AIDS and Behavior

, Volume 23, Issue 6, pp 1634–1646 | Cite as

Alcohol Use Patterns and Subsequent Sexual Behaviors Among Women, Men who have Sex with Men and Men who have Sex with Women Engaged in Routine HIV Care in the United States

  • Heidi E. HuttonEmail author
  • Catherine R. Lesko
  • Ximin Li
  • Carol B. Thompson
  • Bryan Lau
  • Sonia Napravnik
  • Kenneth H. Mayer
  • W. Christopher Mathews
  • Mary E. McCaul
  • Heidi M. Crane
  • Rob J. Fredericksen
  • Karen L. Cropsey
  • Michael Saag
  • Katerina Christopoulos
  • Geetanjali Chander
Original Paper


Among people with HIV, alcohol use is associated with increased prevalence of sexual transmission behaviors. We examined associations between alcohol use in the prior year and sexual behaviors approximately six months later among 1857 women, 6752 men who have sex with men (MSM) and 2685 men who have sex with women (MSW). Any alcohol use was associated with increased risk of unsafe vaginal sex among women; anal sex and =>2 anal sex partners among MSM; and anal sex, =>2 anal or vaginal sex partners, and unsafe vaginal sex among MSW. In particular, among women >7 alcoholic drinks/week and among MSW =>5 alcoholic drinks/drinking day increased the likelihood of certain subsequent sexual behaviors. For all groups, especially women, the risk of sex under the influence of drugs/alcohol markedly increased with increases in quantity and frequency of alcohol consumption. These different patterns of drinking and sexual behaviors indicate the importance of tailored counseling messages to women, MSM and MSW.


HIV Alcohol use Sexual risk behaviors Hazardous drinking Binge drinking Women Men who have sex with men MSM Men who have sex with women MSW 




Compliance with Ethical Standards

Conflict of interest

All the authors declared that they have no conflict of interest.

Ethical Approval

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. Institutional review boards at each CNICS site approved the collection and analysis of the clinical data.

Supplementary material

10461_2018_2337_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)
10461_2018_2337_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 13 kb)


  1. 1.
    Crane HM, McCaul ME, Chander G, et al. Prevalence and factors associated with hazardous alcohol use among persons living with HIV across the US in the current era of antiretroviral treatment. AIDS Behav. 2017;21(7):1914–25.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study. J Stud Alcohol. 2002;63(2):179–86.PubMedGoogle Scholar
  3. 3.
    Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Results from the 2015 National Survey on Drug Use and Health: detailed tables. 2-20b. Accessed 23 Aug 2018.
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health. 2010;55(3):159–66.PubMedGoogle Scholar
  6. 6.
    Chander G, Lau B, Moore RD. Hazardous alcohol use: a risk factor for non-adherence and lack of suppression in HIV infection. J Acquir Immune Defic Syndr. 2006;43(4):411–7.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Cook RL, Sereika SM, Hunt SC, Woodward WC, Erlen JA, Conigliaro J. Problem drinking and medication adherence among persons with HIV infection. J Gen Int Med. 2001;16(2):83–8.Google Scholar
  8. 8.
    Monroe AK, Lau B, Mugavero MJ, et al. Heavy alcohol use is associated with worse retention in HIV care. JAIDS. 2016;73(4):419–25.PubMedGoogle Scholar
  9. 9.
    Canan CE, Lau B, McCaul ME, Keruly J, Moore RD, Chander G. Effect of alcohol consumption on all-cause and liver-related mortality among HIV-infected individuals. HIV Med. 2017;18(5):332–41.PubMedGoogle Scholar
  10. 10.
    Justice AC, McGinnis KA, Tate JP, Braithwaite RS, Bryant KJ, Cook RL, Edelman EJ, Fiellin LE, Freiberg MS, Gordon AJ, Kraemer KL, Marshall BD, Williams EC, Fiellin DA. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend. 2016;161:95–104.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Hutton HE, McCaul ME, Chander G, et al. Alcohol use, anal sex, and other risky sexual behaviors among HIV-infected women and men. AIDS Behav. 2013;17(5):1694–704.PubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    Scott-Sheldon LA, Walstrom P, Carey KB, Johnson BT, Carey MP, MASH Research Team. Alcohol use and sexual risk behaviors among individuals infected with HIV: a systematic review and meta-analysis 2012 to early 2013. Curr HIV/AIDS Rep. 2013;10(4):314–23.PubMedPubMedCentralGoogle Scholar
  14. 14.
    George WH, Stoner SA, Norris J, Lopez PA, Lehman GL. Alcohol expectancies and sexuality: a self-fulfilling prophecy analysis of dyadic perceptions and behavior. J Stud Alcohol. 2000;61(1):168–76.PubMedGoogle Scholar
  15. 15.
    Scott-Sheldon LA, Carey KB, Cunningham K, Johnson BT, Carey MP, MASH Research Team. Alcohol use predicts sexual decision-making: a systematic review and meta-analysis of the experimental literature. AIDS Behav. 2016;20(1):19–39.PubMedCentralGoogle Scholar
  16. 16.
    Berry MS, Johnson MW. Does being drunk or high cause HIV sexual risk behavior? A systematic review of drug administration studies. Pharmacol Biochem Behav. 2017;164:125–38.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Crepaz N, Tungol-Ashmon MV, Higa DH, et al. A systematic review of interventions for reducing HIV risk behaviors among people living with HIV in the United States, 1988–2012. AIDS. 2014;28(5):633–56.PubMedPubMedCentralGoogle Scholar
  18. 18.
    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.PubMedGoogle Scholar
  19. 19.
    Scott-Sheldon LAJ, Carey KB, Johnson BT, Carey MP. Behavioral interventions targeting alcohol use among people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Behav. 2017;21(Suppl 2):1–18.Google Scholar
  20. 20.
    Beckett M, Burnam A, Collins RL, Kanouse DE, Beckman R. Substance use and high-risk sex among people with HIV: a comparison across exposure groups. AIDS Behav. 2003;7(2):209–19.PubMedGoogle Scholar
  21. 21.
    Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Rose CD. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11(1):6–16.Google Scholar
  22. 22.
    Golin C, Marks G, Wright J, et al. Psychosocial characteristics and sexual behaviors of people in care for HIV infection: an examination of men who have sex with men, heterosexual men and women. AIDS Behav. 2009;13(6):1129–42.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Fisher JD, Smith L. Secondary prevention of HIV infection: the current state of prevention for positives. Curr Opin HIV AIDS. 2009;4(4):279–87.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Huebner DM, Perry NS. Do behavioral scientists really understand HIV-related sexual risk behavior? A systematic review of longitudinal and experimental studies predicting sexual behavior. Arch Sex Behav. 2015;44(7):1915–36.PubMedGoogle Scholar
  25. 25.
    Marshall BD, Operario D, Bryant KJ, et al. Drinking trajectories among HIV-infected men who have sex with men: a cohort study of United States veterans. Drug Alcohol Depend. 2015;148:69–76.PubMedGoogle Scholar
  26. 26.
    Marshall BD, Shoveller JA, Kahler CW, et al. Heavy drinking trajectories among men who have sex with men: a longitudinal, group-based analysis. Alcohol Clin Exp Res. 2015;39(2):380–9.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Sander PM, Cole SR, Stall RD, 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):815–23.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Pantalone DW, Huh D, Nelson KM, Pearson CR, Simoni JM. Prospective predictors of unprotected anal intercourse among HIV-seropositive men who have sex with men initiating antiretroviral therapy. AIDS Behav. 2014;18(1):78–87.PubMedGoogle Scholar
  29. 29.
    Pantalone DW, Rood BA, Morris BW, Simoni JM. A systematic review of the frequency and correlates of partner abuse in HIV-infected women and men who partner with men. J Assoc Nurses AIDS Care. 2014;25(1):S15–35.PubMedGoogle Scholar
  30. 30.
    Mustanski B. Moderating effects of age on the alcohol and sexual risk taking association: an online daily diary study of men who have sex with men. AIDS Behav. 2008;12(1):118–26.PubMedGoogle Scholar
  31. 31.
    Kiene SM, Simbayi LC, Abrams A, Cloete A, Tennen H, Fisher JD. High rates of unprotected sex occurring among HIV-positive individuals in a daily diary study in South Africa: the role of alcohol use. J Acquir Immune Defic Syndr. 2008;49(2):219–26.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Mimiaga MJ, Reisner SL, Grasso C, et al. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Am J Public Health. 2013;103(8):1457–67.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Yu G, Wall MM, Chiasson MA, Hirshfield S. Complex drug use patterns and associated HIV transmission risk behaviors in an Internet sample of US men who have sex with men. Arch Sex Behav. 2015;44(2):421–8.PubMedGoogle Scholar
  34. 34.
    Kitahata MM, Rodriguez B, Haubrich R, et al. Cohort profile: the Centers for AIDS Research Network of Integrated Clinical Systems. Int J Epidemiol. 2008;37(5):948–55.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Crane HM, Lober W, Webster E, et al. Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Curr HIV Res. 2007;5(1):109–18.PubMedGoogle Scholar
  36. 36.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.Google Scholar
  37. 37.
    Newcombe DA, Humeniuk RE, Ali R. Validation of the world health organization alcohol, smoking and substance involvement screening test (ASSIST): report of results from the Australian site. Drug Alcohol Rev. 2005;24(3):217–26.PubMedGoogle Scholar
  38. 38.
    WHO Assist Working Group. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–94.Google Scholar
  39. 39.
    Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.Google Scholar
  40. 40.
    Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23(11):1397–404.PubMedGoogle Scholar
  41. 41.
    Hernan MA, Robins JM. Causal inference. Boca Raton: Chapman & Hall/CRC; 2016.Google Scholar
  42. 42.
    Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11(5):550–60.PubMedGoogle Scholar
  43. 43.
    Robins JM, Finkelstein DM. Correcting for noncompliance and dependent censoring in an AIDS clinical trial with inverse probability of censoring weighted (IPCW) log-rank tests. Biometrics. 2000;56(3):779–88.Google Scholar
  44. 44.
    Hanley JA, Negassa A, Edwardes MD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157(4):364–75.PubMedGoogle Scholar
  45. 45.
    Hosmer DW, Lemeshow S. Confidence interval estimation of interaction. Epidemiology. 1992;3(5):452–6.PubMedGoogle Scholar
  46. 46.
    Greenland S, Poole C. Invariants and noninvariants in the concept of interdependent effects. Scand J Work Environ Health. 1988;14(2):125–9.PubMedGoogle Scholar
  47. 47.
    Bilal U, McCaul ME, Crane HM, Mathews WC, Mayer KH, Geng E, Napravnik S, Cropsey KL, Mugavero MJ, Saag MS, Hutton H, Lau B, Chander G. Predictors of longitudinal trajectories of alcohol consumption in people with HIV. Alcohol Clin Exp Res. 2018;42(3):561–70.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: contemporary knowledge and future research considerations. Drug Alcohol Depend. 2015;156:1–3.PubMedGoogle Scholar
  49. 49.
    (49) Carvalho FT, Gonçalves TR, Faria ER, Shoveller JA, Piccinini CA, Ramos MC, Medeiros LRF. Behavioral interventions to promote condom use among women living with HIV. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD007844.Google Scholar
  50. 50.
    Braithwaite RS, Conigliaro J, McGinnis KA, Maisto SA, Bryant K, Justice AC. Adjusting alcohol quantity for mean consumption and intoxication threshold improves prediction of nonadherence in HIV patients and HIV-negative controls. Alcohol Clin Exp Res. 2008;32(9):1645–51.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Justice AC, McGinnis KA, Tate JP, et al. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend. 2016;161:95–103.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Skeer MR, Mimiaga MJ, Mayer KH, O’Cleirigh C, Covahey C, Safren SA. Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS Behav. 2012;16(3):676–89.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Livingston M, Callinan S. Underreporting in alcohol surveys: whose drinking is underestimated? J Stud Alcohol Drugs. 2015;76(1):158–64.PubMedGoogle Scholar
  54. 54.
    Lesko CR, Cole SR, Hall HI, et al. The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009–11. Int J Epidemiol. 2016;45(1):140–50.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Heidi E. Hutton
    • 1
    Email author
  • Catherine R. Lesko
    • 2
  • Ximin Li
    • 3
  • Carol B. Thompson
    • 3
  • Bryan Lau
    • 2
  • Sonia Napravnik
    • 4
  • Kenneth H. Mayer
    • 5
  • W. Christopher Mathews
    • 6
  • Mary E. McCaul
    • 7
  • Heidi M. Crane
    • 8
  • Rob J. Fredericksen
    • 8
  • Karen L. Cropsey
    • 9
  • Michael Saag
    • 10
  • Katerina Christopoulos
    • 11
  • Geetanjali Chander
    • 12
  1. 1.Department of PsychiatryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Biostatics Center, Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of MedicineUniversity of North Carolina School of MedicineChapel HillUSA
  5. 5.Department of Global Health and PopulationHarvard School of Public HealthBostonUSA
  6. 6.Department of MedicineUniversity of California, San DiegoSan DiegoUSA
  7. 7.Department of PsychiatryJohns Hopkins University School of MedicineBaltimoreUSA
  8. 8.Department of MedicineUniversity of Washington School of MedicineSeattleUSA
  9. 9.Department of PsychiatryUniversity of Alabama School of MedicineBirminghamUSA
  10. 10.Department of MedicineUniversity of Alabama School of MedicineBirminghamUSA
  11. 11.Department of MedicineUniversity of California, San Francisco School of MedicineSan FranciscoUSA
  12. 12.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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