Background Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by aggregating findings across studies and examining potential moderators. Methods Literature searches identified 40 qualifying studies totaling over 25,000 participants. Studies were coded on several methodological variables. Results In the combined analysis, alcohol drinkers were approximately 50–60% as likely to be classified as adherent [OR = 0.548, 95% CI: 0.490–0.612] compared to abstainers (or those who drank relatively less). Effect sizes for problem drinking, defined as meeting the National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for at-risk drinking or criteria for an alcohol use disorder, were greater [OR = 0.474, 95% CI = 0.408–0.550] than those reflecting any or global drinking [OR = 0.604, 95% CI = 0.531–0.687]. Several variables moderated the alcohol-adherence association. Conclusions Results support a significant and reliable association of alcohol use and medication nonadherence. Methodological variables appear to moderate this association and could contribute to inconsistencies across studies. Future research would benefit from efforts to characterize theoretical mechanisms as well as mediators and moderators of the alcohol-adherence association.

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To the extent that men who have sex with men (MSM) use the Internet, it serves as a promising medium for behavioral intervention. The present study sought to investigate the efficacy of a web-based skills training and motivational intervention in a randomized trial (N = 112) conducted completely online. After a detailed assessment, MSM were randomly assigned to an online intervention or a control website. The experimental intervention consisted of risk assessment and feedback, motivational exercises, skills training, and education while the control intervention focused on relaxation skills. Follow-up data were collected 3 months later and analyzed with repeated-measures MANOVA. Although both groups evidenced across-the-board reductions in unprotected sex, perhaps due to the detailed assessment, the experimental group showed greater reductions with the riskiest partners, those of positive or unknown serostatus. Thus, this study gives preliminary evidence that a brief web-based intervention offering cognitive behavioral skills training and motivational enhancement can effectively reduce sexual risk in MSM.

Three experiments supported the idea that alcohol fosters sexual risk-taking in men and women, in part, through its effects on sexual arousal. In Experiment 1, increasing alcohol dosage (target blood alcohol levels of .00, .04, .08%) heightened men's and women's risk-taking intentions. Alcohol's effect was indirect via increased subjective sexual arousal; also, men exhibited greater risk-taking than women. In Experiment 2, an extended dosage range (target blood alcohol levels of .00, .06, .08, .10%) heightened men's risk-taking intentions. Alcohol's effect again was indirect via subjective arousal. Physiological sexual arousal, which was unaffected by alcohol, increased risk-taking via increased subjective arousal. In Experiment 3, alcohol increased women's risktaking indirectly via subjective arousal, but alcohol-attenuated physiological arousal had no effect on risk-taking. Implications for alcohol myopia theory and prevention interventions are discussed.

High intake of dietary fat may be key in both the etiology and maintenance of obesity. Because a reduction in the proportion of energy derived from fat will be accompanied by an increase in the proportion of energy derived from carbohydrate, this study compared the effects of these macronutrients on eating behavior in obese and lean individuals. The effects of different amounts of fat and carbohydrate, covertly incorporated into yogurt preloads, on subsequent food intake, hunger, and satiety were assessed. A group of 12 normal-weight men, unconcerned about eating and body weight (unrestrained), accurately compensated for the energy in the preloads regardless of the nutrient composition. Other groups (n = 12 per group), including normal-weight restrained men and normal-weight and obese restrained and unrestrained females, did not show such orderly energy compensation; joule-for-joule, the high-fat preloads suppressed intake at lunch less than did high-carbohydrate preloads. These results suggest that a relative insensitivity to the satiating effect of fat could be involved in the development and maintenance of obesity.

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Most theoretical models of HIV risk behavior have not considered the role of personality factors, and few studies have examined mechanisms accounting for dispositional influences on sexual risk taking. This study elaborated on a conceptual model emphasizing sexual sensation seeking, alcohol expectancies, and drinking before sex as key predictors of HIV risk (S. C. Kalichman, L. Tannenbaum, & D. Nachimson, 1998). Multiple groups structural equation modeling was used to determine whether gender moderated relationships among these variables in a sample of 611 heterosexual, young adult drinkers (49% women, 76% Caucasian, mean age = 25 years). The model provided an excellent fit to the data, and gender differences were not substantiated. Sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. Findings suggest that expectancies and drinking before sex represent proximal mechanisms through which dispositional factors influence sexual risk outcomes. Moreover, these relationships appear to be similar in men and women. Interventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking.

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