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Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men

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Abstract

The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21–50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant’s own or study-provided mobile phone. Individual differences variables were measured by participants’ completing questionnaires measuring effortful control and urgency, and the participant’s self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol’s effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol’s effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.

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Notes

  1. One item from the Negative Urgency scale was inadvertently omitted from the assessment.

  2. We thank Kevin Grimm for this suggestion. We also estimated a model with missing partner relationship values on no sex nights at Level 1 were replaced by the subject mean (a constant for each person) rather than random variates from the subjects’ relationship distribution and a third partner relationship model where the no sex category was dropped. Relationships were largely consistent across models. We think our approach is optimal as it allows all events to be estimated simultaneously and does not attenuate the variance of the Level 1 relationship variable as much as when the subject mean (a constant for each person) was used to replace missing L1 values. The supplement material includes results from two models. Supplemental Tables 1 and 2 replicate the analyses reported in this paper with partner relationship excluded. Supplemental Table 3 includes partner relationship but excludes the “no sex” days from the analysis.

  3. Two participants completed a burst a second time resulting in more than 6 weeks of data. One man traveled out of the county and did not have internet access during a portion of their participation. A second man’s phone broke during their participation. Each requested to re-take the burst and we allowed it. We decided to include both efforts rather than discard their data.

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Acknowledgements

Computations supporting this project were performed on High Performance Computing systems at the University of South Dakota (USD), funded by NSF Award 1626516. We thank USD Research Computing staff Bill Conn for his assistance.

Funding

This study was funded by grant 5R01 AA022301 (MPI: Maisto, Palfai, Simons) from the National Institute on Alcohol Abuse and Alcoholism. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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  1. Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA

    Stephen A. Maisto & Dezarie Moskal

  2. Department of Psychology, University of South Dakota, Vermillion, SD, USA

    Jeffrey S. Simons

  3. Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA

    Tibor P. Palfai & Peter Luehring-Jones

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Maisto, S.A., Simons, J.S., Palfai, T.P. et al. Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men. Arch Sex Behav 50, 2843–2860 (2021). https://doi.org/10.1007/s10508-020-01852-2

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