Barbara C. Leigh

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.

Alcohol and condom use: a meta-analysis of event-level studies.

Background Although it is often assumed that drinking alcohol interferes with condom use, studies on this topic have used several different methods and have yielded inconsistent findings. By examining drinking and condom use in specific sexual encounters, the role of alcohol in influencing unprotected intercourse is targeted. Goal The goal of the study was to assess the relationship of alcohol use and condom use in discrete sexual encounters using meta-analysis. Study Design Studies in the literature were identified by computerized searches of MEDLINE and PsycINFO and hand searches of reference lists. Summary odds ratios were calculated for all analyses and for subgroups formed according to type of sexual encounter (first, most recent, most recent with a new sexual partner). Results The association of alcohol use and condom use varied by type of sexual encounter: drinking at first intercourse was associated with decreased condom use (odds ratio [OR], 0.54; 95% CI, 0.44–0.66), but drinking was unrelated to condom use in recent sexual encounters (OR, 1.04; 95% CI, 0.89–1.21) and in recent encounters with new partners (OR, 1.1; 95% CI, 0.92–1.32). Conclusion Drinking is not necessarily linked to unprotected intercourse; the relationship between alcohol use and unprotected sex depends on context and sexual experience of the partners.

Reasons for having and avoiding sex: Gender, sexual orientation, and relationship to sexual behavior.

Traditional sex‐role stereotypes suggest that men and women engage in sex for different reasons. Previous studies have supported the notion that women are more motivated by emotional expression in having sex, and men are more concerned with physical gratification. In a survey of sexual behavior, heterosexual and homosexual respondents were asked to rate the importance of a variety of reasons for having sex and not having sex. The results showed that men and women differed in the importance attached to emotional and physical motives, with gender differences appearing in both heterosexuals and homosexuals. Certain practical motives (e.g., to reproduce, fear of AIDS, fear of pregnancy) differentiated between homosexuals and heterosexuals. Motivations predicting frequency of sexual behavior in the last month depended on the relationship status of the respondent. These findings, although suggesting that gender differences in motivations for sex persist in all kinds of relationships, point to many similarities ...

The relationship of substance use to sexual activity among young adults in the United States.

Data on substance use and sexual activity from a nationally representative, probability-based sample of young adults aged 18-30 in 1990 indicate that 86% of respondents had had sex in the previous 12 months, with three-fourths reporting no more than one sexual partner. Seventy-five percent of respondents had consumed alcohol in the past 12 months, 40% had smoked cigarettes and 20% had used marijuana. After adjustment for demographic factors, both sexual activity and a history of multiple partners were positively associated with some measures of substance use. Respondents who drank more frequently, those who were heavy drinkers, those who smoked cigarettes and those who used marijuana in the past year were more likely than others to be sexually active. Those who consumed five or more drinks at a sitting and those who used marijuana were more likely than others to have had more than one sexual partner. Heavy drinkers were also less likely to use condoms; however, the results showed no association between having sex under the influence of alcohol and engaging in unsafe sexual practices.

The relationship of substance use during sex to high‐risk sexual behavior

Recent research with homosexual samples in San Francisco (Stall, McKusick, Wiley, Coates, & Ostrow, 1986) has shown that the use of alcohol (or other drugs) in conjunction with sexual activity is strongly related to unsafe sex (i.e., high risk for AIDS infection). Analysis of data from a mail survey of the adult population of San Francisco replicated these results: There was a strong relationship between frequency of using alcohol or other drugs in conjunction with sexual activity and the frequency of engaging in risky sexual behaviors. However, risky sexual behavior was not related to the proportion of sexual activity involving drinking and was related to proportion of sexual activity involving cocaine and other drugs in gay men only. Frequency of risky sex in hetersexuals was predicted largely by total frequency of sex, with small amounts of variance contributed by frequency of sex with a partner who was drinking or using drugs. In gay men, use of cocaine or other drugs during sex contributed a substant...

Sexual behavior of American adolescents: Results from a U.S. national survey☆

PURPOSE This paper reports on data from a 1990 U.S. national survey of the sexual behavior of male and female adolescents aged 12-17. METHODS A household survey using a multi-stage area probability sample of the United States was undertaken in 1990. Adolescents were interviewed about sexual history, contraceptive use, and motivations, attitudes, and expectations with regard to sexual behavior and risk. RESULTS The majority of 17-year-olds and about half of 16-year-olds, both male and female, had initiated sexual activity, with males initiating at younger ages than females. Sexual activity was episodic; only half of sexually experienced adolescents reported having sex in the month prior to the interview. Many sexually active respondents expressed less desire to have sex than confidence that they would have sex. Over half of respondents reported using a condom at most recent intercourse, with boys being more likely than girls to report condom use. Condom use at last intercourse was unrelated to perceptions of risk and concern about AIDS. CONCLUSIONS Given the importance of some of the undesirable consequences of sexual activity in adolescents, such as AIDS and unwanted pregnancy, accurate and up-to-date information on sexual behavior of this age group is crucially important. The results of this study underscore the need for in-depth, population-based research on adolescent sexual behavior.

Alcohol consumption and sexual activity as reported with a diary technique.

Although alcohol is commonly viewed as a sexual disinhibitor, recent research has suggested that alcohol consumption does not consistently lead to increased sexual activity. Nonexperimental work in this area has commonly used correlational procedures that do not control for individual difference variables that may contribute to a drinking-sex relationship. This study examined the relationship of alcohol consumption to sexual behavior by way of within-subjects analyses of data from 99 men and women who kept daily diaries of drinking and sexual events over a 10-week period. Alcohol consumption was associated with a general attenuation of sexual activity, with no effects on the occurrence of sexual behaviors that are risky in terms of AIDS transmission. These data suggest that sexual distribution and lapses in sexual judgment are not necessarily common consequences of alcohol consumption.

Comparison of diary and retrospective measures for recording alcohol consumption and sexual activity

This study examines issues in the measurement of HIV risk factors, using daily diaries to collect data on both alcohol use and sexual behavior. Seventy-nine adolescents and young adults recruited from an STD clinic and from a university campus were studied. Participants gave daily reports of their drinking, drug use, and sexual activities for 4 weeks. Respondents then completed a retrospective questionnaire asking about the frequencies of these behaviors during the preceding period. Diary reports of behavior were strongly correlated with retrospective reports. More frequent drinking was reported on the diary measure than the retrospective measure, and this discrepancy was larger for more frequent drinkers. Frequency of sexual activity was overreported on the retrospective measure only among adolescents. Errors in the measurement of alcohol use, sexual behavior, or their co-occurrence could affect estimations of the relationship of alcohol use to sexual behavior. The types of error inherent in these measures may differ, resulting in different tendencies toward over- or underreporting of alcohol use and sexual behavior, depending on frequency of the behavior and the characteristics of the subject population.

Using daily reports to measure drinking and drinking patterns.

Daily measurements of drinking are used to measure alcohol consumption, validate retrospective questionnaires, and examine associations between drinking and other behaviors. The advantages of using daily reports include reducing retrospective biases and forgetting of drinking occasions; disadvantages include increased costs and potential for reactivity. Methodological issues to consider in using daily reports include reporting method (written, telephone, electronic), reporting interval, data collection period, respondent attrition, and missing data. Compared to retrospective reports, daily reports result in more reported drinking occasions but similar average quantity consumed, and correlations between retrospective and daily measures are generally high. The utility of daily reports depends on the research question and the purpose of the measurements.

The relationship of alcohol use to sexual activity in a U.S. national sample

Recent reports have indicated that the use of alcohol is related to sexual behavior (such as unprotected intercourse) that is high-risk for HIV infection. However, most of these studies have collected data from convenience samples, using measures of varying specificity. This paper describes a study designed to investigate the relationship of alcohol use to unsafe sexual activity in a representative sample of adults. Data were collected from 2058 respondents as part of a survey of a multi-stage area probability sample of the adult household population of the 48 contiguous United States. The interview instrument included measures of alcohol use, sexual activity and condom use. Logistic regression analyses showed that heavier drinkers were more likely to be sexually active, and if sexually active, were more likely to have had more than one sexual partner in the previous year. However, drinking variables were in general not significantly related to condom use. These results suggest that alcohol use may be more strongly related to lifestyle variables (general sexual activity and number of sexual partners) than to more concrete behavioral variables such as condom use. Because these data are correlational, the findings are also consistent with the notion of a general constellation of risk-taking or sensation-seeking activities that includes alcohol use and sexual activity.