Skip to main content

Advertisement

Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

Resumen

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Shuper PA, Joharchi N, Irving H, Rehm J. Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: review and meta-analysis. AIDS Behav. 2009;13(6):1021–36.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  3. Halpern-Felsher BL, Millstein SG, Ellen JM. Relationship of alcohol use and risky sexual behavior: a review and analysis of findings. J Adolesc Health. 1996;19(5):331–6.

    Article  PubMed  CAS  Google Scholar 

  4. Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV: issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035–45.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. 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 

  6. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1–32.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Lang AR. The social psychology of drinking and human sexuality. J Drug Issues. 1985;15(2):273–89.

    Article  Google Scholar 

  10. Rohsenow DJ, Marlatt GA. The balanced placebo design: methodological considerations. Addict Behav. 1981;6(2):107–22.

    Article  PubMed  CAS  Google Scholar 

  11. Marlatt GA, Rohsenow DJ. Cognitive processes in alcohol use: expectancy and the balanced placebo design. In: Mello NK, editor. Advances in substance abuse: behavioral and biological research. Greenwich: JAI Press; 1980. p. 159–99.

    Google Scholar 

  12. 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):142–61.

    Article  PubMed  CAS  Google Scholar 

  13. 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 

  14. Cooper ML. Does drinking promote risky sexual behavior? A complex answer to a simple question. Curr Dir Psychol Sci. 2006;15(1):19–23.

    Article  Google Scholar 

  15. 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 Drugs. 2006;67(1):113.

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

    PubMed  CAS  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks: Sage; 2001.

    Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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 

  22. Cho Y-H, Span SA. The effect of alcohol on sexual risk-taking among young men and women. Addict Behav. 2010;35(8):779–85.

    Article  PubMed  Google Scholar 

  23. Conner M, Sutherland E, Kennedy F, Grearly C, Berry C. Impact of alcohol on sexual decision making: intentions to have unprotected sex. Psychol Health. 2008;23(8):909–34.

    Article  PubMed  Google Scholar 

  24. Davis KC. The influence of alcohol expectancies and intoxication on men’s aggressive unprotected sexual intentions. Exp Clin Psychopharmacol. 2010;18(5):418–28.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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 

  27. Davis KC, Masters NT, Eakins D, et al. Alcohol intoxication and condom use self-efficacy effects on women’s condom use intentions. Addict Behav. 2014;39(1):153–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 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(3):226–33.

    Article  Google Scholar 

  29. George WH, Cue Davis K, 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 

  30. Gilmore AK, George WH, Nguyen HV, Heiman JR, Davis KC, Norris J. Influences of situational factors and alcohol expectancies on sexual desire and arousal among heavy-episodic drinking women: acute alcohol intoxication and condom availability. Arch Sex Behav. 2013;42(6):949–959.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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 

  32. 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 

  33. 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 

  34. MacDonald TK, MacDonald G, Zanna MP, Fong G. 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 

  35. MacDonald TK, Zanna MP. Why common sense goes out the window: effects of alcohol on intentions to use condoms. Pers Soc Psychol Bull. 1996;22:763–75.

    Article  Google Scholar 

  36. 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 

  37. 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 

  38. 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 

  39. Maisto SA, Palfai T, Vanable PA, Heath J, Woolf-King SE. 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.

    Article  PubMed  PubMed Central  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. Purdie MP, Norris J, Davis KC, et al. The effects of acute alcohol intoxication, partner risk level, and general intention to have unprotected sex on women’s sexual decision making with a new partner. Exp Clin Psychopharmacol. 2011;19(5):378–88.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Schacht RL, George WH, Davis KC, et al. Sexual abuse history, alcohol intoxication, and women’s sexual risk behavior. Arch Sex Behav. 2010;39(4):898–906.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Stoner SA. Alcohol and sexual disinhibition among college students [PhD]. US: Psychology, University of Washington; 2003.

    Google Scholar 

  44. Wray TB, Simons JS, Maisto SA. Effects of alcohol intoxication and autonomic arousal on delay discounting and risky sex in young adult heterosexual men. Addict Behav. 2015;42:9–13.

    Article  PubMed  Google Scholar 

  45. Zawacki T. Effects of alcohol on women’s risky sexual decision making during social interactions in the laboratory. Psychol Women Q. 2011;35(1):107–18.

    Article  Google Scholar 

  46. Bushman BJ, Cooper HM. Effects of alcohol on human aggression: an integrative research review. Psychol Bull. 1990;107(3):341–54.

    Article  PubMed  CAS  Google Scholar 

  47. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Fowkes FG, Fulton PM. Critical appraisal of published research: introductory guidelines. Br Med J. 1991;302(6785):1136–40.

    Article  CAS  Google Scholar 

  49. Miller WR, Brown JM, Simpson TL, Handmaker NS, Bien TH, Luckie LF. What works? A methodological analysis of the alcohol treatment outcome literature. In: Hester RK, Miller WR, editors. Handbook of alcoholism treatment approaches: effective alternatives. 2nd ed. Needham Heights: Allyn & Bacon; 1995. p. 12–44.

    Google Scholar 

  50. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Erlbaum; 1998.

    Google Scholar 

  51. Johnson BT, Eagly AH. Meta-analysis of research in social and personality psychology. In: Reis HT, Judd CM, editors. Handbook of research methods in social and personality psychology. 2nd ed. London: Cambridge University Press; 2014. p. 675–707.

    Google Scholar 

  52. Sanchez-Meca J, Marin-Martinez F, Chacon-Moscoso S. Effect-size indices for dichotomized outcomes in meta-analysis. Psychol Methods. 2003;8(4):448–67.

    Article  PubMed  Google Scholar 

  53. Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Edu Behav Stat. 1981;6:107–28.

    Google Scholar 

  54. Stata/SE [computer program], Cohen J. Version 12.1 for Windows. College Station: StataCorp LP; 2013.

    Google Scholar 

  55. Meta-analysis macros for SAS, SPSS, and Stata [computer program]; 2001.

  56. Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206.

    Article  PubMed  Google Scholar 

  57. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  PubMed  Google Scholar 

  58. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327(7414):557–60.

    Article  Google Scholar 

  59. Harbord RM, Higgins JPT. Meta-regression in Stata. Stata J. 2008;8(4):493–519.

    Google Scholar 

  60. Hedges LV. Fixed effects models. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p. 285–99.

    Google Scholar 

  61. Rosenthal R. The “file-drawer” problem and tolerance for null results. Psychol Bull. 1979;86:638–41.

    Article  Google Scholar 

  62. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54(10):1046–55.

    Article  PubMed  CAS  Google Scholar 

  63. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.

    Article  PubMed  CAS  Google Scholar 

  64. Egger M, Smith DG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Br Med J. 1997;315(7109):629–34.

    Article  CAS  Google Scholar 

  65. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.

    Article  PubMed  CAS  Google Scholar 

  66. Borenstein M. Software for publication bias. In: Rothstein H, Sutton AJ, Borenstein M, editors. Publication bias in meta-analysis: prevention, assessment and adjustments. West Sussex: Wiley; 2005.

    Google Scholar 

  67. Emerson JD, Strenio J. Boxplots and batch comparisons. In: Hoaglin DC, Mosteller F, Tukey JW, editors. Understanding robust and exploratory data analysis. New York: Wiley; 1983. p. 58–96.

    Google Scholar 

  68. Terrin N, Schmid CH, Lau J, Olkin I. Adjusting for publication bias in the presence of heterogeneity. Stat Med. 2003;22(13):2113–26.

    Article  PubMed  Google Scholar 

  69. Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I. The case of the misleading funnel plot. Br Med J. 2006;333(7568):597–600.

    Article  Google Scholar 

  70. Sutton AJ. Publication bias. In: Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Sage; 2009. p. 435–52.

    Google Scholar 

  71. Petersen JL, Hyde JS. Gender differences in sexual attitudes and behaviors: a review of meta-analytic results and large datasets. J Sex Res. 2011;48(2/3):149–65.

    Article  PubMed  Google Scholar 

  72. Schroder KE, Carey MP, Vanable PA. Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Ann Behav Med. 2003;26(2):104–23.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Centers for Disease Control and Prevention. HIV in the United States: at a glance. Fast facts. 2015. http://www.cdc.gov/hiv/pdf/statistics_basics_ataglance_factsheet.pdf. Accessed 8 May 2015.

  74. Dermen KH, Cooper ML. Sex-related alcohol expectancies among adolescents: I. Scale development. Psychol Addict Behav. 1994;8(3):152.

    Article  Google Scholar 

  75. George WH, Davis KC, Masters NT, et al. Sexual victimization, alcohol intoxication, sexual-emotional responding, and sexual risk in heavy episodic drinking women. Arch Sex Behav. 2013;42:949–59.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Masters NT, George WH, Davis KC, et al. Women’s unprotected sex intentions: roles of sexual victimization, intoxication, and partner perception. J Sex Res. 2014;51(5):586–98.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Schacht RL, George WH, Heiman JR, et al. Effects of alcohol intoxication and instructional set on women’s sexual arousal vary based on sexual abuse history. Arch Sex Behav. 2007;36(5):655–65.

    Article  PubMed  Google Scholar 

  78. Gilmore AK, Schacht RL, George WH, et al. Assessing women’s sexual arousal in the context of sexual assault history and acute alcohol intoxication. J Sex Med. 2010;7(6):2112–9.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Gordon CM. Alcohol’s influence on requisites for HIV-risk reduction [Dissertation]. Syracuse: Psychology, Syracuse University; 1996

  80. Gordon CM, Carey MP. Alcohol’s effects on requisites for sexual risk reduction in men: an initial experimental investigation. Health Psychol. 1996;15(1):56–60.

    Article  PubMed  CAS  Google Scholar 

  81. MacDonald TK, Fong GT. The effects of alcohol on intentions to use condoms. Paper presented at: 102nd Annual Meeting of the American Psychological Association. Los Angeles, 12–16; 1994

  82. Stoner SA, Norris J, George WH, et al. Women’s condom use assertiveness and sexual risk-taking: effects of alcohol intoxication and adult victimization. Addict Behav. 2008;33(9):1167–76.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Norris J, Stoner SA, Hessler DA, 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 

  84. Zawacki T, Norris J, Hessler DM, et al. Effects of relationship motivation, partner familiarity, and alcohol on women’s risky sexual decision making. Pers Soc Psychol Bull. 2009;35(6):723–36.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Schacht RL. Women’s sexual behavior, attitudes, and alcohol-related sex risk following sexual assault in childhood, adulthood, or both [Ph.D.]. Ann Arbor, University of Washington; 2011.

  86. Stoner SA, George WH, Peters LM, Norris J. Liquid courage: alcohol fosters risky sexual decision-making in individuals with sexual fears. AIDS Behav. 2007;11(2):227–37.

    Article  PubMed  Google Scholar 

  87. Wray TB. Delay discounting and risky sexual intentions: A test of the direct and indirect effects of alcohol intoxication and physiological arousal [Ph.D.]. Ann Arbor, University of South Dakota; 2013.

  88. Wilkinson GS. The wide range achievement test (WRAT3) administration manual. Wilmington: Wide Range; 1993.

    Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Lori A. J. Scott-Sheldon.

Additional information

Meta-Analyses of Alcohol, Sexual Risk Behaviors, and HIV (MASH) team members who collaborated on this project included Angela Colletta, Chiao-Wen Lan, Brittany McCauley, Xinmiao Tan, and Paige Walstrom are given in Appendix.

Electronic supplementary material

Appendix

Appendix

Meta-Analyses of Alcohol, Sexual Risk Behaviors, and HIV (MASH) team members who collaborated on this project included Angela Colletta, Chiao-Wen Lan, Brittany McCauley, Xinmiao Tan, and Paige Walstrom.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scott-Sheldon, L.A.J., Carey, K.B., Cunningham, K. et al. Alcohol Use Predicts Sexual Decision-Making: A Systematic Review and Meta-Analysis of the Experimental Literature. AIDS Behav 20 (Suppl 1), 19–39 (2016). https://doi.org/10.1007/s10461-015-1108-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-015-1108-9

Keywords

Navigation