Skip to main content

Advertisement

SpringerLink
Log in

Alcohol Use, Anal Sex, and Other Risky Sexual Behaviors Among HIV-Infected Women and Men

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Effective sexual risk reduction strategies for HIV-infected individuals require an understanding of alcohol’s influence on specific sexual behaviors. We conducted audio-computer-assisted-self-interviews on 910 patients from two HIV primary care programs. The association between alcohol use and risky sexual behaviors was examined using multivariable logistic regression adjusting for age, education, race/ethnicity and drug use. Frequent/binge drinking was associated with engaging in anal sex and having multiple sex partners among women, engaging in insertive anal sex among gay/bisexual men, and was unrelated to risky sexual behaviors among heterosexual men. Infrequent drinkers did not differ in sexual risk behaviors from abstainers among women or men. Finally, there was no interaction effect between race/ethnicity and alcohol use on the association with sexual risk behaviors. The study has yielded important new findings in several key areas with high relevance to HIV care. Results underscore the importance of routinely screening for alcohol use and risky sexual behaviors in HIV primary care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Chander G, Josephs J, Fleishman JA, et al. HIV Research Network. Alcohol use among HIV-infected person in care: results of a multi-site survey. HIV Med. 2008;9:196–202.

    Article  PubMed  CAS  Google Scholar 

  2. Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: result from the HIV Cost and Services Utilization Study. J STD Alcohol. 2002;63:179–86.

    Google Scholar 

  3. Cook RL, Sereika SM, Hunt SC, Woodward WC, Erlen JA, Conigliaro J. Problem drinking and medication adherence among persons with HIV infection. J Gen Intern Med. 2001;16:83–8.

    Article  PubMed  CAS  Google Scholar 

  4. Samet JH, Phillips SJ, Horton NJ, Traphagen ET, Freedberg KA. Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire. AIDS Res Hum Retrovir. 2004;20:151–5.

    Article  PubMed  Google Scholar 

  5. Shuper PA, Newman M, Kanters F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS—a systematic review. Alcohol Alcohol. 2010;45:159–66.

    Article  PubMed  Google Scholar 

  6. Beckett M, Burnam A, Collins RL, Kanouse DE, Beckman R. Substance use and high-risk sex among people with HIV: a comparison across exposure groups. AIDS Behav. 2003;7:209–19.

    Article  PubMed  Google Scholar 

  7. Stein M, Herman DS, Trisvan E, Pirraglia P, Engler P, Anderson BJ. Alcohol use and sexual risk behavior among human immunodeficiency virus-positive persons. Alcohol Clin Exp Res. 2005;5:837–43.

    Article  Google Scholar 

  8. Ehrenstein V, Horton NJ, Samet JH. Inconsistent condom use among HIV-infected patients with alcohol problems. Drug Alcohol Depend. 2004;73:159–66.

    Article  PubMed  Google Scholar 

  9. Shuper PA, Joharchi N, Rehm J. Alcohol as correlated of unprotected sexual behavior among people living with HIV/AIDS: review and meta-analysis. AIDS Behav. 2009;13:1021–36.

    Article  PubMed  Google Scholar 

  10. Seth P, Wingood GM, DiClemente RJ. Exposure to alcohol problems and its association with sexual behavior and biologically confirmed Trichomonas vaginalis among women living with HIV. Sex Transm Infect. 2008;84:390–2.

    Article  PubMed  CAS  Google Scholar 

  11. Theall KP, Clark RA, Powell A, Smith H, Kissinger P. Alcohol consumption, ART usage and high-risk sex among women infected with HIV. AIDS Behav. 2007;11:205–15.

    Article  PubMed  CAS  Google Scholar 

  12. Cook RL, McGinnis KA, Kraemer KL, et al. Intoxication before intercourse and risky sexual behavior in male veterans with and without human immunodeficiency virus infection. Med Care. 2006;44:S31–6.

    Article  PubMed  Google Scholar 

  13. Braithwaite RS, Conigliaro J, McGinnis KA, Maisto SA, Bryant K, Justice AC. Adjusting alcohol quantity for mean consumption and intoxication threshold improves prediction of nonadherence in HIV patients and HIV-negative controls. Alcohol Clin Exp Res. 2008;32:1645–51.

    Article  PubMed  Google Scholar 

  14. Golin C, Marks G, Wright J, et al. Psychosocial characteristics and sexual behaviors of people in care for HIV infection: an examination of men who have sex with men, heterosexual men and women. AIDS Behav. 2009;13:1129–42.

    Article  PubMed  Google Scholar 

  15. Courtenay-Quirk C, Pals SL, Colfax G, McKirnan D, Gooden L, Eroğlu D. Factors associated with sexual risk behavior among persons living with HIV: gender and sexual identity group differences. AIDS Behav. 2007;12:685–94.

    Article  PubMed  Google Scholar 

  16. Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Rose CD. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11:S6–16.

    Article  PubMed  Google Scholar 

  17. McBride KR, Fortenberry JD. Heterosexual anal sexuality and anal sex behaviors: a review. J Sex Res. 2010;472:123–36.

    Article  Google Scholar 

  18. Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39:1048–63.

    Article  PubMed  Google Scholar 

  19. Erikson P, Bastani R, Maxwell AE, Marcus A, Capell F, Yan K. Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors. AIDS Educ Prev. 1995;7:477–93.

    Google Scholar 

  20. Hutton HE, McCaul ME, Santora PB, Erbelding EJ. The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients. Alcohol Clin Exp Res. 2008;32:2008–15.

    PubMed  Google Scholar 

  21. Grimley DM, Bachmann LH, Jenckes MW, Erbelding EJ. Provider-delivered, theory-based, individualized prevention interventions for HIV positive adults receiving HIV comprehensive care. AIDS Behav. 2007;11:S39–47.

    Article  PubMed  Google Scholar 

  22. Nollen C, Drainoni ML, Sharp VL. Designing and delivering a prevention project within an HIV treatment setting: lessons learned from a specialist model. AIDS Behav. 2007;11:S84–94.

    Article  PubMed  Google Scholar 

  23. NOVA Research Company. QDS: Questionnaire Development System, Bethesda. 2005. http://www.novaresearch.com.

  24. Ghanem K, Hutton HE, Zenilman JM, Shaw R, Erbelding EJ. Audio computer assisted self-interview and face to face interview modes in assessing response bias among STD clinic patients. Sex Transm Infect. 2005;81:421–5.

    Article  PubMed  CAS  Google Scholar 

  25. SPSS. Statistical package for the social sciences. Version 15.0.1. Chicago: McGraw-Hill; 2006.

    Google Scholar 

  26. Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. J Subst Abuse. 2001;13:185–200.

    Article  PubMed  CAS  Google Scholar 

  27. Morin SF, Steward WT, Charlebois ED, Remien RH, Pinkerton SD, Johnson MO, Rotheram-Borus MJ, Lightfoot M, Goldstein RB, Kittel L, Samimy-Muzaffar F, Weinhardt L, Kelly JA, Chesney MA. Predicting HIV transmission among HIV-infected men who have sex with men: findings from the healthy living project. J Acquir Immune Defic Syndr. 2005;40:226–35.

    Article  PubMed  Google Scholar 

  28. Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, Barresi PJ, Coates TJ, Chesney MA, Buchbinder S. Predicting HIV transmission among HIV-infected men who have sex with men. AIDS. 2006;20:731–9.

    Article  PubMed  Google Scholar 

  29. Reynolds GL, Fisher DG, Fremming BW, Jansen MA. Heterosexual anal sex reported by women receiving HIV prevention services in Los Angeles county. Women Health Issues. 2010;20:414–9.

    Article  Google Scholar 

  30. Frezza M, DePadova C, Pozzato G, Terpin M, Baraona E, Lieber CS. High blood alcohol levels in women: the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med. 1990;322:95–9.

    Article  PubMed  CAS  Google Scholar 

  31. George WH, Stoner SA. Understanding acute alcohol effects on sexual behavior. Annu Rev Sex Res. 2000;11:92–124.

    PubMed  CAS  Google Scholar 

  32. Leichliter JS, Chandra A, Liddon N, Fenton KA, Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis. 2007;196:1852–9.

    Article  PubMed  Google Scholar 

  33. Friedman SR, Flom PL, Kottiri BJ, et al. Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood. AIDS. 2001;15:2057–60.

    Article  PubMed  CAS  Google Scholar 

  34. Halperin DT. Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care STDS. 1999;13:717–30.

    Article  PubMed  CAS  Google Scholar 

  35. Chin-Hong PV, Palefsky JM. Natural history and clinical management of anal human papillomavirus disease in men and women infected with human immunodeficiency virus. Clin Infect Dis. 2002;35:1127–34.

    Article  PubMed  Google Scholar 

  36. Rosa-Cunha I, Cardenas GA, Dickinson G, Metsch LR. Addressing anal health in the HIV primary care setting: a disappointing reality. AIDS Patient Care STDS. 2010;24:533–8.

    Article  PubMed  Google Scholar 

  37. Leynaert B, Downs AM, de Vincenzi I. Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV. Am J Epidemiol. 1998;148:88–96.

    Article  PubMed  CAS  Google Scholar 

  38. Gindi RM, Erbelding EJ, Page KR. Sexually transmitted infection prevalence and behavioral risk factors among Latino and non-Latino patients attending the Baltimore City STD clinics. Sex Transm Dis. 2010;37:191–6.

    Article  PubMed  Google Scholar 

  39. Skeer MR, Mimiaga MJ, Mayer KH, O’Cleirigh C, Covahey C, Safren SA. Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS Behav. 2012;16:676–89.

    Article  PubMed  Google Scholar 

  40. Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, Lin LS, An Q, Mermin J, Lansky A, Hall HI. Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE. 2011;6:e17502.

    Article  PubMed  CAS  Google Scholar 

  41. Wyatt GE, Williams JK, Gupta A, Malebranche D. Are cultural values and beliefs included in U.S. based HIV interventions? Prev Med. 2011 Aug 22. [Epub ahead of print].

  42. Aharonovich E, Hatzenbuehler ML, Johnston B, et al. A low-cost, sustainable intervention for drinking reduction in the HIV primary care setting. AIDS Care. 2006;18:561–8.

    Article  PubMed  CAS  Google Scholar 

  43. Gerbert B, Danley DW, Herzig K, et al. Reframing “prevention with positives”: incorporating counseling techniques that improve the health of HIV-positive patients. AIDS Patient Care STDS. 2006;20:19–29.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This publication is supported by grant number 5 H97 HA00261 from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of HRSA or the SPNS program. It was presented as a poster session at the 33rd Annual Meeting of the Research Society on Alcoholism, San Antonio, TX, June, 2010. The authors thank Samuel A. Bozzette MD, PhD for his thoughtful comments on an earlier draft of the manuscript.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA

    Heidi E. Hutton & Mary E. McCaul

  2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Geetanjali Chander, Mollie W. Jenckes & Emily J. Erbelding

  3. Center for Comprehensive Care, HIV Center St. Luke’s Roosevelt Hospital, New York, NY, USA

    Christine Nollen & Victoria L. Sharp

Authors
  1. Heidi E. Hutton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary E. McCaul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geetanjali Chander
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mollie W. Jenckes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christine Nollen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victoria L. Sharp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emily J. Erbelding
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heidi E. Hutton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hutton, H.E., McCaul, M.E., Chander, G. et al. Alcohol Use, Anal Sex, and Other Risky Sexual Behaviors Among HIV-Infected Women and Men. AIDS Behav 17, 1694–1704 (2013). https://doi.org/10.1007/s10461-012-0191-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-012-0191-4

Keywords

Search

Navigation