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，北美男男性行为者（MSM）中新的艾滋病毒感染人数大幅增加，主要是由于持续的无保护的性活动。虽然酒精消费被认为是无保护的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高危性行为中的因果作用。因此，本研究的具体目的集中在：1)评估急性饮酒对艾滋病毒阳性男男性接触者进行无保护性行为意图的因果影响，并探索急性饮酒、性唤起和风险相关伴侣因素对性决策过程的相互作用；2)评估风险人格特质和酒精预期对急性酒精消费与hiv阳性MSM风险性行为意图因果关系的调节作用。这项调查将涉及一种创新的实验方法，其中130名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%)，观看简短的视频片段作为性唤起诱导的一部分（无唤起/性唤起），并表明他们与18个假设的性伴侣进行一系列有保护和无保护的性行为的意图，这些性伴侣在风险相关特征（即艾滋病毒血清状态，身体吸引力，关系类型和使用安全套的偏好）方面有所不同。在实验程序之前，还将对性感觉寻求、性强迫和与性有关的酒精预期进行测量。假设急性饮酒（H1）和性唤起（H2）会导致hiv阳性MSM表现出更强的无保护性行为意图，并且在这两个因素的主要影响之外，同时接受酒精和性唤起诱导（H3）的hiv阳性MSM的风险意图将是最强的。将探讨急性饮酒、性唤起和伴侣相关因素之间的高阶相互作用（H4），以及性感觉寻求、性强迫（H5）和酒精相关预期（H6）在酒精风险性关系中的调节作用。这项调查的结果不仅可能对针对HIV阳性个体的性风险行为的干预措施的发展产生影响，而且可能对与酒精相关的干预措施产生影响，这些干预措施可能与降低HIV风险的举措相一致。

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.