The Causal Role of Acute Alcohol Consumption in Risky Sex among HIV-Positive MSM

描述（由申请人提供）：艾滋病毒继续构成一个重大的公共卫生问题，最近的估计表明，北美男性同性性行为（MSM）中新的艾滋病毒感染大幅增加，主要是由于持续的无保护的性活动。虽然饮酒被认为是无保护性行为和随后的艾滋病毒传播的一个因素，但迄今为止还没有研究评估酒精在艾滋病毒阳性人群中的危险性行为中的因果作用。因此，本研究的具体目的是：1）评估急性饮酒对HIV阳性MSM进行无保护性行为的意图的因果影响，并探讨急性饮酒、性唤起和风险相关性伴因素在性决策过程中的相互作用;（2）评估危险人格特质和饮酒期望在急性饮酒与HIV阳性MSM的危险性行为意图之间的调节作用。这项调查将涉及一个创新的实验方法，其中130艾滋病毒阳性男男性行为者将接受酒精操纵（对照/安慰剂/酒精：目标BAC=0.08%），观看简短的视频剪辑作为性唤起诱导的一部分（无性唤起/性唤起），并表明他们打算与18名假设的性伴侣进行一系列有保护和无保护的性行为，这些性伴侣在以下方面不同：风险相关特性（即，艾滋病毒血清状况、身体吸引力、关系类型和使用避孕套的偏好）。在实验程序之前，还将进行性感觉寻求、性强迫和性相关酒精预期的测量。据推测，急性酒精消费（H1）和性唤起（H2）将导致艾滋病毒阳性的男男性接触者表示更强的意图，从事无保护的性行为，和以上的影响，这两个因素的主要影响，风险的意图将是最强的艾滋病毒阳性的男男性接触者接受了酒精和性唤起诱导（H3）。急性酒精消费，性唤起和合作伙伴相关因素之间的高阶相互作用将被探讨（H4），以及性感觉寻求，性强迫（H5）和酒精相关的预期（H6）对酒精风险性关系的调节作用。这项调查的结果可能不仅对制定专门针对艾滋病毒阳性者性风险行为的干预措施产生影响，而且对可能与艾滋病毒风险降低举措协同工作的酒精相关干预措施也产生影响。

DESCRIPTION (provided by applicant): HIV continues to pose a significant public health concern, and recent estimates have indicated a substantial increase in new HIV infections among North American men who have sex with men (MSM), mainly resulting from continued unprotected sexual activity. Although alcohol consumption has been implicated as a factor in unprotected sex and subsequent HIV transmission, no research to date has assessed the causal role of alcohol in risky sex among HIV-positive populations. The specific aims of the present investigation therefore focus on 1) assessing the causal impact of acute alcohol consumption on intentions to engage in unprotected sex among HIV-positive MSM, and exploring the interactions among acute alcohol consumption, sexual arousal, and risk-relevant partner factors on the sexual decision making process; and 2) assessing the moderating role of risky personality traits and alcohol expectancies on the causal relationship between acute alcohol consumption and HIV-positive MSM's risky sex intentions. This investigation will involve an innovative experimental approach in which 130 HIV-positive MSM will undergo an alcohol manipulation (control/placebo/alcohol: target BAC=0.08%), watch brief video clips as part of a sexual arousal induction (no arousal/sexual arousal), and indicate their intentions to engage in a range of protected and unprotected sexual acts with 18 hypothetical sexual partners who differ in terms of risk-relevant characteristics (i.e., HIV serostatus, physical attractiveness, relationship type, and preference for condom use). Prior to experimental procedures, measures of sexual sensation seeking, sexual compulsivity, and sex-related alcohol expectancies will also be administered. It is hypothesized that acute alcohol consumption (H1) and sexual arousal (H2) will cause HIV-positive MSM to indicate stronger intentions to engage in unprotected sex, and over and above the impact of the main effects for these two factors, risk intentions will be strongest for HIV-positive MSM who have received both alcohol and the sexual arousal induction (H3). Higher order interactions among acute alcohol consumption, sexual arousal, and partner-related factors will be explored (H4), as will the moderating roles of sexual sensation seeking, sexual compulsivity (H5), and alcohol-related expectancies (H6) on the alcohol-risky sex relationship. Results from this investigation may have an impact not only on the development of interventions that specifically target sexual risk behavior among HIV-positive individuals, but also on alcohol- related interventions that could potentially work in concert with HIV risk-reduction initiatives.