Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment

Abstract

Background Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission, but to date, experimental evidence for the causal risk-taking impact of alcohol among HIV-positive populations is lacking. The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men (MSM), and to assess whether alcohol's impact differs between MSM who are HIV-positive versus HIV-negative. Methods In a randomized controlled alcohol administration experiment, HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and randomly assigned to beverage consumption condition: alcohol (target BAC=.080%), placebo alcohol (target BAC=.000%), or water (control). Participants then underwent a video-based sexual arousal manipulation (sexually aroused/non-aroused) and indicated their intentions to engage in condom-protected and condomless sexual acts in a standardized paradigm. The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex. Results A total of 282 MSM (141 HIV-positive; 141 HIV-negative) completed experimental procedures. MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water (F(1,274)=9.43, p=0.002). The impact of alcohol did not differ between HIV-positive and HIV-negative MSM (F(1,274)=1.86, p=0.174). Conclusions The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample, and results demonstrated that consuming alcohol had an independent, causal impact on intentions to engage in sexual behaviors that can result in HIV transmission. Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts.

Causal Effects of Alcohol Intoxication on Sexual Risk Intentions and Condom Negotiation Skills Among High-Risk Men Who Have Sex with Men (MSM)

“…As such, these results are most consistent with the interpretation that alcohol’s effects on CAS intentions among MSM are primarily accounted for by alcohol’s expectancy effects. These results contrast starkly with similar past studies conducted both among heterosexual men and women (16, 29) and among MSM (30, 32), since the majority of these studies did not find significant placebo effects on condomless sex intentions. Indeed, a meta-analysis of these studies, the majority of which were conducted among heterosexual men and women, found no differences between placebo and control conditions on condomless sex intentions (29).…”

“…One possible explanation for our results could be that the placebo manipulations we used in this study might have been more effective than those in previous studies, and thus more effective in producing expectancy effects. However, this seems unlikely, given past studies show differences in perceived intoxication and the amount of alcohol consumed that are of similar magnitude as those reported here (30, 32). As such, our findings could suggest that alcohol’s expectancy effects on intentions may be stronger among MSM than previously understood.…”

“…Indeed, a meta-analysis of these studies, the majority of which were conducted among heterosexual men and women, found no differences between placebo and control conditions on condomless sex intentions (29). Moreover, the two similar previously published placebo-controlled studies that focused on MSM ultimately combined their control and placebo conditions since there were no differences between these two groups on intentions (30, 32). One possible explanation for our results could be that the placebo manipulations we used in this study might have been more effective than those in previous studies, and thus more effective in producing expectancy effects.…”

“…We are aware of just two published studies that have used randomized, placebo-controlled designs to explore the effects of acute alcohol consumption on sexual decision-making among MSM, and these studies report somewhat inconsistent results. In a study of 283 HIV-negative and HIV-positive MSM, those who consumed alcohol reported higher intentions to engage in CAS after viewing a video-based hypothetical sexual scenario, compared with non-alcohol control and placebo condition participants, and CAS intentions did not differ across the placebo and control groups (32). However, no other outcomes relevant to sexual decision-making were reported.…”

Clinical round-up

“…An experiment by Shuper et al 1 in Toronto was carried out to test the hypothesis that acute alcohol consumption would directly increase HIV-positive MSM’s intentions to engage in CLS. It also looked at whether impact of acute alcohol consumption on CLS intentions differed between HIV-positive and negative MSM.…”