behavior intentions. Exp Clin Psychopharmacol. 2005;13(2):146–56.

    Article  PubMed  Google Scholar 

  53. MacDonald TK, Fong GT, Zanna MP, Martineau AM. Alcohol myopia and condom use: can alcohol intoxication be associated with more prudent behavior? J Pers Soc Psychol. 2000;78(4):605–19.

    Article  PubMed  CAS  Google Scholar 

  54. Maisto SA, Carey MP, Carey KB, Gordon CM, Schum JL. Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women. Exp Clin Psychopharmacol. 2004;12(4):288–97.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Shuper PA, Fisher WA. The role of sexual arousal and sexual partner characteristics in HIV + MSM’s intentions to engage in unprotected sexual intercourse. Health Psychol. 2008;27(4):445–54.

    Article  PubMed  Google Scholar 

  56. Ebel-Lam AP, MacDonald TK, Zanna MP, Fong GT. An experimental investigation of the interactive effects of alcohol and sexual arousal on intentions to have unprotected sex. Basic Appl Soc Psychol. 2009;31:226–33.

    Article  Google Scholar 

  57. George WH, Davis KC, Norris J, et al. Alcohol and erectile response: the effects of high dosage in the context of demands to maximize sexual arousal. Exp Clin Psychopharmacol. 2006;14(4):461–70.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  58. Jarvis BG. MediaLab. New York: Empirisoft Corporation [computer program]. Version 2010.3. 2010.

  59. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care. World Health Organization Department of Mental Health and Substance Dependence. 2001.

  60. National Institute on Drug Abuse. Resource Guide: Screening for Drug Use in General Medical Settings. https://www.drugabuse.gov/publications/resource-guide (2012). Accessed 6 July 2015.

  61. The Explore Team. Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet. 2004;364:41–50.

    Article  Google Scholar 

  62. Langer E. The illusion of control. J Pers Soc Psychol. 1975;32:311–28.

    Article  Google Scholar 

  63. National Advisory Council on Alcohol Abuse and Alcoholism—Recommended Council Guidelines on Ethyl Alcohol Administration in Human Experimentation. NIAAA. http://www.niaaa.nih.gov/Resources/ResearchResources/job22.htm (2005).

  64. Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269–77.

    Article  PubMed  Google Scholar 

  65. Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.

    Article  PubMed  CAS  Google Scholar 

  66. Ross L, Lepper MR, Hubbard M. Perseverance in self-perception and social perception: biased attributional processes in the debriefing paradigm. J Pers Soc Psychol. 1975;32(5):880–92.

    Article  PubMed  CAS  Google Scholar 

  67. Box GEP, Hunter WG, Hunter JS. Statistics for experimenters—design, innovation and discovery. New York: John Wiley and Sons; 2005.

    Google Scholar 

  68. Rosenthal R, Rosnow RL, Rubin DB. Contrasts and effect sizes in behavioral research: a correlational approach. New York: Cambridge University Press; 2000.

    Google Scholar 

  69. Aneshensel CS. Theory-based data analysis for the social sciences. Thousand Oaks: Pine Forge Press; 2002.

    Google Scholar 

  70. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.

    Article  PubMed  CAS  Google Scholar 

  71. Edwards JR, Lambert LS. Methods for integrating moderation and mediation: a general analytical framework using moderated path analysis. Psychol Methods. 2007;12(1):1–22.

    Article  PubMed  Google Scholar 

  72. Fisher JD, Fisher WA, Shuper PA. The information-motivation-behavioral skills model of HIV preventive behavior. In: DiClemente RJ, Crosby RA, Kegler MC, editors. Emerging theories in health promotion practice and research. 2nd ed. San Francisco: Jossey-Bass; 2009. p. 21–63.

    Google Scholar 

  73. Centers for Disease Control and Prevention. Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Disease Society of America. MMWR. 2003;52(RR-12):1–24.

    Google Scholar 

  74. Janssen RS, Holtgrave DR, Valdiserri RO, Shepherd M, Gayle HD, De Cock KM. The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. Am J Public Health. 2001;91(7):1019–24.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  75. Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study. J Stud Alcohol. 2002;63(2):179–86.

    Article  PubMed  Google Scholar 

  76. Cook RL, Sereika SM, Hunt SC, Woodward WC, Erlen JA, Conigliaro J. Problem drinking and medication adherence among persons with HIV infection. J Gen Intern Med. 2001;16(2):83–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  77. Kaner EF, Beyer F, Dickinson HO, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007;(2):CD004148.

  78. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    Article  PubMed  CAS  Google Scholar 

  79. Fisher WA, Fisher JD, Shuper P. Social psychology and the fight against AIDS: an information-motivation-behavioral skills model for the prediction and promotion of health behavior change. In: Olson J, Zanna M, editors. Elsevier; 2014.

  80. Drumright LN, Colfax GN. HIV risk and prevention for non-injection substance users. In: Mayer KH, Pizer H, editors. HIV prevention: a comprehensive approach. Burlington: Academic Press; 2009. p. 340–75.

    Chapter  Google Scholar 

  81. Kalichman SC, Greenberg J, Abel GG. HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention. AIDS Care. 1997;9(4):441–50.

    Article  PubMed  CAS  Google Scholar 

  82. Dal Cin S, MacDonald TK, Fong GT, Zanna MP, Elton-Marshall TE. Remembering the message: the use of a reminder cue to increase condom use following a safer sex intervention. Health Psychol. 2006;25(3):438.

    Article  PubMed  Google Scholar 

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Acknowledgments

Funding for this work was provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (4R21AA020236-02, PI: Shuper). We would like to thank the patients and staff at the Maple Leaf Medical Clinic for their collaboration and support. We would also like to thank Dr. Peter Monti, Ioana-Smarandita Arbone, Sulagna Sarker, Christina Schell, Shayna Skakoon-Sparling, and Rose Wang for their contributions to this project.

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Shuper, P.A., Joharchi, N. & Rehm, J. Protocol for a Controlled Experiment to Identify the Causal Role of Acute Alcohol Consumption in Condomless Sex among HIV-Positive MSM: Study Procedures, Ethical Considerations, and Implications for HIV Prevention. AIDS Behav 20 (Suppl 1), 173–184 (2016). https://doi.org/10.1007/s10461-015-1128-5

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