AIDS and Behavior

, Volume 10, Issue 3, pp 299–307 | Cite as

Alcohol and Sexual HIV Risk Behavior Among Problem Drinking Men Who Have Sex With Men: An Event Level Analysis of Timeline Followback Data

  • Thomas W. Irwin
  • Jon Morgenstern
  • Jeffrey T. Parsons
  • Milton Wainberg
  • Erich Labouvie
Other Research Articles

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.

KEY WORDS:

HIV risk alcohol use gay and bisexual men. 

Notes

ACKNOWLEDGMENT

This work was supported by Grant AA 011745 from the National Institute on Alcohol Abuse and Alcoholism.

REFERENCES

  1. Avins, A. L., Woods, W. J., and Lindan, C. P. (1994). HIV infection and risk behaviors among heterosexuals in alcohol treatment programs. Journal of the American Medical Association, 271, 515–518.CrossRefPubMedGoogle Scholar
  2. Bellis, M. A., Cook, P., Clark, P., Syed, Q., and Hoskins, A. (2002). Re-emerging syphilis in gay men: A case-control study of behavioral risk factors and HIV status. Journal of Epidemiology and Community Health, 56, 235–236.CrossRefPubMedGoogle Scholar
  3. Burcham, J. L., Tindall, B., Marmor, M., Cooper, D. A., Berry, G., and Penny, R. (1989). Incidence and risk factors for human immunodeficiency virus seroconversion on a cohort of Sydney homosexual men. Medical Journal of Australia, 150, 634–639.PubMedGoogle Scholar
  4. Calzavara, L., Burchell, A. N., Major, C., Remis, R. S., Corey, P., Myers, T., et al. (2002). Increases in HIV incidence among men who have sex with men undergoing repeat diagnostic HIV testing in Ontario, Canada. AIDS, 16, 1655–1661.CrossRefPubMedGoogle Scholar
  5. Carey, M. P., Carey, K. B., Maisto, S. A., Gordon, C. M., and Weinhardt, L. S. (2001). Assessing sexual risk behavior with the timeline followback (TLFB) approach: Continued development and psychometric evaluation with psychiatric outpatients. International Journal of STDs and AIDS, 12, 365–375.CrossRefGoogle Scholar
  6. Catania, J. A., Osmond, D., Stall, R. D., Pollack, L., Paul, J. P., Blower, S., et al. (2001). The continuing HIV epidemic among men who have sex with men. American Journal of Public Health, 91, 907–914.PubMedGoogle Scholar
  7. Centers for Disease Control and Prevention (2002). Unrecognized HIV infection, risk behaviors, and perceptions of risk among young black men who have sex with men—six U.S. cities, 1994–1998. Morbidity and Mortality Weekly Report, 51, 733–736.Google Scholar
  8. Chesney, M. A., Barrett, D. C., and Stall, R. (1998). Histories of substance use and risk behavior: Precursors to HIV seroconversion in homosexual men. American Journal of Public Health, 88, 113–116.PubMedGoogle Scholar
  9. Colfax, G., Vittinghoff, E., Husnik, M. J., McKirnan, D., Buchbinder, S., Koblin, B., et al. (2004). Substance use and sexual risk: A Participant- and episode- level analysis among a cohort of men who have sex with men. American Journal of Epidemiology, 159, 1002–1012.CrossRefPubMedGoogle Scholar
  10. Cooper, M. L. (2002). Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol, 14, S101–S117.Google Scholar
  11. Dermen, K. H., and Cooper, M. L. (2000). Inhibition conflict and alcohol expectancy as moderators of alcohol's relationship to condom use. Experimental and Clinical Psychopharmacology, 8, 198–206.CrossRefPubMedGoogle Scholar
  12. Dermen, K. H., Cooper, M. L., and Agocha, V. B. (1998). Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol, 59, 71–77.PubMedGoogle Scholar
  13. Doll, L. S., O’Malley, P. M., Pershing, A. L., Darrow, W. W., Hessol, N. A., and Lifson, A. R. (1990). High-risk sexual behavior and knowledge of HIV antibody status in the San Francisco City Clinic Cohort. Health Psychology, 9, 253–265.CrossRefPubMedGoogle Scholar
  14. Fox, K. K., del Rio, C., Holmes, K. K., Hook, E. W., Judson, F. N., Knapp, J. S., et al. (2001). Gonorrhea in the HIV era: A reversal in trends among men who have sex with men. American Journal of Public Health, 91, 959–964.PubMedGoogle Scholar
  15. Fromme, K., D’Amico, E., and Katz, E. C. (1999). Intoxicated sexual risk taking: An expectancy or cognitive impairment explanation? Journal of Studies on Alcohol, 60, 54–63.PubMedGoogle Scholar
  16. George, W. H., Stoner, S. A., Norris, J., Lopez, P. A., and Lehman, G. L. (2000). Alcohol expectancies and sexuality: A self-fulfilling prophecy analysis of dyadic perceptions and behavior. Journal of Studies on Alcohol, 61, 168–176.PubMedGoogle Scholar
  17. Gillmore, M. R., Morrison, D. M., Leigh, B. C., Hoppe, M. J., Gaylord, J., and Rainey, D. T. (2002). Does “high=high risk”? An event-based analysis of the relationship between substance use and unprotected anal sex among gay and bisexual men. AIDS and Behavior, 6, 361–370.CrossRefGoogle Scholar
  18. Halkitis, P. N., and Parsons, J. T. (2000). Oral sex and HIV risk reduction: Perceived risk, behaviors, and strategies among young HIV-negative gay men. Journal of Psychology and Human Sexuality, 11, 1–24.CrossRefGoogle Scholar
  19. Halkitis, P. N., and Parsons, J. T. (2002). Recreational drug use and HIV risk sexual behavior among men frequenting urban gay venues. Journal of Gay and Lesbian Social Services, 14, 19–39.CrossRefGoogle Scholar
  20. Jaffe, H. (2003). HIV/AIDS in America today. Paper presented at the National HIV Prevention Conference: Atlanta, GA.Google Scholar
  21. Justus, A. N., Finn, P. R., and Steinmetz, J. E. (2000). The influence of traits of disinhibition on the association between alcohol use and risky sexual behavior. Alcoholism: Clinical and Experimental Research, 24, 1028–1035.CrossRefGoogle Scholar
  22. Kellogg, T., McFarland, W., and Katz, M. (1999). Recent increase in HIV seroconversions among repeat anonymous testers in San Francisco. AIDS, 13, 2303–2304.CrossRefPubMedGoogle Scholar
  23. Leigh, B. C. (1993). Alcohol consumption and sexual activity as reported with a diary technique. Journal of Abnormal Psychology, 102, 490–493.CrossRefPubMedGoogle Scholar
  24. Leigh, B. C. (2002). Alcohol and condom use; A Meta-analysis of event-level studies. Sexually Transmitted Diseases, 29, 476–482.CrossRefPubMedGoogle Scholar
  25. Leigh, B. C., and Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation and prevention. American Psychologist, 48, 1035–1045.CrossRefPubMedGoogle Scholar
  26. MacDonald, T. K., MacDonald, G., Zanna, M. P., and Fong, G. T. (2000). Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior. Health Psychology, 19, 290–298.CrossRefPubMedGoogle Scholar
  27. McKirnan, D. J., Vanable, P. A., Ostrow, D. G., and Hope, B. (2001). Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse, 13, 137–154.CrossRefPubMedGoogle Scholar
  28. Page-Shafer, K. A., McFarland, W., Kohn, R., Klausner, J., Katz, M. H., Wohlfeiler, D., et al. (1999). Increases in unsafe sex and rectal gonorrhea among men who have sex with men—San Francisco, California, 1994–1997. Morbidity and Mortality Weekly Report, 48, 45–48.PubMedGoogle Scholar
  29. Parsons, J. T., and Halkitis, P. N. (2002). Sexual and drug using practices of HIV+ men who frequent commercial and public sex environments. AIDS Care, 14, 815–826.CrossRefPubMedGoogle Scholar
  30. Paul, J. P., Stall, R., and Davis, F. (1993). Sexual risk for HIV transmission among gay/bisexual men in substance abuse treatment. AIDS Education and Prevention, 5, 11–24.PubMedGoogle Scholar
  31. Paul, J. P., Stall, R. D., Crosby, G. M., Barrett, D. C., and Midanik, L. T. (1994). Correlates of sexual risk-taking among gay male substance abusers. Addiction, 89, 971–983.CrossRefPubMedGoogle Scholar
  32. Penkower, L., Dew, M. A., Kingsley, L., Becker, J. T., Satz, P., Schaerf, F. W., et al. (1991). Behavioral, health and psychosocial factors and risk for HIV infection among sexually active homosexual men: The Multicenter AIDS Cohort Study. American Journal of Public Health, 81, 194–196.PubMedGoogle Scholar
  33. Perry, M. J., Solomon, L. J., Winett, R. A., Kelly, J. A., Roffman, R. A., Desiderado, L. L., et al. (1994). High risk sexual behavior and alcohol consumption among bar-going gay men. AIDS, 8, 1321–1324.PubMedGoogle Scholar
  34. Purcell, D. W., Parsons, J. T., Halkitis, P. N., Mizuno, Y., and Woods, W. J. (2001). Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse, 13, 185–200.CrossRefPubMedGoogle Scholar
  35. Seage, G. R., Mayer, K. H., Wold, C., Lenderking, W., Goldstein, R., Cai, B., Gross, M., Herren, T. and Hingson, R. (1998). The Social context of drinking, drug use, and unsafe sex in the Boston Men Study. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 17(4), 368–375.Google Scholar
  36. Silvestre, A. J., Lyter, D. W., Valdiserri, R. O., Huggins, R., and Rinaldo, C. R. (1989). Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session. AIDS, 3, 647–650.PubMedCrossRefGoogle Scholar
  37. Sobell, L. C., Brown, J., Leo, G. I., and Sobell, M. B. (1996). The reliability of the Alcohol Timeline Followback when administered by telephone and by computer. Drug & Alcohol Dependence, 42(1), 49–54.CrossRefGoogle Scholar
  38. Sobell, L. C., and Sobell, M. B. (1992). Timeline follow-back: A technique assessing self-reported alcohol consumption. In R. Litton, and J. P. Allen (Eds.), Measuring Alcohol Consumption: Psychosocial and Biochemical Methods (pp. 41–69). Totowa, NJ: Humana Press.Google Scholar
  39. Stall, R., McKusick, L., Wiley, J., Coates, T. J., and Ostrow, D. G. (1986). Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: The AIDS behavioral research project. Health Education Quarterly, 13, 359–371.PubMedGoogle Scholar
  40. Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., et al. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The urban men's health study. Addiction, 96, 1589–1601.CrossRefPubMedGoogle Scholar
  41. Vanable, P. A., McKirnan, D. J., Buchbinder, S. P., Bartholow, B. N., Douglas, J. M., Judson, F. N., et al. (2004). Alcohol use and high-risk sexual behavior among men who have sex with men: The effects of consumption level and partner type. Health Psychology, 23, 525–532.CrossRefPubMedGoogle Scholar
  42. Vittinghoff, E., Douglas, J., Judson, F., McKirnan, D., MacQueen, K., and Buchbinder, S. P. (1999). Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology, 150, 306–311.PubMedGoogle Scholar
  43. Watters, J. K., and Biernacki, P. (1989). Targeted sampling: Options and considerations for the study of hidden populations. Social Problems, 36, 416–430.CrossRefGoogle Scholar
  44. Weinhardt, L. S. (2002). Effects of a detailed sexual behavior interview on perceived risk of HIV infection: Preliminary experimental analysis in a high risk sample. Journal of Behavioral Medicine, 25, 195–203.CrossRefPubMedGoogle Scholar
  45. Weinhardt, L. S., and Carey, M. P. (2000). Does alcohol lead to sexual risk behavior? Findings from event-level research. Annual Review of Sex Research 11, 125–157.PubMedGoogle Scholar
  46. Weinhardt, L. S., Carey, M. P., Maisto, S. A., Carey, K. B., Cohen, M. M., and Wickramasinghe, S. M. (1998). Reliability of the timeline follow-back sexual behavior interview. Annals of Behavioral Medicine, 20, 25–30.PubMedCrossRefGoogle Scholar
  47. Weinhardt, L. S., Carey, M. P., Carey, K. B., Maisto, S. A., and Gordon, C. M. (2001). The relation of alcohol use to HIV-risk sexual behavior among adults with a severe and persistent mental illness. Journal of Consulting and Clinical Psychology, 69, 77–84.CrossRefPubMedGoogle Scholar
  48. Wolitski, R. J., Valdiserri, R. O., Denning, P. H., and Levine, W. C. (2001). Are we headed for a resurgence of the HIV epidemic among men who have sex with men? American Journal of Public Health, 91, 883–888.PubMedCrossRefGoogle Scholar
  49. World Health Organization. (1990). Composite International Diagnostic Interview. Geneva, Switzerland.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Thomas W. Irwin
    • 1
    • 6
  • Jon Morgenstern
    • 1
    • 2
  • Jeffrey T. Parsons
    • 3
  • Milton Wainberg
    • 4
  • Erich Labouvie
    • 5
  1. 1.Mount Sinai School of MedicineNew YorkUSA
  2. 2.National Center on Addiction and Substance Abuse at Columbia UniversityNew YorkUSA
  3. 3.Hunter College and the Graduate Center of the City University of New YorkNew YorkUSA
  4. 4.Columbia UniversityNew YorkUSA
  5. 5.Rutgers—The State University of New JerseyPiscatawayUSA
  6. 6.Assistant Professor of Psychology in Psychiatry, Cornell University, Weill Medical College, Program Director, Substance Abuse Treatment ServicesNew York—Presbyterian Hospital, Payne Whitney WestchesterWhite PlainsUSA

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