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.

Comments:

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

Reference:

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)