A Mixed-Methods Examination of HIV Risk in Men Who Have Sex With Men: Effects of Alcohol and Sexual Compulsivity

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PROJECT SUMMARY HIV is a significant public health concern in the United States, particularly among men who have sex with men (MSM). In the past decade, MSM have accounted for approximately 70% of new HIV diagnoses, resulting in billions of dollars in lifetime healthcare costs. Alcohol significantly contributes to HIV risk behavior among MSM. There is a robust association between acute alcohol intoxication and condomless anal sex (CAS), as well as failure to utilize and adhere to preventative treatments including Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and adherence to antiretroviral therapy (ART). However, event-level research provides more mixed results, indicating a variety of moderating factors. One potential moderating factor that has not yet been investigated is sexual compulsivity (SC), which is the inability to control frequent and intense sexual urges or impulses. SC is associated with HIV risk, alcohol use, and increased likelihood of alcohol use before sex, suggesting those high in SC may be more susceptible to alcohol’s effects on sexual risk. The inhibition conflict model (ICM) of alcohol myopia suggests that alcohol has the greatest impact on sexual risk behavior in situations where a person is conflicted due to simultaneously experiencing high sexual instigation and high sexual inhibition. Individuals high in SC have demonstrated elevated levels of both sexual instigation and inhibition factors, potentially making them particularly vulnerable to alcohol-induced sexual risk. The proposed research aims to investigate of the effects of alcohol use and SC, both individually and synergistically, on HIV risk behavior in three steps. First, the proposed project would examine the potential moderating role or SC on the relationship between alcohol use and CAS through secondary analysis of a 90- day timeline follow-back dataset. Next, a cross-sectional survey of MSM at elevated HIV risk will evaluate the effects of SC and alcohol use on other methods of HIV risk mitigation, including PrEP, PEP and ART use, update, and adherence. Finally, a qualitative interview study will provide rich idiographic data on the lived experience of those with elevated SC, alcohol use, and sexual risk behavior, as well as the interactive effects of SC and alcohol on HIV risk. This proposal is commensurate with the candidate’s desire to develop a research program in sexual minority health focused on HIV risk, alcohol use, and problematic sexual behavior and supports his training goals of becoming proficient in both quantitative and qualitative methods. Through the proposed research and training plan, the applicant will develop the skills and expertise necessary to make a substantive contribution to the field of alcohol and HIV risk behavior as an independent clinical scientist.