Black men who have sex with men (MSM) are the most at-risk group for HIV infection. Efforts are needed to understand correlates of HIV risk among this group. Alcohol consumption is highly prevalent among MSM, is associated with condomless sex, and may contribute to HIV risk among Black MSM. This study aimed to: 1) examine the association between alcohol consumption (i.e. drinking before/during sex and levels of alcohol use problems) and condom use during lifetime, past 6 months, and the event level; and 2) test moderators (i.e. sex-related alcohol expectancies, impulsivity, sensation seeking, and partner type) of the relationship between problem drinking and condom use across all three levels of analysis.
Black MSM (N = 116) reported sexual behavior and condom use for lifetime, past 6 months, and the most recent condom and condomless sex events. The Alcohol Use Disorders Identification Test determined problem drinking (i.e. AUDIT scores ≥ 8). Ordinal and binary regression analyses analyzed associations between AUDIT scores, condomless receptive and insertive sex, and hypothesized moderators. AUDIT scores were associated with a greater likelihood of condomless sex (lifetime receptive sex: OR = 1.06, p < .05; past 6 months insertive sex: OR = 1.09, p < .01). At the event level, there was no greater likelihood of drinking during last condomless sex as compared to last condom sex, χ2(1) = .18, p = .39. The association between problem drinking and lifetime condomless receptive sex was strongest among men with: 1) predominately casual/anonymous sexual partners (OR = 8.54, 95% CI, .74 – 98.12); 2) high levels of impulsivity, OR = 2.52, 95% CI, 1.06 – 6.02. Significant moderation was found for lifetime receptive sex only.
Global patterns of problem drinking were associated with a greater likelihood of risky sexual behavior. Drinking before/during sex was not related to condom use. The association between problem drinking and receptive condomless sex was strongest among men with predominately casual/anonymous sexual partners and high levels of impulsivity. These findings highlight several pathways to sexual risk behavior among Black MSM, as well as important differential risk factors given sexual position.
