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Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV

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Abstract

While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46–1.85); OR 1.65 (95% CI 1.14–2.39); OR 2.88 (95% CI 2.01–4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.

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Acknowledgements

This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (T32-AA007583, PI: Leonard). The sponsor had no role in the study design, writing of the report, or collection, analysis, and interpretation of the data.

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Authors and Affiliations

  1. Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA

    Sarahmona M. Przybyla & Gabriela Krawiec

  2. Department of Psychology, Rochester Institute of Technology, Rochester, NY, USA

    Stephanie A. Godleski

  3. Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, USA

    Cory A. Crane

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Appendix: Search Terms

Appendix: Search Terms

For PubMed, search terms were: (“alcohol drinking”[mh] OR liquor OR alcohol[tiab] OR “substance use”[tiab] OR binge[tiab] OR drink*[tiab]) AND AIDS[sb] AND (sex[tiab] OR condom*[tiab] OR “unprotected sex”[tiab] OR “unsafe sex”[tiab] OR “risky sex”[tiab] OR sexual partner*[tiab] OR sexual behavior[tiab] OR “condomless sex”[tiab] OR “serodiscordant”[tiab] OR discordant[tiab] OR intercourse[tiab]).

For EMBASE, search terms were: (“alcohol drinking” OR liquor OR alcohol OR “substance use” OR binge OR drink*) AND (AIDS OR HIV OR “acquired immune deficiency syndrome” OR “Human immunodeficiency virus”) AND (sex OR condom* OR “unprotected sex” OR “unsafe sex” OR “risky sex” OR sexual partner* OR sexual behavior OR “condomless sex” OR “serodiscordant” OR discordant).

For PsycINFO, search terms were: AB (hiv OR AIDS OR human immunodeficiency virus OR acquired immune deficiency syndrome) AND AB (alcohol OR drink* OR binge OR substance use) AND (sex OR unprotected OR unsafe OR risk* OR “sexual partner*” OR “condomless sex” OR intercourse OR condom* OR serodiscordant OR discordant).

For CINAHL, search terms were: S1: AB hiv OR AB aids OR AB human immunodeficiency virus OR AB acquired immune deficiency syndrome; S2: AB alcohol OR AB binge OR AB drink* OR AB substance use; S3: (S1 AND S2); S4: (S3) AND AB sex OR AB unprotected OR AB unsafe OR AB risk* OR AB sexual partner* OR AB “condomless sex” OR AB condom* OR AB serodiscordant OR AB discordant OR intercourse; S5: (S3 AND S4).

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Przybyla, S.M., Krawiec, G., Godleski, S.A. et al. Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV. Arch Sex Behav 47, 1351–1366 (2018). https://doi.org/10.1007/s10508-017-1050-1

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  • DOI: https://doi.org/10.1007/s10508-017-1050-1

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