Depressive Symptoms, Acute Alcohol Intoxication, and Risk Rationale Effects on Men's Condom Use Resistance

Coercive Condom Use Resistance: A Scoping Review

Objective

Sexual aggression research has recently expanded to include empirical investigations of coercion during condom negotiation and use. This scoping review presents and discusses peer-reviewed, quantitative, English-language studies conducted on coercive condom use resistance (CUR) behavior and intentions.

Method

Our systematic literature search yielded 20 articles that assessed coercive CUR perpetration behaviors or intentions and met other inclusion criteria. Data on rates and correlates of coercive CUR behavior and intentions were extracted.

Results

Identified studies used varied methods including cross-sectional surveys, 3-month longitudinal studies, and alcohol administration experiments, primarily with young adult samples. Overall, results indicated that a substantial minority (up to 42.6%) of sampled individuals endorsed lifetime perpetration of coercive CUR, with men reporting higher prevalence of coercive CUR perpetration than women. The majority of studies (70%) assessed coercive CUR through the Condom Use Resistance Tactics Scale (Davis et al., 2014). Although correlates largely differed by gender, alcohol-related variables emerged as risk factors for both men and women.

Conclusions

Burgeoning evidence indicates that coercive CUR is relatively common, and, particularly for men, risk factors are similar to those associated with sexual aggression more generally. Review findings demonstrate that continued research in this area is warranted and should expand to include more diverse populations, to consider other risk factors and sequelae, and to utilize novel methodological approaches.

The Effect of State, Trait, and Situational Factors on Young Men's Coercive Condom Use Resistance

Coercive Condom Use Resistance (CUR) is a significant problem, associated with increases in STIs, unplanned pregnancy, feelings of betrayal, and a loss of sexual autonomy. Furthermore, young men are much more likely to perpetrate coercive CUR than young women. Thus, the present study sought to examine the past experiences, trait characteristics, and state emotions which may precede coercive CUR perpetration intentions, including alcohol intoxication, childhood emotional abuse, trait impulsivity, sexual sensation seeking, state impulsivity, and state anxiety, using an alcohol administration procedure. Young, single, non-problem drinking, and sexually active men who have sex with women from the United States (N = 297; 66% White, 9.4% Black, 10.7% Multi-racial, 5.1% Asian, 1.0% Native American, 1.0% Pacific Islander, and 10.4% Hispanic or Latino) were recruited for participation. They were randomly assigned to either receive alcohol or remain sober before projecting themselves into a hypothetical sexual scenario with a woman who asked to use a condom. Results showed that greater levels of childhood emotional abuse were associated with increased trait impulsivity and sexual sensation seeking, and that sexual sensation seeking was associated with increased state impulsivity and subsequent anxiety during the scenario. Finally, alcohol intoxication moderated the relationship between state anxiety and coercive CUR such that state anxiety was positively associated with coercive CUR among intoxicated men only. Findings suggest that interventions targeting coercive CUR behavior may be improved by focusing on men who have experienced childhood trauma, as well as their alcohol consumption and in-the-moment experiences of impulsivity and anxiety.

Drug and Alcohol Use with Condomless Anal Sex among Men Who Have Sex with Men in Melbourne, Australia: A Retrospective Data Analysis from 2011 to 2017

Rises in condomless anal sex among men who have sex with men (MSM) have been reported over the last decade but there is less certainty about the role that drugs, alcohol, play in this change. We examined the changes in drug and alcohol use among 22,255 MSM reporting condomless anal sex at Melbourne Sexual Health Centre in 2011-2017. There was a 7% annual increase in using drugs before and/or during condomless anal sex but a 3% annual reduction in condomless anal sex while drunk. MSM taking PrEP were more likely to report condomless anal sex with drug use (AOR: 1.21; 95%CI: 1.07-1.37) and alcohol use (AOR: 1.29; 95%CI: 1.14-1.46) compared with MSM not taking PrEP.

The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda

HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.

Sexual Aggression Analogues Used in Alcohol Administration Research: Critical Review of Their Correspondence to Alcohol-Involved Sexual Assaults

BACKGROUND

Alcohol administration studies are crucial because causal questions about alcohol's role in human behavior can only be answered through experimental research that randomly assigns participants to drink conditions. The primary goal of this review was to catalogue the characteristics of experimental analogues used in alcohol administration research to assess men's sexual aggression proclivity and evaluate the extent to which they represent the scope of alcohol-involved sexual aggression. Although this review focuses on sexual aggression analogues, the identified methodological issues are relevant to a wide range of alcohol administration studies.

METHODS

Online databases were searched for published studies that randomly assigned participants to drink conditions and assessed participants' sexual aggression proclivity with an experimental analogue. Characteristics of the analogues were coded by both authors.

RESULTS

Seventeen studies were identified that used 12 unique experimental analogues. All of the analogues depicted a completed or potential sexual assault in an apartment between a male perpetrator and female victim who did not know each other well. This information was presented in written (n = 7), audio (n = 1), video (n = 3), or virtual simulation (n = 1) format. Sexual aggression proclivity was measured through participants' self-reports (n = 10) and behavioral responses (n = 2). Perpetrators primarily used physical force which the woman verbally and physically resisted. Only one analogue depicted behavioral signs of the woman's alcohol impairment; none included signs of the man's alcohol impairment.

CONCLUSIONS

These analogues were designed to address important theoretical questions; however, they do not represent the full range of alcohol-involved sexual assaults. This hampers the development of evidence-based prevention and treatment programs because we do not know whether these findings generalize to other types of sexual assaults (e.g., with incapacitated victims, within serious relationships, with sexual and other gender minorities). Funding agencies need to support more alcohol administration research in order to provide a strong foundation for the development of effective interventions.

A Prospective Examination of Men's Condom Use Resistance: Event-Level Associations with Sexual Aggression, Alcohol Consumption, and Trait Anger

Burgeoning research suggests that men engage in a variety of coercive and non-coercive tactics to avoid condom use (condom use resistance; CUR), suggesting a risk nexus regarding sexual risk and sexual aggression (SA). Laboratory-based research has found that acute alcohol intoxication is associated with CUR; however, no study has examined event-level associations among alcohol consumption, SA history, and CUR or the moderating effects of trait anger. Non-problem drinking young adult men who have sex with women (N = 430) completed a background survey and follow-up assessments regarding their sex events and alcohol consumption over three months. CUR was reported in 113 sex events; 6.2% of these involved SA and 40.7% involved alcohol consumption. Generalized estimating equations demonstrated that men with more severe SA histories were more likely to perpetrate CUR. Men lower in trait anger were more likely to perpetrate CUR the more they increased above their typical level of alcohol consumption, whereas men higher in trait anger were similarly likely to perpetrate CUR regardless of their alcohol consumption. Results suggest that men with greater SA histories and high trait anger are at increased risk of perpetrating CUR, and that risk of CUR increases among other men the more they increase their alcohol consumption beyond their average.

Alcohol and Sexual Health Behavior: "What We Know and How We Know It"

Alcohol, despite salutary associations with sexuality, has been implicated in sexual health problems. This review examines the relationship between alcohol and outcomes related to sexual health. Methodological considerations limiting causal assertions permissible with nonexperimental data are discussed, as are advantages of experimental methods. Findings from laboratory experiments are reviewed evaluating causal effects of acute alcohol intoxication on a variety of outcomes, including sexual arousal, sexual desire, orgasm, and sexual risk behaviors related to sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Several variables exerting mediating and moderating influences are identified. It is concluded that acute alcohol intoxication is capable of exerting a causal impact on multiple constituent components of sexual responding related to sexual health. Both alcohol expectancy and alcohol myopia theories have been supported as explanations for these causal effects. Furthermore, for sexual risk behavior, noteworthy recent developments include research highlighting the importance of women's sexual victimization history and men's condom use resistance. Limitations and implications associated with this body of research are also discussed.