AIDS and Behavior

, Volume 12, Issue 5, pp 729–740 | Cite as

A Daily Process Investigation of Alcohol-involved Sexual Risk Behavior Among Economically Disadvantaged Problem Drinkers Living with HIV/AIDS

  • William D. BartaEmail author
  • David B. Portnoy
  • Susan M. Kiene
  • Howard Tennen
  • Khamis S. Abu-Hasaballah
  • Rebecca Ferrer
Original Paper


Alcohol use is believed to increase sexual risk behavior among people living with HIV/AIDS (PLWHA). As drinking and sexual risk acts often occur in the same social contexts, this association is difficult to confirm. In this study, electronic daily diaries were completed by 116 PLWHA over 5 weeks. This yielded a total of 1,464 records consisting of data pertaining to discrete occasions of anal and vaginal sex. Simultaneous within- and between-person multilevel analyses were conducted, including situational variables (partner type, partner serostatus, partner drinking) and individual difference variables (gender, level of alcohol dependence). The resulting model explains 27.5% of the variance and reveals that interactions among these situational and individual difference variables predict changes in the estimated rate of unprotected sex (US). Also, in defined contexts, the amount of alcohol consumed prior to sex significantly affects the rate of US among members of the sample. Implications are discussed.


Interactive Voice Response Condom use HIV-positive Daily process approach Alcohol 



This research was supported by the National Institute on Alcohol Abuse and Alcoholism, R21 AA015665-01A1. We also wish to acknowledge services provided by the University of Connecticut Health Center’s General Clinical Research Center, NIH M01 RR006192. The authors also wish to thank M. Kaye White for her critical contributions.


  1. Allen, J. P., & Wilson, V. B. (2003). Assessing alcohol problems: A guide for clinicians and researchers (2nd ed.). Washington: U.S. Department of Health and Human Services. National Institute on Alcohol Abuse and Alcoholism.Google Scholar
  2. Anzala, A. O., Simonsen, J. N., Kimani, J., Ball, T. B., Nagelkerke, N. J. D., Rutherford, J., Ngugi, E. N., Bwayo, J. J., & Plummer, F. A. (2000). Acute sexually transmitted infections increase human immunodeficiency virus type 1 plasma viremia, increase plasma type 2 cytokines, and decrease CD4 cell counts. Journal of Infectious Disease, 182, 459–466.CrossRefGoogle Scholar
  3. Bailey, S. L., Gao, W., & Clark, D. B. (2006). Diary study of substance use and unsafe sex among adolescents with substance use disorders. Journal of Adolescent Health, 38(3), 297.e13–297.e20.Google Scholar
  4. Barta, W., Kiene, S. M., Tennen, H., Abu-Hasaballah, K. S., & Ferrer, R. (in press, AIDS Care). The idiographic study of inconsistent condom use behavior of persons living with HIV.Google Scholar
  5. Barta, W. D. & Tennen, H. (in press). An idiographic-nomothetic approach to personality and psychological influences on health risk behavior. In F. Columbus (Ed.), Focus on personality and social psychology. Hauppauge: Nova Science Publishers.Google Scholar
  6. Carpenter, K. M., & Hasin, D. S. (1998). Reasons for drinking alcohol: Relationships with DSM-IV alcohol diagnoses and alcohol consumption in a community sample. Psychology of Addictive Behaviors, 12(3), 168–184.CrossRefGoogle Scholar
  7. Centers for Disease Control, Prevention. (2003). Advancing HIV prevention: New strategies for a changing epidemic–United States, 2003. Morbidity and Mortality Weekly Report, 52(15), 329–332.Google Scholar
  8. Cooper, M. L., Flanagan, M. E., Talley, A. E., & Micheas, L. (2006). Individual differences in emotion regulation and their relation to risk taking during adolescence. In D. K. Snyder, J. A. Simpson, & J. N Hughes (Eds.), Emotion regulation in couples and families: Pathways to dysfunction and health (pp. 183–203). Washington: American Psychological Association.CrossRefGoogle Scholar
  9. Dingle, G. A., & Oie, T. P. S. (1997). Is alcohol a cofactor of HIV and AIDS? Evidence from immunological and behavioral studies. Psychological Bulletin, 122(1), 56–71.PubMedCrossRefGoogle Scholar
  10. Folch, C., Marks, G., Esteve, A., Zaragoza, K., Muñoz, R., & Casabona, J. (2006). Factors associated with unprotected sexual intercourse with steady male, casual male, and female partners among men who have sex with men in Barcelona, Spain. AIDS Education and Prevention, 18(3), 227–242.PubMedCrossRefGoogle Scholar
  11. Forna, F. M., Fitzpatrick, L., Adimora, A. A., McLellan-Lemal, E., Leone, P., Brookes, J. T., Marks, G., & Greenberg, A. (2006). A case–control study of factors associated with HIV infection among black women. Journal of the National Medical Association, 98(11), 1798–1804.PubMedGoogle Scholar
  12. Gaughan, M. (2006). The gender structure of adolescent peer influence on drinking. Journal of Health and Social Behavior, 47, 47–61.PubMedCrossRefGoogle Scholar
  13. Kahneman, D., Krueger, A. B., Schkade, D. A., Schwarz, N., & Stone, A. A. (2004). A survey method for characterizing daily life experiences: The day reconstruction method. Science, 306, 1776–1780.PubMedCrossRefGoogle Scholar
  14. Kalichman, S. C., Greenberg, J., & Abel, G. G. (1997). HIV-seropositive men who engage in high-risk sexual behavior: Psychological characteristics and implications for prevention. AIDS Care, 9, 441–450.PubMedCrossRefGoogle Scholar
  15. Leigh, B. C., & Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV—issues in methodology, interpretation, and prevention. American Psychologist, 48, 1035–1045.PubMedCrossRefGoogle Scholar
  16. Lejoyeux, M., Claudon, M., McLoughlin, M., & Adès, J. (2001). Comparison of alcohol-dependent patients with and without physiological dependence. European Addiction Research, 7, 198–201.PubMedCrossRefGoogle Scholar
  17. Luke, D. A. (2004). Multilevel modeling. Thousand Oaks: Sage.Google Scholar
  18. Maclure, M., & Mittleman, M. A. (2000). Should we use a case-crossover design? Annual Review of Public Health, 21, 193–221.PubMedCrossRefGoogle Scholar
  19. MacDonald, T. K., Fong, G. T., Zanna, M. P., & Martineau, A. M. (2000). Alcohol myopia and condom use: Can alcohol intoxication be associated with more prudent behavior? Journal of Personality and Social Psychology, 78(4), 605–619.PubMedCrossRefGoogle Scholar
  20. McCoul, M. D., & Haslam, N. (2001). Predicting high risk sexual behaviour in heterosexual and homosexual men: The roles of impulsivity and sensation seeking. Personality and Individual Differences, 31, 1303–1310.CrossRefGoogle Scholar
  21. Morrison, D. M., Gillmore, R., Hoppe, M. J., Gaylord, J., Leigh, B. C., & Rainey, D. (2003). Adolescent drinking and sex: Findings from a daily diary study. Perspectives on Sexual and Reproductive Health, 35, 162–168.PubMedCrossRefGoogle Scholar
  22. Nolen-Hoeksema, S. (2004). Gender differences in risk factors and consequences for alcohol use and problems. Clinical Psychology Review, 24(8), 981–1010.PubMedCrossRefGoogle Scholar
  23. Petry, N. M. (1999). Alcohol use in HIV patients: What we don’t know may hurt us. International Journal of STD and AIDS, 10, 561–570.PubMedCrossRefGoogle Scholar
  24. Purcell, D. W., Moss, S., Remien, R. H., Woods, W. J., & Parsons, J. T. (2005). Illicit substance use, sexual risk, and HIV-positive gay and bisexual men: Differences by serostatus of casual partners. AIDS, 19(Suppl 1), S37–S47.PubMedGoogle Scholar
  25. Robinson, W. S. (1950). Ecological correlations and the behavior of individuals. American Sociological Review, 15, 351–357.CrossRefGoogle Scholar
  26. Simons, J. S., & Carey, K. B. (2006). An affective and cognitive model of marijuana and alcohol problems. Addictive Behaviors, 31, 1578–1592.PubMedCrossRefGoogle Scholar
  27. Singer, M. C., Erickson, P. I., Badiane, L., Diaz, R., Ortiz, D., Abraham, T., & Nicolaysen, A. M. (2006). Syndemics, sex and the city: Understanding sexually transmitted diseases in social and cultural context. Social Science and Medicine, 63(8), 2010–2021.PubMedCrossRefGoogle Scholar
  28. Skinner, H. A., & Horn, J. L. (1984). Alcohol dependence scale: Users’ guide. Toronto: Addiction Research Foundation.Google Scholar
  29. Smith, D. M., Wong, J. K., Hightower, G. K., Ignacio, C. C., Koelsch, K. K., Petropoulos, C. J., Richman, D. D., & Little, S. J. (2005). HIV drug resistance acquired through superinfection. AIDS, 19, 1251–1256.PubMedCrossRefGoogle Scholar
  30. Snijders, T., & Bosker, R. (1999). Multilevel analysis: An introduction to basic and advanced multilevel modeling. London: Sage.Google Scholar
  31. Steain, M. C., Wang, B., Dwyer, D. E., & Saksena, N. K. (2004). HIV-1 co-infection, superinfection, and recombination. Sexual Health, 1, 239–250.PubMedCrossRefGoogle Scholar
  32. Stein, M., Herman, D. S., Trisvan, E., Pirraglia, P., Engler, P., & Anderson, B. J. (2005). Alcohol use and sexual risk behavior among human immunodeficiency virus-positive persons. Alcoholism: Clinical and Experimental Research, 29(5), 837–843.CrossRefGoogle Scholar
  33. Suarez, T., & Miller, J. (2001). Negotiating risks in context: A perspective on unprotected anal intercourse and barebacking among men who have sex with men—where do we go from here? Archives of Sexual Behavior, 30(3), 287–300.PubMedCrossRefGoogle Scholar
  34. Tennen, H., Affleck, G., Armeli, S., & Carney, M. A. (2000). A daily process approach to coping: Linking theory, research, and practice. American Psychologist, 55, 626–636.PubMedCrossRefGoogle Scholar
  35. Thompson, S. C., Nanni, C., & Levine, A. (1996). The stressors and stress of being HIV-positive. AIDS Care, 8, 5–14.PubMedCrossRefGoogle Scholar
  36. Toh, R. S., Hu, M. Y., & Lee, E. (2004). Respondent non-cooperation in surveys and diaries: An analysis of item non-response and panel attrition. International Journal of Market Research, 46(3), 311–326.Google Scholar
  37. Van Kesteren, N. M. C., Hospers, H. J., & Kok, G. (2007). Sexual risk behavior among HIV-positive men who have sex with men: A literature review. Patient Education and Counseling, 65, 5–20.PubMedCrossRefGoogle Scholar
  38. Vanable, P. A., McKirnan, D. J., Buchbinder, S. P, Bartholomew, B. N., Douglas, J. M., Judson, F. N., & MacQueen, K. M. (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(5), 525–532.PubMedCrossRefGoogle Scholar
  39. Walls, T. A., & Schafer, J. L. (2006). Models for intensive longitudinal data. New York: Oxford.Google Scholar
  40. Weinhardt, L. S., & 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
  41. Weinstein, N. D. (2007). Misleading tests of health behavior theories. Annals of Behavioral Medicine, 33(1), 1–10.PubMedCrossRefGoogle Scholar
  42. Woodrome, S. E., Zimet, G. D., Orr, D. P., & Fortenberry, J. D. (2006). Dyadic alcohol use and relationship quality as predictors of condom non-use among adolescent females. Journal of Adolescent Health, 38, 305–306.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • William D. Barta
    • 1
    • 2
    Email author
  • David B. Portnoy
    • 1
  • Susan M. Kiene
    • 3
  • Howard Tennen
    • 4
  • Khamis S. Abu-Hasaballah
    • 5
  • Rebecca Ferrer
    • 1
  1. 1.Department of Psychology, Center for Health, Intervention, and PreventionUniversity of ConnecticutStorrsUSA
  2. 2.Department of Psychology, Center for Health, Intervention, and PreventionUniversity of ConnecticutStorrsUSA
  3. 3.Rhode Island Hospital, Warren Alpert School of MedicineBrown UniversityProvidenceUSA
  4. 4.Department of Community Medicine and Health CareUniversity of Connecticut Health CenterFarmingtonUSA
  5. 5.General Clinical Research CenterUniversity of Connecticut Health CenterFarmingtonUSA

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