![]() ![]() There are two major limitations of this sort of analysis. ![]() The majority, but by no means all, of these studies have shown that people who are heavier drinkers or drug users tend to have more sexual partners and to use condoms less consistently (see Appendix for a listing of the studies reviewed). ![]() In these studies, respondents were asked about the frequency with which they engaged in high-risk behaviors (in some studies, a dichotomous variable reflecting whether the respondent had engaged in any high-risk activities or not), and about the overall frequency and/or quantity of their alcohol or drug use. Thus, we begin our review with studies that includes measures specifically of higher-risk sex. For example, heavier drinkers may have more frequent sex but not more frequent risky sex this distinction cannot be determined from data on general patterns of sexual activity. The existence of a global association between substance use and general sexual activity does not necessarily indicate a link between substance use and risky sexual activity in particular. Many correlational studies have examined the relationship of substance use to sexual behavior in general, showing that general drinking habits are correlated with more liberal sexual behavior (see Wilsnack, 1984), and that recreational drug use is associated with early sexual activity in adolescents (see Kandel, 1989). The third group of studies ( event analyses) focuses on discrete sexual events: respondents are asked about the circumstances of a specific sexual encounter, including whether high-risk sex occurred and whether alcohol or drugs were used during that encounter. The second type of study is similar, except that instead of general substance use, the frequency of use of alcohol or drugs in conjunction with sexual activity is measured we call these studies situational association studies. In this paper, we term these studies global association studies. 1 In the first type of study, measures of overall substance use (for example, quantity or frequency of use) and measures of risky sexual behaviors (for example, frequency of engaging in unprotected intercourse) are collected, and the relationship between these two variables is examined. However, it is impossible (for both ethical and practical reasons) to design a controlled experiment to study the influence of a drug on actual sexual behavior in a natural setting - much as researchers might dream bemusedly of studies in which they randomly assign some bar patrons to drink alcohol, others to drink soft drinks, and then watch what happens.Īnalyses of the relationship between substance use and high-risk sex fall into three broad categories. Such controlled laboratory experiments have been used to investigate the influence of alcohol on various physiological and psychological arousal responses to sexual stimuli (see Crowe & George, 1989 for review). The ideal method for testing whether any drug causes individuals to engage in high-risk sex would be a study in which the drug is administered to an experimental group and withheld from a control group. We end with a discussion of implications of these findings for AIDS prevention policies.Īny discussion of research on the relationship of substance use to sexual risk-taking must take into account the limitations of research methods used. We then consider additional methodological concerns, including measurement and sampling issues, that affect interpretation of research findings. First, we review research that examines the link between substance use and high-risk behavior, while discussing the limitations of the research designs used to investigate this link. In this paper we examine the evidence for and against the hypothesis that a causal relationship exists between alcohol and/or drug use and high-risk sexual behavior for HIV transmission. In the last few years, a number of reports have appeared suggesting a link between alcohol or drug use and sexual behavior, such as unprotected intercourse, that is known to place an individual at higher risk for HIV infection. ![]() Because alcohol and drugs are thought to interfere with judgment and decision-making, it has been suggested that their use in conjunction with sexual activity might increase the probability that risky behaviors will occur (e.g., Howard et al., 1988 USDHHS, 1991). One factor that has been proposed as a contributor to sexual risk-taking is the use of alcohol or other drugs with sex (see Leigh, 1990a Stall, 1988). Recent behavioral research has focused on identification of potentially modifiable variables that may contribute to risk-taking behaviors. As the United States enters the second decade of the AIDS epidemic, it has become evident that the primary defense against the spread of this disease is prevention of the behaviors that result in HIV transmission. ![]()
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