Causal Effects of Alcohol Intoxication on Sexual Risk Intentions and Condom Negotiation Skills Among High-Risk Men Who Have Sex with Men (MSM)
Alcohol use is a key risk factor for HIV infection among MSM, in part because intoxication may interfere with the use of prevention methods like condoms. However, few studies have examined whether this is due to alcohol’s pharmacological or expectancy effects or explored the specific aspects of sexual decision-making that may be affected. In this study, high-risk, heavy drinking MSM (N = 121) were randomly assigned to receive either (1) alcohol beverages, (2) placebo beverages, or (3) control beverages, before navigating a video-based sexual risk scenario that assessed several aspects of sexual decision-making. Results showed that condom use intentions and negotiation behaviors were lower among alcohol and placebo participants compared with controls, but that few significant differences emerged between the alcohol and placebo groups. These findings contrast with similar past studies, and suggest that alcohol’s expectancy effects may play a role in sexual decision-making.
KeywordsAlcohol Men who have sex with men HIV risk behavior Condom use
This manuscript was supported by P01AA019072 (to PM), L30AA023336 (to TW), K05AA019681 (to PM), and K08AA024056 (to MC) from the National Institute on Alcohol Abuse and Alcoholism.
Compliance with Ethical Standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380:367–77.Google Scholar
- 2.Centers for Disease Control and Prevention. Trends in HIV diagnoses, 2005–2014 Atlanta, GA: U.S. Department of Health and Human Services; 2016. http://www.webcitation.org/6vAPQZG6c. Accessed 2 Nov 2017.
- 3.Centers for Disease Control and Prevention. Lifetime risk of HIV diagnosis Atlanta, GA: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; 2016. https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html. Accessed 10 Dec 2017.
- 4.Centers for Disease Control and Prevention. Estimates of New HIV Infections in the United States. Atlanta, GA: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; 2016.Google Scholar
- 5.Centers for Disease Control and Prevention. HIV Prevention: Progress to Date. Atlanta, GA: U.S. Department of Health and Human Services; 2013.Google Scholar
- 6.Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2013;17(6):2162–72.Google Scholar
- 7.Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV?: a review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18(2):195–216.Google Scholar
- 8.McGowan I. Rectal microbicides: can we make them and will people use them? AIDS Behav. 2011;15(1):66–71.Google Scholar
- 9.Kirby T, Thornber-Dunwell M. Uptake of PrEP for HIV slow among MSM. Lancet. 2014;383(9915):399.Google Scholar
- 10.Smith D, Grant R, Weidle P, Lansky A, Mermin J, Fenton K. Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011;60(3):65–8.Google Scholar
- 11.Uthman OA. Global, regional, and national life expectancy, all-cause and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–544.Google Scholar
- 12.Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. MMWR Morb Mortal Wkly Rep. 2014;63:3–27.Google Scholar
- 13.Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. Aids. 2006;20(5):731–9.Google Scholar
- 14.Sander PM, Cole SR, Stall RD, Jacobson LP, Eron JJ, Napravnik S, et al. Joint effects of alcohol consumption and high-risk sexual behavior on HIV seroconversion among men who have sex with men. AIDS. 2013;27(5):815.Google Scholar
- 15.Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Pub Health. 2010;55(3):159–66.Google Scholar
- 16.Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107(1):51–9.Google Scholar
- 17.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.Google Scholar
- 18.Bruce D, Kahana S, Harper GW, Fernández MI. ATN t. Alcohol use predicts sexual risk behavior with HIV-negative or partners of unknown status among young HIV-positive men who have sex with men. AIDS Care. 2013;25(5):559–65.Google Scholar
- 19.Sen B. Does alcohol-use increase the risk of sexual intercourse among young people? Evidence from the NLSY97. J Health Econ. 2002;21:1085–93.Google Scholar
- 20.Grossman M, Markowitz S. I did what last night?! Adolescent risky sexual behaviors and substance use. East Econ J. 2005;31:383–405.Google Scholar
- 21.Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012;16(6):1394–410.Google Scholar
- 22.Kahler CW, Wray TB, Pantalone DW, Kruis RD, Mastroleo NR, Monti PM, et al. Daily associations between alcohol use and unprotected anal sex among heavy drinking HIV-positive men who have sex with men. AIDS Behav. 2015;19(3):422–30.Google Scholar
- 23.Dermen KH, Cooper ML. Sex-related alcohol expectancies among adolescents: I. Scale development. Psychol Addict Behav. 1994;8(3):152.Google Scholar
- 24.Leigh BC. The relationship of sex-related alcohol expectancies to alcohol consumption and sexual behavior. Addiction. 1990;85(7):919–28.Google Scholar
- 25.Jones BT, Corbin W, Fromme K. A review of expectancy theory and alcohol consumption. Addiction. 2001;96(1):57–72.Google Scholar
- 26.Darkes J, Goldman MS. Expectancy challenge and drinking reduction: process and structure in the alcohol expectancy network. Exp Clin Psychopharmacol. 1998;6(1):64.Google Scholar
- 27.Scott-Sheldon LA, Terry DL, Carey KB, Garey L, Carey MP. Efficacy of expectancy challenge interventions to reduce college student drinking: a meta-analytic review. Am Psychol Assoc. 2012;26:393.Google Scholar
- 28.Woolf-King SE, Maisto S, Carey M, Vanable P. Selection of film clips and development of a video for the investigation of sexual decision making among men who have sex with men. J Sex Res. 2010;47(6):589–97.Google Scholar
- 29.Scott-Sheldon LA, Carey KB, Cunningham K, Johnson BT, Carey MP, Team MR. Alcohol use predicts sexual decision-making: a systematic review and meta-analysis of the experimental literature. AIDS Behav. 2016;20(1):19–39.Google Scholar
- 30.Maisto SA, Palfai T, Vanable P, Heath J, Woolf-King S. The effects of alcohol and sexual arousal on determinants of sexual risk in men who have sex with men. Arch Sex Behav. 2012;41(4):971–86.Google Scholar
- 31.Centers for Disease Control and Prevention. Fact Sheet: Today’s HIV Epidemic Atlanta, GA: U.S. Department of Health and Human Services; 2016. http://www.webcitation.org/6vAPiBrwN. Accessed 2 Nov 2017.
- 32.Shuper PA, Joharchi N, Monti PM, Loutfy M, Rehm J. Acute alcohol consumption directly increases HIV transmission risk: a randomized controlled experiment. J Acquir Immune Defic Syndr. 2017;76(5):493–500.Google Scholar
- 33.National Institute on Alcohol Abuse and Alcoholism. Overview of Alcohol Consumption: Drinking Levels Defined Rockville, MD: U.S. Department of Health and Human Services; 2017. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed 4 June 2018.
- 34.Skinner H. The drug abuse screening test. Addict Behav. 1982;7:363–71.Google Scholar
- 35.Donovan DM, Kivlahan DR, Doyle SR, Longabaugh R, Greenfield SF. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study. Addiction. 2006;101(12):1696–704.Google Scholar
- 36.Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.Google Scholar
- 37.Allen JP, Litten RZ, Fertig JB, Babor T. A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcohol Clin Exp Res. 1997;21(4):613–9.Google Scholar
- 38.Reinert DF, Allen JP. The alcohol use disorders identification test (AUDIT): a review of recent research. Alcohol Clin Exp Res. 2002;26(2):272–9.Google Scholar
- 39.Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J Subst Abuse Treat. 2007;32(2):189–98.Google Scholar
- 40.Sobell LC, Sobell MB. Timeline follow-back. Measuring alcohol consumption. New York: Springer; 1992. p. 41–72.Google Scholar
- 41.Sobell LC, Brown J, Leo GI, Sobell MB. The reliability of the Alcohol Timeline Followback when administered by telephone and by computer. Drug Alcohol Depend. 1996;42(1):49–54.Google Scholar
- 42.Maisto SA, Conigliaro JC, Gordon AJ, McGinnis KA, Justice AC. An experimental study of the agreement of self-administration and telephone administration of the Timeline Followback interview. J Stud Alcohol Drugs. 2008;69(3):468–71.Google Scholar
- 43.Rueger SY, Trela CJ, Palmeri M, King AC. Self-administered web-based timeline followback procedure for drinking and smoking behaviors in young adults. J Stud Alcohol Drugs. 2012;73(5):829–33.Google Scholar
- 44.Schroder KE, Johnson CJ, Wiebe JS. Interactive voice response technology applied to sexual behavior self-reports: a comparison of three methods. AIDS Behav. 2007;11(2):313–23.Google Scholar
- 45.Wray TB, Kahler CW, Monti PM. Using ecological momentary assessment (EMA) to study sex events among very high-risk men who have sex with men (MSM). AIDS Behav. 2016;20(10):2231–42.Google Scholar
- 46.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.Google Scholar
- 47.Helweg-Larsen M, Collins BE. The UCLA Multidimensional Condom Attitudes Scale: documenting the complex determinants of condom use in college students. Health Psychol. 1994;13(3):224.Google Scholar
- 48.Leigh BC. Alcohol expectancies and reasons for drinking: Comments from a study of sexuality. Psychol Addict Behav. 1990;4(2):91.Google Scholar
- 49.Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. J Consult Psychol. 1960;24(4):349.Google Scholar
- 50.Reynolds WM. Development of reliable and valid short forms of the Marlowe–Crowne social desirability scale. J Clin Psychol. 1982;38(1):119–25.Google Scholar
- 51.George WH, Davis KC, Norris J, Heiman JR, Stoner SA, Schacht RL, 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.Google Scholar
- 52.Fromme K, D’Amico EJ, Katz EC. Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation? J Stud Alcohol Drugs. 1999;60(1):54.Google Scholar
- 53.Maisto SA, Carey MP, Carey KB. Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women. Exp Clin Psychopharmacol. 2004;12(4):288–97.Google Scholar
- 54.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.Google Scholar
- 55.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.Google Scholar
- 56.Curtin JJ, Fairchild BA. Alcohol and cognitive control: Implications for regulation of behavior during response conflict. J Abnorm Psychol. 2003;112(3):424–36.Google Scholar
- 57.Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull. 2001;127(1):142.Google Scholar
- 58.Schacht RL, Stoner SA, George WH, Norris J. Idiographically determined versus standard absorption periods in alcohol administration studies. Alcohol Clin Exp Res. 2010;34(5):925–7.Google Scholar