Sex and the risk of HIV infection: the role of alcohol

Operational Sex Ratio Predicts Binge Drinking Across U.S. Counties

Previous research suggests that binge drinking among young men serves as a "costly signal" to potential mates, such that the binge drinker is capable of bearing the harmful consequences of alcohol consumption. Here, we propose that binge drinking among young adults is conditionally dependent upon the signaler's willingness to take risks, which is influenced by the local operational sex ratio (OSR). Using archived binge drinking estimates from 2009 to 2012 and Census Bureau records of OSRs, we tested the relationship between OSR and binge drinking rates at the county level across 3,143 U.S. counties against hypotheses drawn from evolutionary theory. Results from our mixed-effects models revealed that a higher overall OSR (i.e., more eligible men compared to women) was associated with higher male binge drinking rates but lower female binge drinking rates. A higher OSR particularly in the 20-29 and 50+ age groups predicted higher male binge drinking rates but lower female binge drinking rates. Our findings generally support predictions derived from evolutionary theory and suggest that binge drinking may function as a costly sexual signal, conditionally regulated by age and the local sex ratio.

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.

When Women Imbibe

The present research examines how alcohol, or even the illusion of imbibing alcohol, affects women's perceived self-efficacy for avoiding HIV. Women ( N= 82) were randomly assigned to one of four conditions in a 2 (alcohol or no alcohol) × 2 (expect alcohol or not) balanced placebo design. After consuming alcoholic or nonalcoholic beverages, participants assessed their self-efficacy for HIV risk prevention. Both alcohol consumption and alcohol expectancy increased women's confidence that they could detect whether a potential partner was HIV positive simply by interacting with the potential partner.

Alcohol use and sexual risks: use of the Alcohol Use Disorders Identification Test (AUDIT) among female sex workers in China

The association between alcohol use and sexual risks among female sex workers (FSWs) has been insufficiently studied. This article reports a cross-sectional study of the relationship between alcohol use risk, measured by the Alcohol Use Disorders Identification Test (AUDIT), and sexual risk behaviors among 1,022 FSWs in Guangxi, China. Bivariate analysis showed that FSWs at higher AUDIT levels tended to have earlier sexual initiation, became involved in the sex trade at a younger age, and were more vulnerable to sex under the influence of alcohol. Multivariate analysis revealed an independent association of problem drinking with both unprotected sex and a history of sexually transmitted diseases (STDs). Alcohol use in commercial sex shall be considered as an occupational hazard that requires immediate intervention. Future longitudinal studies are needed to confirm the association between alcohol use and sexual risks among this most-at-risk population.

Risk Estimation and Sexual Behaviour: A Longitudinal Study of 16- 21-year olds

The relationships among risk estimation, impulsivity and patterns of sexual risk-taking in 16-21-year-olds are examined. A sample of 236 males and 340 females completed a postal questionnaire on three occasions at annual intervals. They reported their assessment of their own risk of HIV infection, the risk of HIV infection associated with six types of sexual activity, their likelihood of engaging in each of these activities, and whether they had participated in these activities between the first and second data collections. Impulsivity was indexed using a standard test. The data support the conclusion that strong social representations of sexual risks exist which do not markedly change during late adolescence. These risk estimates predict behavioural expectations, primarily for the riskiest behaviours, and for females (actual participation in vaginal sex); but for males, risk estimates fail to predict behaviour. Evidence here for a rational model of individual decision- making in relation to sexual risk- taking is sparse. Impulsivity was not a good predictor of expected or actual patterns of sexual behaviour, though higher impulsivity was associated with having more sexual partners and, in females, with starting to have sex younger.

Risk factors of alcohol problem drinking among female bar/hotel workers in Moshi, Tanzania: a multi-level analysis

There is limited information on alcohol problem drinking, which has been associated with sexually transmitted infections (STIs), including HIV, among female bar/hotel workers in Africa. This paper aimed to identify the individual- and facility-level determinants of alcohol problem drinking in this setting. Problem drinking was defined based on the CAGE alcohol screening scale. Multi-level logistic regression was used to identify individual- and facility-level factors associated with problem drinking. About 37.3% of women (N = 1629) were classified as having probable or definite problem drinking. In multi-level analysis, main characteristics associated with problem drinking included: having 3-4 partners in the past 5 years compared to having 1-2, used a condom in the last sex comparing to non-use, history of transactional sex, having more pregnancies, and facilities whose employees do not live on the premises. Interventions which combine alcohol and sexual risk reduction counseling are urgently needed in this population.

Adapting and applying a multiple domain model of condom use to Chinese college students

This study adapts a multiple domain model (MDM) to explain condom use among a sample of sexually active Chinese college students. A cross-sectional survey was conducted and structural equation modeling was used to test the proposed model. Preparatory behaviors, theory of reasoned action (TRA)/theory of planned behavior variables, impulsivity, length of relationship, and alcohol use were significant direct predictors of condom use. The results suggest that MDM can provide a better understanding of heterosexual condom use among Chinese youth, and help in the design of HIV-preventive and safer sex interventions in China.

Risk factors for syphilis and prevalence of HIV, hepatitis B and C among men who have sex with men in Beijing, China: implications for HIV prevention

To examine the correlates for syphilis and the prevalence for HIV, hepatitis B, hepatitis C among men-who-have-sex-with-men (MSM) in Beijing, China. A total of 541 MSM was recruited using peer-referral, community outreach, and Internet. Questionnaire-based interviews provided information including, demographics, sexual and other risk behaviors. HIV prevalence was 4.8%, syphilis 19.8%, HCV 0.4% and HBsAg 6.5%. The median number of lifetime male sex partners was ten. In the past 3 months, 20.7% drank alcohol > or =1 times per week. In the past month, 21.3 and 14.6% had unprotected anal intercourse with regular and casual male sex partners, respectively. Syphilis infection was associated with less education, alcohol use, finding male sex partners through bathhouses/public washrooms/parks, and diagnoses of sexual transmitted diseases (STDs). Syphilis is now epidemic among Beijing's MSM. Prevention efforts are urgent as HIV prevalence is already near 5%. Education, condom promotion, STD control, and alcohol-related intervention are needed urgently.

Relations among religiousness, spirituality, and sexual practices

Although religiousness is commonly associated with limited sexual activity, little is known about spirituality's unique effect. Study aims involved measuring spirituality's unique affect on young adults' sexual practices (frequency of sex, number of sexual partners, and condom use) and determining whether spirituality adds significant increment over well-established predictors. Three hundred fifty-three (61% female) heterosexual young adults aged 17 to 29 completed this cross-sectional, self-report questionnaire study. Hierarchical regression analyses demonstrated spirituality is positively associated with participants' number of sexual partners and frequency of sex without a condom. Spirituality contributed to the prediction of participants' number of partners and condom use above and beyond the variance accounted for by religiousness, alcohol use, and impulsivity. A moderating effect for gender was found. Spirituality appears to have a unique and strong association with the sexual practices of young adults, particularly women, and should be assessed in future studies of young adults' sexual practices.

Psychological and behavioural factors associated with sexual risk behaviour among Slovak students

Background

Knowledge about the prevalence of sexual risk behaviour (SRB) in adolescence is needed to prevent unwanted health consequences. Studies on SRB among adolescents in Central Europe are rare and mostly rely on a single indicator for SRB. This study aims to assess the association of behavioural and psychological factors with three types of SRB in adolescents in Central Europe.

Methods

We obtained data on behavioural factors (having been drunk during previous month, smoking during previous week, early sexual initiation), psychological factors (self-esteem, well-being, extroversion, neuroticism, religiousness), and SRB (intercourse under risky conditions, multiple sexual partners, and inconsistent condom use) in 832 Slovak university students (response 94.3%).

Results

Among those with sexual experience (62%), inconsistent condom use was the most prevalent risk behaviour (81% in females, 72% in males). With the exception of having been drunk in males, no factor was associated with inconsistent condom use. Regarding the other types of SRB, early sexual initiation was most strongly associated. In addition, other, mostly behavioural, factors were associated, in particular having been drunk.

Conclusion

Results suggest that behavioural factors are more closely related to SRB than psychological factors. Associations differ by type of SRB and gender but offer few clues to target risk groups for inconsistent condom use. Results show a high need for health-promotion programmes in early adolescence that target SRB in conjunction with other health risk behaviours such as alcohol abuse.

HIV rates and risk behaviors are low in the general population of men in Southern India but high in alcohol venues: results from 2 probability surveys

BACKGROUND

As the HIV epidemic continues to expand in India, empiric data are needed to determine the course of the epidemic for high-risk populations and the general population.

METHODS

Two probability surveys were conducted in Chennai slums among a household sample of men and alcohol venue patrons ("wine shops") to compare HIV and other sexually transmitted disease (STD) prevalence and to identify STD behavioral risk factors.

RESULTS

The wine shop sample (n = 654) had higher rates of HIV and prevalent STDs (HIV, herpes simplex virus 2 [HSV-2], syphilis, gonorrhea, or chlamydia) compared with the household sample (n = 685) (3.4% vs. 1.2%, P = 0.007 and 21.6% vs. 11.8%, P < 0.0001, respectively). High-risk behaviors in the household sample was rare (<4%), but 69.6% of wine shop patrons had >2 partners, 58.4% had unprotected sex with a casual partner, and 54.1% had exchanged sex for money in the past 3 months. A multivariate model found that older age, ever being married, ever being tested for HIV, and having unprotected sex in the past 3 months were associated with STD prevalence in wine shop patrons.

CONCLUSIONS

Prevalent HIV and STDs, and sexual risk behaviors are relatively low among the general population of men. We found that men who frequent alcohol venues practice high-risk behaviors and have high rates of STDs, including HIV, and may play an important role in expanding the Indian epidemic.

The co-occurrence of substance use and high-risk behaviors

Study findings suggest that alcohol and methamphetamine use heighten the risk for violence, multiple sexual partners, and unprotected sexual intercourse. Although the odds of engaging in risky behaviors increased dramatically with alcohol and methamphetamine use, the majority of subjects did not become involved in high risk behaviors even though they used alcohol and illicit drugs.

Effects of alcohol, expectancies, and partner type on condom use in college males: event-level analyses

Sexually active heterosexual college males (N = 93) provided data on over 1,500 sexual encounters. Alcohol consumption, expectancies about alcohol's impact on condom use, and partner type each contributed to use of a condom. Partner type covaried with alcohol consumption and condom use. The men consumed significantly more alcohol with new partners, followed by casual partners, and then by regular partners. In contrast, they were more likely to use condoms with new partners than with casual or regular partners. Drinking alcohol decreased condom use, but only with casual partners. Expectancies about alcohol's disinhibiting sexual effects decreased condom use as well. These data suggest that alcohol consumption does decrease condom use, particularly with casual partners and when drinkers believe alcohol alters sexual disinhibition. Improving knowledge about HIV and other STD transmission in casual partners and challenging expectancies about alcohol as a sexual disinhibitor could help decrease the spread of HIV and other STDs.

The relationship between alcohol use and risk-taking sexual behaviors in a large behavioral study

BACKGROUND

Sexually transmitted infections (STIs) present a continuing challenge to the efforts to prevent disease in the military. Since the degree of high-risk sexual behavior is a primary determinant for acquiring STIs, the identification of personality traits or situations associated with such behavior is of special interest.

METHODS

Data for this study were obtained from the 1998 Department of Defense Survey of Health Related Behaviors Among Military Personnel. The survey instrument was a self-administered questionnaire that was conducted using a stratified, two-stage, two-phase probability design to obtain representative samples of U.S. active duty personnel worldwide.

RESULTS

More frequent episodes of alcohol intoxication were associated in a dose-dependent manner with an increased risk of having more sexual partners in the previous 12 months. Men and women who experienced intoxication more than 3 days per week were, respectively, 4.55 and 6.18 times more likely to have more than one sexual partner in the previous year.

CONCLUSIONS

This study is based on retrospective self-report and may be subject to recall bias as well as information bias due to the sensitive nature of the subject matter. However, the results are compatible with a personality-based hypothesis, in which individuals with certain sensation-seeking tendencies may incur an increased risk for sexually transmitted infections.

Scope of HIV risk and co-occurring psychosocial health problems among young adults: violence, victimization, and substance use

PURPOSE

This study examines the co-occurrence of sexual risk with violence, victimization, risky substance use, and drug-related problems among young adults.

METHODS

Data were collected from 3392 young adults drawn from California and Oregon as youth, as part of the RAND adolescent panel study. Logistic regression analyses were used to test differences in psychosocial health problems for participants at high, moderate, and low sexual risk, overall, and by gender.

RESULTS

Nearly 80% of young adults exhibited some degree of sexual risk. Both moderate (56%) and high (22%) HIV risks were associated with multiple forms of drug use, drug-related problems, violence and victimization. Males and females had similar relative risk profiles, but females reported higher rates of victimization in the form of partner abuse and sexual coercion. Over 80% of those at high sexual risk exhibited psychosocial health problems in at least 2 other areas.

CONCLUSIONS

Sexual risk-taking is widespread among young adults and typically co-occurs with other psychosocial health problems. Interventions designed for young adults at high sexual risk should take into account their additional psychosocial problems; broad media campaigns may be useful for those at moderate risk.

Alcohol abuse, gender-based violence and HIV/AIDS in Botswana: establishing the link based on empirical evidence

The existence of gender-based violence has been a source of concern within the public and private sectors as well as civil society organisations in Botswana. The present study investigated the link between alcohol abuse, gender-based violence and HIV/AIDS. Further, it attempted to unravel the often unquestioned assumption that gender-based violence is perpetuated by cultural practices. Case study qualitative methodology was used to gather data for the study. A sample of 20 cases was selected purposively from five women's non-governmental organisations. In addition, in-depth interviews were conducted with agency coordinators, social workers, police commanders and police officers. The findings of the study revealed a relationship between alcohol abuse and gender-based violence, which makes victims vulnerable to HIV infection. From the findings, it is recommended that gender-based programmes be established to sensitise people about the link between alcohol abuse, gender-based violence and HIV/AIDS.

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.

Gender differences in predicting high-risk drinking among undergraduate students

The purpose of this study was to examine gender differences in college students' high-risk drinking as measured by an estimated blood alcohol concentration (eBAC) based on gender, height, weight, self-reported number of drinks, and hours spent drinking. Using a developmental/contextual framework, high-risk drinking is conceptualized as a function of relevant individual characteristics, interpersonal factors, and contextual factors regularly mentioned in the college drinking literature. Individual characteristics include race, gender, and age; interpersonal characteristics include number of sexual partners and having experienced forced sexual contact. Finally, contextual factors include Greek membership, living off-campus, and perception of peer drinking behavior. This study is a secondary data analysis of 1,422 students at a large university in the Southeast. Data were gathered from a probability sample of students through a mail survey. A three-step hierarchical logistic regression analysis showed gender differences in the pathway for high-risk drinking. For men, high-risk drinking was predicted by a combination of individual characteristics and contextual factors. For women, interpersonal factors, along with individual characteristics and contextual factors, predicted high-risk drinking, highlighting the importance of understanding female sexual relationships and raising questions about women's risk-taking behavior. Implications for prevention and assessment are discussed.

Inconsistent condom use among HIV-infected patients with alcohol problems

BACKGROUND

Unsafe sexual behavior is common among persons with negative or unknown HIV status and it is augmented by alcohol use in some populations. We examined the association between alcohol consumption level (abstinent, moderate, at-risk) and inconsistent condom use in a cohort of HIV-infected individuals with a history of alcohol problems.

METHODS

Subjects (n=345) had up to seven structured interviews over 36 months. Identical questions on alcohol consumption and inconsistent condom use were asked at each interview. We used generalized estimating equations (GEE) multivariate logistic regression for repeated measurements analysis. We adjusted for potential confounding factors and explored possible interactions.

RESULTS

At baseline, 132 (38%) participants reported inconsistent condom use. We detected a significant (P=0.0002) interaction between alcohol consumption and injection drug use (IDU) variables. Among active injection drug users, at-risk drinking was associated with inconsistent condom use, adjusted odds ratio (OR; 95% confidence interval) 4.3 (1.5, 12.2). Among those who did not inject drugs, at-risk drinking and inconsistent condom use were not associated, 0.7 (0.4, 1.3). Inconsistent condom use was more common among women, those believing condoms to be 'a hassle', and persons living with a partner.

CONCLUSION

In HIV-infected drug-injecting individuals, excessive use of alcohol is associated with unsafe sexual practices.

Expectancies specific to condom use mediate the alcohol and sexual risk relationship

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.

Binge drinking among female Veterans Affairs patients: prevalence and associated risks

This study evaluated the prevalence and associated risks of binge drinking, defined as having > or = 4 drinks on an occasion in the past year, in a female patient population. Of 1,259 female Veterans Affairs patients surveyed, 780 reported drinking alcohol in the past year, and 305 (24% of respondents, 39% of drinkers) reported binge drinking in the past year; 84 (11% of drinkers) had done so monthly or more often. Age-adjusted logistic regression analyses indicated that women who reported past-year binge drinking monthly or more often reported significantly increased odds of morning drinking (odds ratio [OR] = 40.3), others worrying about their drinking (OR = 38.6), arguments after drinking (OR = 13.5), hepatitis or cirrhosis (OR = 3.1), frequent injuries (OR = 2.6), smoking (OR = 3.7), drug use (OR = 22.2), and multiple sexual partners (OR = 4.6).

Increasing the practice of health promotion initiatives by licensed premises

Licensees of all licensed premises in the Hunter Region of New South Wales, Australia, were offered free services to encourage adoption of health promotion initiatives relating to responsible service of alcohol, environmental tobacco smoke, healthy food choices, breast and cervical cancer prevention, and the prevention of HIV/AIDS. A total of 239 premises participated in the follow-up survey. Increases in prevalence ranged between 11% and 59% for alcohol-related initiatives. The prevalence of smoke-free areas and healthy food choices increased from 32% to 65% and 42% to 96%, respectively, and the provision of cancer prevention information increased from 3% to 59%. Licensed premises represent a particularly challenging sector for health promotion practitioners to work in. The results of this study suggest that the adoption of health promotion initiatives by licensed premises can be increased. A considerable opportunity therefore exists for health promotion practitioners to become more actively involved in facilitating the adoption of such initiatives in this setting.

High-risk sexual behaviors in a context of substance abuse: a focus group approach

Clinical studies show that heavy and dependant substance users engage with high frequency in high-risk sexual behaviors. To better understand the dynamics of unsafe sexual practices among alcoholics or non-intravenous drug users (IDUs), a series of focus group discussions was conducted with 26 single, sexually active men and women in treatment for substance abuse. Results show that unsafe sexual practices in this subgroup may be explained by three factors: (1) intoxication, (2) negative perceptions of condoms, and (3) cognitive distortions. Furthermore, men's negative perceptions of condoms and women's concerns about not opposing men by fear of being rejected seem to be synergetic to bringing about the negative outcome. Implications for clinical practices are discussed.

Prevalence and acceptability of public health initiatives in licensed premises

OBJECTIVES

To determine the prevalence and acceptability of public health initiatives in licensed premises.

METHODS

Licensees/managers of all 333 licensed premises in the Hunter Region of NSW were interviewed to assess the practice of, and interest in undertaking public health initiatives relating to: responsible service of alcohol; environmental tobacco smoke; healthy-food choices; skin, breast and cervical cancer prevention; and the prevention of HIV/AIDS.

RESULTS

Ninety eight percent of contacted premises participated in the study. Approximately two-thirds of premises reported having a responsible service of alcohol policy and training their staff in responsible service. One third of premises reported the provision of healthy food choices and smoke-free areas. Initiatives concerned with the prevention of cancer and HIV/AIDS were practised by less than 25% of premises. Between 41% and 85% of premises expressed an interest in undertaking all but two initiatives. Almost all interested premises accepted the offer of resources to facilitate adoption of public health initiatives.

CONCLUSIONS

The study suggests that licensed premises are already involved in a number of public health initiatives, and that they appear willing to consider the introduction of a wide range of such initiatives.

IMPLICATIONS

The prevalence of public health initiatives in licensed premises, and the extent of interest expressed by licensees/managers in undertaking such initiatives suggests that both a need and an opportunity exist for public health and other agencies to be more actively involved in disseminating appropriate services in this setting.

Alcohol use and sexual behavior among "Black" adolescents

This paper reports on findings collected from 1993-1995 from an ethnographic interview study that investigated whether a pattern of HIV-related risk behavior varies across subpopulations of minority adolescents by studying behaviors and perceptions of risk for HIV infection among two ethnic groups of 314 Black adolescents-African-American and Haitian Blacks. Of those who had sex within the past 6 months and were current drinkers, 69% said they did not have sex after drinking. Although many of the adolescents believe that drinking has a disinhibitory effect and may be a factor in nonuse of condoms, alcohol is but one element in a constellation of factors related to sexual intercourse and condom use.

Individual risk factors for adolescent substance use

Identification of risk factors that influence initiation and escalation of drug use in the adolescent population is the approach which has gained currency. The wide array of risk factors involved can be condensed into three main domains: constitutional predisposition, environmental factors (family and peers) and life events. This has been complemented by a surging interest in protective factors. Recent research evidence has been helpful in defining the direction and strategy of prevention efforts. A definite trend has emerged in that family influences are being increasingly targeted. The rationale for this shift seems to come from the observation that home environment, family relationships and parenting styles are almost always involved as risk factors, mediators or as protective factors.

[Is there a correlation between alcohol drinking and sexual risk taking? A discussion of conceptional aspects exemplified by HIV infected men with homosexual behavior]

Does sexual risk behavior and alcohol consumption correlate or is sexual risk behavior due to alcohol consumption? These questions are controversially discussed in the literature. We investigated whether the two different methodological concepts (global association, e.g. not specific to the critical incident and situational association) cause these discrepancies in a sample of 64 HIV-infected gay men. There was no significant global association between alcohol consumption and sexual risk behavior. Using the situational approach, drinking was not related to sexual risk behavior. The combination of these two concepts may help to identify persons at risk.

Safer sex behavior and alcohol consumption. Research Group of the Swiss HIV Prevention Study

To test the hypothesis that safer sex procedures are less consistently observed by persons under the influence of alcohol, data from the Swiss human immunodeficiency virus (HIV) Prevention Study (HIPS) were evaluated. HIPS is a large prospective cohort study involving 724 HIV-negative and mainly heterosexual subjects who entertain casual sexual contacts. Of the 724 participants, 36% reported that they had had sex while under the influence of alcohol. Of this group, 31% indicated that safer sex procedures were neglected owing to the influence of alcohol. No significant differences with regard to unprotected sexual intercourse were found between subjects who combine sex and alcohol and those who do not. The same was found to be true among subjects with different levels of general alcohol consumption. However, a significant correlation was found between the intensity of alcohol consumption (i.e., the quantity of alcohol intake per sitting) and the incidence of unprotected sexual intercourse. These findings show that the relationship between alcohol consumption and safer sex is complex; they also emphasize the need for preventive efforts to reinforce safer sexual behavior, for example through individual counseling of persons at risk for HIV-infection.

Characteristics of African-Americans with multiple risk factors associated with HIV/AIDS

Multiple risk factors in young African-Americans have tremendous implications for the spread of AIDS. Two hundred forty-two heterosexual college students were classified as having low, moderate, or high risk for HIV infection based upon their self-reported sexual practices. Results indicated that subjects differed in AIDS knowledge and attitudes toward condoms with respect to both Gender and Risk level, with men and High Risk individuals being less knowledgeable and having more negative attitudes than their female and Low Risk counterparts respectively. Interaction effects revealed that High Risk men were less knowledgeable than both Low Risk men and High Risk women. High Risk men as well as High and Low Risk women reported more anger surrounding condom usage than Low Risk men. Low perceptions of vulnerability for AIDS were reflected in the entire sample. The implications of this study for primary prevention and future research are discussed.

Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention

Recent reports have suggested that the use of alcohol or drugs is related to sexual behavior that is high risk for HIV infection. If substance use leads to unsafe sexual activity, understanding the dynamics of this relationship can contribute to research and preventive and educational efforts to contain the spread of AIDS. In this article, we review research on the relationship between substance use and high-risk sexual behavior. We then consider the inherent limitations of the research designs used to study this relationship, outline some methodological concerns including measurement and sampling issues, and comment on causal interpretations of correlational research findings. We end with a consideration of potential avenues for future research and a discussion of implications of these findings for current AIDS prevention policies.