Working memory moderates the relation between implicit alcohol associations and heavy episodic drinking in moderate-to-heavy drinking men who have sex with men

Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study

Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI.

Sexual alcohol expectancies moderate the relation between alcohol use and sexual behavior among men who have sex with men

BACKGROUND

HIV transmission remains a significant health concern for men who have sex with men (MSM) in the United States. Heavy episodic drinking (HED) is related to increased rates of condomless anal intercourse (CAI) among MSM, though evidence suggests that this association may vary by individual difference factors. The present secondary analysis tested whether sexual alcohol expectancies (SAEs) moderate the associations between frequency of HED and anal intercourse (AI) with and without a condom among moderate-to-heavy drinking HIV- MSM.

METHODS

Two hundred and forty-eight moderate-to-heavy drinking MSM completed self-report questionnaires including the Sexual Behavior Questionnaire, the Modified Daily Drinking Questionnaire, and the Sexual Alcohol Expectancies Questionnaire.

RESULTS

Negative binomial regressions indicated that SAEs moderated the association between frequency of HED and AI with a condom, but not between the frequency of HED and condomless AI (CAI).

CONCLUSIONS

These results suggest that stronger SAEs play a role in alcohol-related sexual behavior among MSM, but do not provide evidence that SAEs are associated with increased risk for HIV transmission through CAI.

External validity of analogue sexual risk laboratory data

This article presents data on the external validity of an alcohol administration study of sexual decision-making in men who have sex with men (MSM) ages 21-50. Men (N = 135) randomized to alcohol (blood alcohol concentration [BAC] = .075%) or water control conditions reported intentions to engage in condomless anal intercourse (CAI) in response to video vignettes. Following the experiment participants provided 6 weeks of experience sampling method (ESM) data assessing intoxication, sexual arousal, partner relationship, and sexual behavior. Laboratory CAI intentions were hypothesized to predict future CAI behavior, and associations were hypothesized to be conditional upon sexual arousal and intoxication contextual factors as well as laboratory beverage condition. The hypotheses were partially supported. CAI intentions were correlated with subject proportions of days engaging in CAI (r = .29). A multilevel analysis indicated, on average, CAI intention predicted increased probability of CAI versus anal intercourse with a condom (relative risk ratio [RRR] = 1.43). There was mixed evidence of CAI intentions effects being conditional upon laboratory condition as well as arousal and intoxication contextual factors. Graphs of conditional marginal effects identified regions of significance. Effects of CAI intention for men in the alcohol condition on the CAI versus No Sex contrast were significant when sexual arousal was elevated. CAI intentions for men in the water control condition predicted a higher probability of CAI versus anal intercourse with a condom when intoxication was moderately elevated and/or arousal moderately low. The results support the external validity of alcohol administration experiments of sexual decision-making among MSM and, reciprocally, provide support for the validity of ESM assessment of sexual behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of Alcohol Intoxication on Sexual Decision-Making among Men Who Have Sex with Men (MSM): Alcohol's Influences on Self-Control Processes

This experiment tested mechanisms linking alcohol intoxication and analogue determinants of condomless anal intercourse (CAI) in a sample of 257 men who have sex with men (MSM). The two mechanisms tested were implicit approach biases toward CAI stimuli and executive working memory. Participants were randomized to 3 conditions (water control, placebo, or alcohol) and following beverage administration completed a working memory task, an Approach Avoidance Task of sexual vs. condom stimuli, and two video role-play vignettes of high-risk sexual scenarios. Sexual arousal and CAI intentions were assessed by self-report, and behavioral skills and risk exposure were derived from participants' role-play behavior. Estimation of four path models showed that the hypothesized mechanisms were supported for the CAI intention outcome, but the findings for the skills and risk exposure outcome were mixed. Implications for development and enhancement of HIV prevention interventions were discussed.