Alcohol Expectancies and Inhibition Conflict as Moderators of the Alcohol–Unprotected Sex Relationship: Event-Level Findings from a Daily Diary Study Among Individuals Living with HIV in Cape Town, South Africa

Abstract

Literature from sub-Saharan Africa and elsewhere supports a global association between alcohol and HIV risk. However, more rigorous studies using multiple event-level methods find mixed support for this association, suggesting the importance of examining potential moderators of this relationship. The present study explores the assumptions of alcohol expectancy theory and alcohol myopia theory as possible moderators that help elucidate the circumstances under which alcohol may affect individuals’ ability to use a condom. Participants were 82 individuals (58 women, 24 men) living with HIV who completed daily phone interviews for 42 days which assessed daily sexual behavior and alcohol consumption. Logistic generalized estimating equation models were used to examine the potential moderating effects of inhibition conflict and sex-related alcohol outcome expectancies. The data provided some support for both theories and in some cases the moderation effects were stronger when both partners consumed alcohol.

Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis

“…Alcohol use by both partners during an encounter was associated with increased odds of engaging in multiple rounds of sex and with inconsistent condom use during the encounter. The observed association between alcohol use by both partners and engaging in multiple rounds of sex and with inconsistent condom use is similar to the findings from other event-level studies of alcohol use, 13,14 methamphetamine use 8 and prescription opioid use. 15 Given the diverse pharmacological effects of methamphetamine, prescription opioids, and alcohol, it seems unlikely that these risk behaviors are driven by the effects of the drugs themselves.…”

The Information–Motivation–Behavioral Skills Model Revisited: A Network-Perspective Structural Equation Model Within a Public Sexually Transmitted Infection Clinic Sample of Hazardous Alcohol Users

“…The inhibitory cues of higher self-efficacy could be stronger for sexual encounters with non-primary partners regardless of alcohol use, but perceptions of higher self-efficacy could be misinterpreted as confidence in a low-risk unprotected sex event with their primary partner potentially caused by alcohol-related behavioral disinhibition. Kiene et al [55] applied the alcohol myopia theory [56] to study the moderating factors between condom use self-efficacy and unprotected sex with event-level data to find that alcohol consumption before sex disrupted the inhibitory cues of stronger self-efficacy. Based on our own findings, we suggest future research to determine whether this moderating effect differs based on partnership type.…”

Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study

“…In young adults, alcohol expectancy mediated the association between reward sensitivity and hazardous alcohol use (Gullo et al, 2010) and predicted or interacted with impulsivity, social anxiety, or mood state to predict alcohol use and alcohol-related problems (Fu et al, 2007, McCarthy et al, 2001, Meade Eggleston et al, 2004, Stein et al, 2000, Zamboanga, 2006). Alcohol expectancy and disinhibition both moderated alcohol use related risky sexual behavior (Kiene et al, 2016). Characterizing the interactive effects of alcohol expectancy and impulsivity may help to better identify factors promoting the development of problem drinking.…”