Alcohol consumption has an impact on the intention of
individuals to have unprotected sex, according to the results of a systematic
review and meta-analysis published in the journal Addiction.
“The higher the blood alcohol content, the more pronounced
the intention to engage in unsafe sex,” comment the investigators.
Alcohol can lead to disinhibition, affect cognitive
capacity, and has an impact on immune function. But a direct relationship
between alcohol and the transmission of HIV and other infections is difficult
to prove conclusively. This may be because people who consume alcohol may be
more likely to have unprotected sex because they generally lead riskier lives.
One way of overcoming this limitation is to examine the
relationship between blood alcohol levels and self-reported intention to use a
condom or engage in unprotected sex.
Investigators from Canada therefore performed a systematic
review and meta-analysis, identifying randomised studies that explored the
relationship between alcohol consumption and sexual behaviour.
To be included in the analysis the studies had to satisfy
- Original research published in a peer-reviewed
- Individuals were randomised to receive differing
doses of alcohol.
- The intention to engage in unprotected sex was
- The association between blood alcohol level and
intention to engage in risky sex was tested.
- Individuals were assessed individually.
The twelve studies that met the inclusion criteria were
conducted in the US between 2004 and 2010. All included young adults (mean age
23 to 27 years) recruited in college or community settings.
There was a consistent relationship between blood alcohol
content and intention to engage in unprotected sex.
An increase in blood alcohol content of 0.1mg/ml (compared
to a content of 0.0mg/ml) was associated with a 5% increase (95% CI, 2.8-7.1%)
in the likelihood of having unsafe sex.
The investigators adjusted their results to take account of
publication bias and other potentially confounding factors.
A clear relationship between alcohol consumption and
intention to engage in unprotected sex remained apparent, with each 0.1 mg/ml
increase in blood alcohol consumption increasing the likelihood of reporting an
intention to have unprotected sex by 3% (95% CI, 2.0-3.9%).
“In experimental studies there is a consistent significant
effect of the level of alcohol consumption on intention to use condoms,
indicating that the higher the blood alcohol content, the higher the intention
to engage in unsafe sex,” comment the authors.
However, they acknowledge that their study has a number of
limitations: “Most importantly, this investigation does not focus on actual
condom use, but instead examines the intentions to use condoms.”
Nevertheless, the investigators believe that their study is
an important addition to the literature on alcohol use and the transmission of
HIV and other sexually transmitted infections.
“We found evidence of potential pathways explaining this
association,” write the researchers. “Alcohol impacted on intentions about
unsafe sex with a clear dose-response relationship. This may, in part, be
explained by its effect on cognitive functioning.”
The authors also believe their findings have public health
implications and suggest “studies varying alcohol consumption experimentally
using proven effective interventions in at risk groups with later measurement
of incidence of HIV and sexually transmitted infections would be advisable.”