# Why Some but Not Others? Exploring Factors That Determine Whether Alcohol Intoxication Increases Sexual Risk Behavior Among Men Who Have Sex with Men

## TL;DR

This study explores why some men who have sex with men (MSM) perceive alcohol as increasing sexual risk behavior while others do not.

## Contribution

The study identifies perceived STI risk and partner familiarity as potential moderating factors in the relationship between alcohol intoxication and sexual risk behavior.

## Key findings

- Participants who believed alcohol affects sexual risk behavior reported concerns about STI risk and focused on new partners.
- Participants who did not perceive alcohol effects reported minimal STI risk and similar behavior whether drunk or sober.
- The study suggests future research should consider factors beyond CAS, such as partner familiarity and perceived STI risk.

## Abstract

Experimental research demonstrates that alcohol intoxication can increase likelihood of condomless anal sex (CAS) among men who have sex with men (MSM), and qualitative research indicates MSM generally perceive this to be true. However, event-level quantitative research suggests alcohol does not affect likelihood of CAS for all MSM in all circumstances, and factors that may moderate this relationship have yet to be explored with qualitative methods.

The current study sought to explore such moderating factors by conducting qualitative interviews with N=26 MSM who reported frequent casual sex and alcohol use. Interview transcripts were coded using thematic analysis.

Two main themes were identified. First, participants who perceived alcohol to affect sexual risk (n=11) identified many behaviors that alcohol affected including CAS, communication with partners, and partner selection. Second, a major difference between participants who reported alcohol effects and those who did not was perception of sexually transmitted infection (STI) risk. Participants who perceived alcohol to affect sexual risk generally expressed concern about STI risk and indicated that alcohol primarily affects sexual risk decisions with new sexual partners because these partners are perceived as riskier for STIs. Participants that perceived no alcohol effects (n=15) generally perceived minimal STI risk associated with their sexual behavior and would therefore engage in the same sexual behavior whether they were drunk or sober.

The results of the present study suggest future research on alcohol use and sexual risk should focus on behaviors beyond CAS and should explore moderating factors like partner familiarity and perceived STI risk.