The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients

Background: Binge drinking is associated with risky sexual behaviors and sexually transmitted diseases (STDs). Few studies have investigated this by gender or in an STD clinic. This cross‐sectional study examined the association between binge drinking and risky sexual behaviors/STDs among patients attending an urban STD clinic. Method: A total of 671 STD clinic patients were tested for STDs, and queried about recent alcohol/drug use and risky sexual behaviors using audio computer‐assisted‐self‐interview. The association between binge drinking and sexual behaviors/STDs was analyzed using logistic regression adjusting for age, employment, and drug use. Results: Binge drinking was reported by 30% of women and 42% of men. Gender differences were found in rates of receptive anal sex which increased linearly with increased alcohol use among women but did not differ among men. Within gender analyses showed that women binge drinkers engaged in anal sex at more than twice the rate of women who drank alcohol without binges (33.3% vs. 15.9%; p < 0.05) and 3 times the rate of women who abstained from alcohol (11.1%; p < 0.05). Having multiple sex partners was more than twice as common among women binge drinkers than women abstainers (40.5% vs. 16.8%; p < 0.05). Gonorrhea was nearly 5 times higher among women binge drinkers compared to women abstainers (10.6% vs. 2.2%; p < 0.05). The association between binge drinking and sexual behaviors/gonorrhea remained after controlling for drug use. Among men, rates of risky sexual behaviors/STDs were high, but did not differ by alcohol use. Conclusion: Rates of binge drinking among STD clinic patients were high. Among women, binge drinking was uniquely associated with risky sexual behaviors and an STD diagnosis. Our findings support the need to routinely screen for binge drinking as part of clinical care in STD clinics. Women binge drinkers, in particular, may benefit from interventions that jointly address binge drinking and risky sexual behaviors. Developing gender‐specific interventions could improve overall health outcomes in this population.     

Binge drinking by gender and race/ethnicity among California adults, 2007/2009

Background: This study provides binge drinking population estimates for California adults by gender and detailed race/ethnicity categories. This information may be helpful for planning targeted initiatives to decrease binge drinking. Method: Data were from the 2007 and 2009 California Health Interview Surveys. The 98?662 respondents represent an annual estimated population of 27.2 million adults. Survey adjusted binary logistic regression was used to calculate gender-specific binge drinking population rates and multinomial logit regression to estimate binge drinking frequency. Results: Adjusting for socio-demographics, any binge drinking during the past year was reported by 31.0% (95% Confidence Interval?=?30.5–31.4%) of men and 18.0% (17.7–18.3%) of women. Rates among White men and women were 30.5% and 19.6%, respectively. Binge drinking rates ranged from 11.9% among Chinese to 42.9% among Mexican men and from 4.8% among Vietnamese to 25.7% among “Other Latino” women. Five race/ethnicity categories of men and seven categories of women were significantly less likely to binge drink compared to Whites. Although Whites had the highest overall binge drinking rates, an estimated 12.5% of White men binge drank less than monthly, significantly exceeded by Mexican and Central American men, 19.9 and 19.6%, respectively. An estimated 9.6% of White women binge drank less than monthly, exceeded only by “Other Latino” women, 13.6%. Conclusion: These findings underscore the importance of detailed gender and race/ethnicity breakdowns when examining any binge drinking. Furthermore, there is variability across Asian and Latino subgroups in the frequency of binge drinking episodes, which is not evident in broad-group population studies.     

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

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.     

Binge Drinking Among California Adults: Results from the 2005 California Health Interview Survey

Objective: To calculate binge drinking rates among California adults and describe the characteristics of female and male binge drinkers. Method: Analyses of 2005 California Health Interview Survey (CHIS) data. Results: At least one binge drinking episode over a 30-day period was reported by 1.4 million California women (10.7% of all adult women) and 3.2 million California men (24.7%). For both women and men, factors associated with binge drinking included being 18–44 years of age, smoking, and having mid-range psychological distress scores. There were gender differences in binge drinking risk by race/ethnicity and health status. Method: Given the multi-stage sampling design and non-responses in the 2005 California Health Interview Survey-Specific techniques were employed to ensure that the 43,020 compteted result yeilded reasonable state wide estimates. Conclusion: Binge drinking is a serious public health concern that affects millions of adult Californians.     

Alcohol use and sexual risk behavior among human immunodeficiency virus-positive persons

BACKGROUND: This study was undertaken to determine if alcohol use is associated with sexual risk taking among human immunodeficiency virus (HIV)-infected persons. METHODS: Cross-sectional interviews of 262 HIV-infected patients in the Brown University AIDS Program were performed. Factors associated with any sexual activity, unsafe sexual activity, and a 4-fold typology of sexual risk were examined. Alcohol measures included drinking days, drinks per drinking day, binge drinking, and hazardous alcohol use. RESULTS: The sample was 58% male and 40% white; 67% of patients were self-identified as heterosexual, and 48% drank alcohol. Nearly two thirds of patients reported sexual activity in the past 6 months, with 38% reporting unprotected sex during that period. All measures of alcohol use were significantly associated with any sexual activity and with unsafe sexual behavior. As an example, controlling for age, HIV transmission risk, marital status, and HIV clinical indicators, hazardous drinkers were 5.64 times more likely to report unprotected sex and have multiple partners (p < 0.01) than were those not drinking at hazardous levels. CONCLUSIONS: A high proportion of HIV-infected persons were sexually active and having unsafe sex. Alcohol, at all levels of use, was associated with increased sexual risk taking.     

Binge drinking concurrent with anal intercourse and condom use among men who have sex with men

Men who have sex with men (MSM) are the demographic group most severely affected by HIV in the USA. Global association studies have shown that MSM who binge drink are more likely to engage in risky sexual behaviors and day- and event-level analyses have linked binge drinking to sexual risk behavior on specific days and during specific sexual encounters. Despite this strong foundation of research, no studies have examined the association between the frequency of situational binge drinking (i.e., binge drinking concurrent with sexual activity) and aggregated sexual risk over periods of longer duration. We used multivariable logistic regression to assess the relationship between situational binge drinking (i.e., binge drinking concurrent with anal intercourse) and condomless anal intercourse (CAI) and among a cross-sectional sample of 124 MSM in San Francisco, CA. There was a positive relationship between frequency of situational binge drinking and CAI (1–5 times vs. never: adjusted odds ratio?=?2.78, 95% CI?=?1.01–7.63; 6–10 times vs. never: 6.19, 1.27–30.22; more than 10 times vs. never: 11.88, 1.31–107.60). By filling a methodological gap and complementing existing global and event-level analyses, this positive situational relationship strengthens the evidence linking binge drinking and sexual risk, enhances the comparability of the existing literature, and further suggests that the integration of dual strategies that aim to prevent HIV and reduce binge drinking may be warranted.     

Alcohol use among Hispanic college students along the US/Mexico border

Background: The trend of alcohol use among college students has been shown to vary by ethnicity and has been linked to acculturation among Hispanics. Consistent findings indicate that males consume alcohol more frequently and in greater quantities compared to females. Objectives: This study investigated the drinking habits of Hispanic college students living in the border region of South Texas. The study evaluated the influence of acculturation on alcohol consumption among Hispanic males and females. Methods: Two hundred and ninety-six Hispanic students participated in this study. The participants reported their drinking behaviors over the past 30 days and completed a measure of acculturation. Results: Fifty-nine percent of the participants reported consuming alcohol in the past 30 days with more males than females reporting alcohol consumption. Logistic regression analysis indicated that age and gender, and not acculturation or enculturation, predicted drinking in the last 30 days. Among drinkers, the regression analyses indicated that gender and lower levels of Anglo orientation were linked to increased alcohol consumption, suggesting that Hispanics who were less oriented toward the Anglo culture consumed more alcohol than those more oriented toward the Anglo culture. Among drinkers, males and females did not differ in frequency or binge drinking, but males consumed more alcohol than females. Conclusion: Previous research indicates that greater acculturation is linked to greater consumption of alcohol; however, we found it to be associated with less consumption. The findings regarding gender represent some consistencies with previous research but there are some inconsistencies as well. These results suggest that less acculturated Hispanic male college students residing in the border region may be at a higher risk of alcohol abuse than Hispanic female students and more acculturated male students.     

Risk Factors for Drinking among HIV-Positive African American Adults: The Depression–Gender Interaction

Background: Alcohol misuse disproportionately affects people living with HIV. People who struggle with alcohol are also likely to be concurrently struggling with depression. Although there is evidence linking depression to HIV, depression to alcohol, and alcohol to HIV, there is limited research that simultaneously examines the interlocking associations between all three factors. Objective: To investigate the interaction between depression symptomatology and gender on alcohol misuse, while controlling for motivation to reduce drinking, among HIV-positive African Americans. This population was examined because of their increased for developing alcohol dependence. Methods: Data analysis was conducted on baseline survey data of HIV-positive African American adults (N = 88) who drink and were enrolled in the Project PLUS (Positive Living through Understanding and Support) intervention to examine the correlates (i.e., gender, motivation, depression) of drinking in the past 30 days. Results: Hierarchical linear regression analysis showed a significant interaction between gender and depression to predict total drinks reported (R² = .56, p < .001). While depression was the sole predictor of drinking for men and suppressed the role of motivation, the reverse was true for women; depression was not a significant predictor after controlling for motivation to reduce drinking. Conclusion: African American men and women living with HIV have different risk factors for recent drinking. Scientific significance: Understanding the link between depression, gender, and motivation to reduce drinking for HIV-positive adults with alcohol problems is crucial for the development of gender and culturally relevant treatments.     

A new measure of binge drinking: prevalence and correlates in a probability sample of undergraduates

BACKGROUND: A standard measure defines binge drinking as the consumption of 5 or more drinks in a row for men (4 or more drinks for women) on at least 1 occasion during the past 2 weeks. A revised operational definition of binge drinking was developed by the National Institute on Alcohol Abuse and Alcoholism in 2004 and incorporated the duration of the drinking episode in addition to the quantity of alcohol consumed. This study compares the standard and new binge measures for overall and subgroup prevalence rates; associations with gender, race/ethnicity, and age of drinking onset; and associations with negative drinking consequences. METHODS: A probability sample of 4,580 randomly selected college students (50.3% female, M age=19.9, SD=2.0) at a large Midwestern university in the United States completed a Web-based survey of alcohol and other drug use. Participants reported on past 2-week binge drinking using the standard measure and past-year binge drinking using the new measure. RESULTS: The longer past-year time frame of the new measure yielded a higher prevalence estimate of binge drinking (63.6%) compared with the 2-week standard measure (53.2%). Approximately 9.9% of those who were classified as binge drinkers using the 2-week standard measure were classified as non-binge drinkers using the new measure specification of a 2-hour duration for the drinking episode. The past-year new binge measure was positively associated with negative drinking consequences even when the 2-week measure was statistically controlled. CONCLUSIONS: Using a longer time frame and incorporating the duration of the drinking episode, the new measure of binge drinking appears to capture an important element of risky alcohol involvement in college students that is not fully assessed by the standard measure.     

Differences in testing,stigma, and perceived consequences of stigmatization among heterosexual men and women living with HIV in Bengaluru,India

Approximately 2.4 million people in India are living with HIV. Gender inequality affects HIV prevention, detection, and management. The purpose of this paper was to describe gender differences in the experience of living with HIV in Bengaluru, India. A subsample of n = 313 (159 men and 154 women) from a larger cohort was used for these analyses. Participants were recruited through AIDS service organizations. They completed an interviewer-administered survey assessing HIV testing experience, types of stigma, and perceived consequences of stigmatization. The majority of men (67%) reported getting HIV tested because of illness, while women were more likely to be tested after learning their spouse's HIV-positive status (42%). More men (59%) than women (45%, p<0.05) were tested in private care settings. Men reported significantly higher mean levels of internalized stigma (men: M=0.71, SD = 0.63; women: M=0.46, SD = 0.55; p<0.001), whereas the women reported significantly higher scores for enacted stigma (men: M=1.30, SD = 1.69; women: M=2.10, SD = 2.17; p<0.001). These differences remained significant after controlling for potential socio-demographic covariates. Following their diagnosis, more women reported moving out of their homes (men: 16%; women: 26%; p<0.05). More men (89%) than women (66%; p<0.001) reported to have modified their sexual behavior after being diagnosed. These findings suggest that the experience of living with HIV and HIV stigma varies by gender in this population. Suggestions for a gender-based approach to HIV prevention and stigma reduction are provided.     

Alcohol and Risky Sexual Behavior Among Heavy Drinking College Students

Multiple event-level methodology was used to examine the relation between risky sexual behavior and alcohol use among sexually active, heavy drinking college students (N = 221). Using a structured timeline followback interview, participants reported their sexual, alcohol, and drug use behaviors over a 3-month period. Over 2,700 vaginal or anal sexual events were reported from 177 participants. Overall, condom use was not associated with heavy or non-heavy alcohol consumption among those reporting both sexual events concurrent with heavy drinking and when no alcohol was consumed. Results from multilevel regression analyses revealed a more complex pattern. Among women, but not men, less condom use was associated with steady versus casual sexual partners, but partner type interacted with alcohol consumption such that less condom use occurred when heavy drinking preceded sex with steady partners. At the event-level, alcohol consumption among heavy drinking college students leads to risky sexual behavior but the relation differs by gender and partner type.     

Gender and risk behaviors for HIV and sexually transmitted infections among recently released inmates: A prospective cohort study

Women in prison have a higher prevalence of HIV than men. After release from prison, former inmates have the opportunity to engage in risk behaviors for HIV and other sexually transmitted infections (STIs). We sought to assess change in risk behaviors over time and the association of gender with risk behavior in the postrelease period. In this prospective cohort study, we interviewed 200 former inmates (51 women) approximately two weeks (baseline) and three months (follow-up) after release and tested them for HIV infection at follow-up. We examined the association of gender with unprotected vaginal or anal sex in the last seven days using chi-square and Fisher's exact tests and multivariable logistic regression. At baseline, 22% of men and 41% of women reported unprotected vaginal sex (p < 0.01) and 5% of men and 8% of women reported unprotected anal sex (p = 0.51). Being younger (OR for each decade increase 0.48, 95% CI = 0.29–0.80), being gay/lesbian or being bisexual (compared with being heterosexual, OR = 4.74, 95% CI = 1.01–22.17 and OR = 3.98, 95% CI = 1.41–11.26, respectively), or reporting a drug of choice of heroin/speedballs or cocaine/crack (compared with marijuana/no drug of choice, OR = 24.00, 95% CI = 5.15–111.81 and OR = 3.49, 95% CI = 1.20–10.18, respectively) was associated with unprotected vaginal or anal sex after adjusting for race, homelessness, and hazardous drinking. At follow-up, 21% of men and 44% of women reported unprotected sex (p = 0.005), and female gender (OR = 4.42, 95% CI = 1.79–10.94) and hazardous drinking (compared with not meeting criteria for hazardous drinking, OR = 3.64, 95% CI = 1.34–9.86) were associated with unprotected sex, adjusting for race and homelessness. In this population with a high prevalence of HIV, we demonstrated persistent engagement in sexual risk behavior during the postrelease period. Enhanced efforts to promote sexual health and reduced risk behavior among both male and female current and former prison inmates are needed, including improved access to preventive care and HIV and STI screening, testing, and treatment.     

Frequency,Quantity, and Contextual Use of Alcohol Among Sexually Transmitted Infection Clinic Patients in Cape Town,South Africa

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This article reports a study of the association between alcohol use and HIV risk-related behavior among 614 men and 157 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results for men showed that drinking in sexual contexts as well as their partner's drinking were related to higher rates of unprotected intercourse. However, the number of sex partners men reported was only associated with their own use of alcohol before sex. In contrast, women's partners drinking before sex was related to higher frequencies of unprotected intercourse, but it was their own drinking before sex that was related to women's number of sex partners. Results therefore suggest that the context of alcohol use is more closely related to sexual risks than are the quantity or frequency of use. Interventions are needed that integrate HIV risk reduction with alcohol risk reduction in South Africa.     

Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This article reports a study of the association between alcohol use and HIV risk-related behavior among 614 men and 157 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results for men showed that drinking in sexual contexts as well as their partner's drinking were related to higher rates of unprotected intercourse. However, the number of sex partners men reported was only associated with their own use of alcohol before sex. In contrast, women's partners drinking before sex was related to higher frequencies of unprotected intercourse, but it was their own drinking before sex that was related to women's number of sex partners. Results therefore suggest that the context of alcohol use is more closely related to sexual risks than are the quantity or frequency of use. Interventions are needed that integrate HIV risk reduction with alcohol risk reduction in South Africa.     

Combining Rapid HIV Testing and a Brief Alcohol Intervention in Young Unhealthy Drinkers in the Emergency Department: A Pilot Study

Background: We sought to determine the feasibility and impact of brief alcohol/ sexual risk reduction counseling with rapid HIV testing in the emergency department (ED). Methods: We recruited 18–40 year olds with unhealthy alcohol use, sexual risk behaviors, and negative/unknown HIV status and assessed for differences in their alcohol consumption and sexual risk behaviors at baseline versus 2 months. Results: Participants (n = 85) were 61% male, mean age 26 years old, 59% white, 92% unmarried, 57% college educated, 45% without a regular doctor, and 80% with an Alcohol Use Disorders Identification Test (AUDIT) score ≥8. All rapid HIV tests were negative. Among the 70 (82%) with follow-up, alcohol consumption decreased with fewer average weekly drinks (23.6 vs. 9.8, p = .003) and binge drinking episodes (2.0 vs. .9, p = .012). Post-intervention, sexual risk decreased, including increased condom use (23% vs. 46%, p = .007). Women had a greater decrease in alcohol use prior to sex compared with men (p = .021 for interaction). Conclusions: Alcohol/sexual risk reduction counseling with HIV testing in the ED is feasible and potentially effective for reducing alcohol use and sexual risk behaviors among young unhealthy drinkers. Scientific Significance: Future randomized controlled trials are warranted to assess efficacy of this intervention, which would provide young at-risk populations with important preventive services, which they may not have access to otherwise.     

Sexual risk behavior has decreased among men who have sex with men in Los Angeles but remains greater than that among heterosexual men and women

We examined changes and correlates of sexual risk behavior of men who have sex with men (MSM) compared with heterosexual men and women over three time periods. Data from the 1997, 1999, and 2003 Los Angeles County Health Surveys, a population-based telephone survey, were analyzed to examine the association of sociodemographic and health-related factors with sexual risk behaviors among the three groups. In each time period, MSM reported a significantly greater percentage of sexual risk (i.e., both inconsistent condom use and multiple sex partners in the past 12 months) compared with heterosexual men and women. Multivariate analyses indicated that MSM and heterosexual men reported greater sexual risk than heterosexual women. Respondents who were younger, U.S. born, reported heavy alcohol consumption, or had been tested for HIV in the past 24 months were more likely to report sexual risk behavior. The findings suggest the need for continued targeted prevention for MSM and prevention efforts for segments of the general population at elevated risk for HIV.     

Predictors of condom use in women receiving court-mandated drug and alcohol treatment: implications for intervention

Women who abuse substances are at a high-risk for contracting HIV. Condom use interventions are important in reducing HIV in high-risk populations, but current interventions have small effects. The aim of this study is to examine the relative impact of substance use, personal variables (sexual impulsivity and condom expectancies), and relationship variables (perceptions of relationship commitment and partner risk, perceptions of power within the relationship) on condom use in women in court-mandated substance abuse treatment. Information was collected from 312 sexually active women in an inpatient drug and alcohol treatment facility in the Southeastern US Participants completed questionnaires and were interviewed using the Timeline Follow-back method and provided information about sexual activity in the 30-days prior to intake, including type of sexual event, co-occurrence with substance use, condom use, and characteristics of sexual partners and the nature of the relationship. Multilevel logistic modeling revealed that perception of relationship commitment, condom outcome expectancies, and age significantly affected condom use for women in the sample. Specifically, condom use was least likely when women reported that the relationship was committed (odds ratio [OR] = 0.31, 95% confidence interval [CI]: 0.23, 0.43) or when the participant was older (OR = 0.96, 95% CI: 0.94, 0.99), and more likely when women reported more positive condom outcome expectancies (OR = 1.02, 95% CI: 1.00, 1.03). The findings suggest that perceptions of relationship commitment, regardless of perceptions of partner risk, strongly affect condom use among women court-mandated into drug and alcohol treatment. In addition, positive outcome expectancies (e.g., positive self-evaluations and perceived positive partner reactions) are associated with a greater likelihood of condom use. These findings have important implications for condom use interventions, which have failed to produce large or lasting effects within this population.     

Childhood Sexual Abuse and HIV Risk-Taking Behavior Among Gay and Bisexual Men

We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001). Perception of having been coerced was associated with greater sexual risk. Furthermore, childhood sexual abuse and level of coercion were associated with reported levels of HIV infection among gay and bisexual men. It is recommended that existing programs for those at risk for HIV be modified to deal with these issues, and that efforts to bring about behavior change will require approaches that go beyond simply increasing knowledge and awareness.     

Social and behavioral characteristics of HIV-positive MSM who trade sex for methamphetamine

Background: Previous research among drug-using men who have sex with men (MSM) indicates that trading sex for methamphetamine may be common. Objectives: This study identified background characteristics, substance use variables, contextual factors, and sexual risk behaviors associated with trading sex for methamphetamine in a sample of HIV-positive MSM. Baseline data were gathered from 155 participants who were enrolled in a sexual risk-reduction intervention. Logistic regression was used to compare MSM who traded sex for methamphetamine with men who did not. Results: Forty-three percent of the sample reported trading sex for methamphetamine in the past 2 months. Trading sex for methamphetamine was associated with being a binge user, homelessness, having an income of less than $20,000 per year, being less assertive at turning down drugs, engaging in more anal sex without a condom, and seeking out risky sex partners when high on methamphetamine. Conclusion: These data suggest that the trading of sex for methamphetamine may be a primary source of new HIV infections within and outside of the MSM community, necessitating targeted interventions with this vulnerable subgroup.