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

描述(由申请人提供)：艾滋病毒仍然是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)中新感染艾滋病毒的人数大幅增加，主要是由于持续的无保护措施的性行为。尽管酒精消费被认为是无保护措施的性行为和随后的艾滋病毒传播的一个因素，但到目前为止，还没有研究评估酒精在艾滋病毒阳性人群中危险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HIV阳性男男性接触者无保护性行为意向的因果影响，并探索急性饮酒、性唤醒和与风险相关的伴侣因素对性决策过程的交互作用；2)评估高风险人格特征和酒精预期对急性饮酒与HIV阳性男男性接触者高危性意图之间的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，130名HIV阳性MSM将接受酒精操作(对照组/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(没有性唤起/性唤起)，并表明他们打算与18个在风险相关特征(即HIV血清状况、身体吸引力、关系类型和使用避孕套偏好)方面不同的假设性伴侣进行一系列受保护和无保护的性行为。在实验程序之前，还将进行性感觉寻求、性强迫症和与性有关的酒精预期的测量。假设急性饮酒(H1)和性唤醒(H2)会导致HIV阳性MSM表现出更强烈的从事无保护措施性行为的意图，除了这两个因素的主要影响之外，同时接受酒精和性唤醒(H3)的HIV阳性MSM的风险意图将最强烈。本课程将探讨急性饮酒、性唤起和伴侣相关因素之间的更高层次的相互作用(H4)，以及性感觉寻求、性强迫(H5)和与酒精相关的期望(H6)对高酒精风险性关系的调节作用。这项调查的结果不仅可能对制定专门针对艾滋病毒阳性个人性行为危险行为的干预措施产生影响，而且还可能对可能与减少艾滋病毒风险倡议相协调的与酒精有关的干预措施产生影响。 与公共卫生相关：这项调查将包括一项涉及艾滋病毒阳性男同性恋者和双性恋者的实验，以评估饮酒是否会增加他们不使用避孕套发生性行为的意图。鉴于最近男同性恋者和双性恋者中新感染艾滋病毒的人数有所增加，这项研究的结果将对公共卫生产生重大影响，因为所获得的知识将有助于指导制定更安全的性行为促进计划和酒精干预措施，这些计划和酒精干预措施可以一起使用，帮助艾滋病毒阳性者保持安全，这应该会减少艾滋病毒传播给其他未感染艾滋病毒的人的机会。

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. PUBLIC HEALTH RELEVANCE: This investigation will consist of an experiment involving HIV-positive gay and bisexual men to assess whether consuming alcohol increases their intentions to have sex without condoms. Given the recent increases in new HIV infections among gay and bisexual men, results from this study will have a significant impact on public health, in that the knowledge to be gained will help guide the development of safer sex promotion programs and alcohol interventions that can be used together to help HIV-positive individuals stay safe, which should reduce the chances of HIV being transmitted to non-infected others.