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Research Summary

Risky Sex: It's the Alcohol

Limiting spread of HIV infection depends partially on identifying factors that contribute to risky sexual behaviors. Researchers studied a prospective cohort of adults with HIV and current or past alcohol problems to better understand alcohol’s effects on inconsistent condom use during 3 years of follow-up.

Of 345 subjects, 29% reported sexual abstinence at study entry, 33% used condoms all of the time during sex, 16% most of the time, 12% some of the time, and 10% none of the time. Alcohol consumption was significantly associated with inconsistent condom use (<100% over the last 6 months). Fifty-one percent of heavier drinkers (>14 drinks per week for men, >7 for women) and 41% of moderate drinkers, compared with 32% of abstainers, reported inconsistent condom use.

In multivariable analyses adjusted for possible confounding factors (e.g., race, education, other drug use), the following were significantly associated with inconsistent condom use (odds ratios between 2 and 4):

  • heavier drinking in users of injection drugs
  • being female
  • identifying as gay or lesbian
  • living with a partner
  • having 2 or more sexual partners
  • agreeing that condoms are a hassle to use

Recently testing HIV-positive, selling sex for drugs or money, and having a higher CD4 cell count were associated with borderline significant increases in risk.


Whether the findings in this cohort (30% employed, 67% non-white, 29% homeless) will hold true for others with HIV is unknown. However, drinking >1–2 drinks per day appears to increase risk of inconsistent condom use, particularly among users of injection drugs. When addressing this risk, clinicians, public health practitioners, and others must consider factors that contribute to inconsistent use—many of which are modifiable.

Richard Saitz, MD, MPH


Ehrenstein V, Horton NJ, Samet JH. Inconsistent condom use among HIV-infected patients with alcohol problems. Drug Alcohol Depend. 2004;73(2):159–166.
(view abstract)