AIDS and Behavior

, Volume 20, Supplement 1, pp 19–39 | Cite as

Alcohol Use Predicts Sexual Decision-Making: A Systematic Review and Meta-Analysis of the Experimental Literature

  • Lori A. J. Scott-SheldonEmail author
  • Kate B. Carey
  • Karlene Cunningham
  • Blair T. Johnson
  • Michael P. Carey
  • The MASH Research Team
Original Paper


Alcohol is associated with HIV and other sexually transmitted infections through increased sexual risk-taking behavior. Establishing a causal link between alcohol and sexual behavior has been challenging due to methodological limitations (e.g., reliance on cross-sectional designs). Experimental methods can be used to establish causality. The purpose of this meta-analysis was to evaluate the effects of alcohol consumption on unprotected sex intentions. We searched electronic bibliographic databases for records with relevant keywords; 26 manuscripts (k = 30 studies) met inclusion criteria. Results indicate that alcohol consumption is associated with greater intentions to engage in unprotected sex (d +s = 0.24, 0.35). The effect of alcohol on unprotected sex intentions was greater when sexual arousal was heightened. Alcohol consumption is causally linked to theoretical antecedents of sexual risk behavior, consistent with the alcohol myopia model. Addressing alcohol consumption as a determinant of unprotected sex intentions may lead to more effective HIV interventions.


Alcohol Sexual behavior Unprotected sex Experimental methods Meta-analysis 


El alcohol está asociado con el VIH y otras infecciones de transmisión sexual mediante el aumento de las conductas de riesgo sexual. Establecer un vínculo causal entre el alcohol y la conducta sexual ha sido un reto debido a las limitaciones metodológicas (por ejemplo, la dependencia en diseños transversales). Los métodos experimentales se pueden utilizar para establecer la causalidad. El propósito de este meta-análisis es evaluar los efectos del consumo de alcohol sobre las intenciones sexuales sin protección. Se realizaron búsquedas en bases bibliogràficas electrónicas para localizer estudios que contuvieran una serie de palabras clave; 26 manuscritos (k = 30 estudios) cumplieron los criterios de inclusión. Los resultados indican que el consumo de alcohol se asocia con mayores intenciones de tener relaciones sexuales sin protección (d +s = 0,24; 0,35). El efecto del alcohol sobre las intenciones sexuales sin protección fue mayor cuando se intensificó la excitación sexual. El consumo de alcohol está vinculado causalmente a los antecedentes teóricos de la conducta sexual de riesgo, consistente con el modelo de la miopía del alcohol. Incluyendo el consumo de alcohol como factor determinante de las intenciones sexuales sin protección puede conducir a intervenciones más eficaces contra el VIH.



Research reported in this paper was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under award number R01 AA021355 to Lori A. J. Scott-Sheldon. Karlene Cunningham was supported by the Child/Adolescent Biobehavioral HIV Research Training Grant (T32 MH078788) from the National Institute of Mental Health of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We thank the following study authors who provided additional information and/or data: Young-Hee Cho, Ph.D., Amanda K. Gillmore, Ph.D., Tara K. MacDonald, Ph.D., Stephen A. Maisto, Ph.D., and Tyler B. Wray, Ph.D. We also thank Erica Sevetson, MLS., for assistance with our electronic bibliographic database search statement, and Karla Pineda Dvgas, BA., for translating our abstract from English to Spanish.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lori A. J. Scott-Sheldon
    • 1
    • 2
    • 3
    Email author
  • Kate B. Carey
    • 4
  • Karlene Cunningham
    • 1
    • 2
    • 5
  • Blair T. Johnson
    • 6
  • Michael P. Carey
    • 1
    • 2
    • 3
  • The MASH Research Team
    • 1
  1. 1.Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceUSA
  2. 2.Department of Psychiatry and Human Behavior, Alpert School of MedicineBrown UniversityProvidenceUSA
  3. 3.Department of Behavioral and Social SciencesBrown School of Public HealthProvidenceUSA
  4. 4.Center for Alcohol and Addiction StudiesBrown School of Public HealthProvidenceUSA
  5. 5.Bradley/Hasbro Children’s Research CenterRhode Island HospitalProvidenceUSA
  6. 6.Department of PsychologyUniversity of ConnecticutStorrsUSA

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