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Intoxication Before Intercourse and Risky Sexual Behavior in Male Veterans With and Without Human Immunodeficiency Virus Infection

Cook, Robert L. MD, MPH*; McGinnis, Kathleen A. MS; Kraemer, Kevin L. MD, MSc*; Gordon, Adam J. MD, MPH*‡; Conigliaro, Joseph MD, MPH§; Maisto, Stephen A. PhD; Samet, Jeffrey H. MD, MA, MPH; Crystal, Stephen PhD**; Rimland, David MD††‡‡; Bryant, Kendall J. PhD§§; Braithwaite, R Scott MD¶¶∥∥; Justice, Amy C. MD, PhD∥∥

doi: 10.1097/01.mlr.0000223710.35008.d9
Original Article

Background: Male veterans represent a large population at risk for acquiring or transmitting human immunodeficiency virus (HIV) infection. We sought to determine the prevalence of risky sexual behavior among veterans with and without HIV infection and to assess the relationship of intoxication before intercourse and other measures of drug and alcohol use to risky sexual behavior in this population.

Methods: We analyzed baseline data on 1009 HIV-positive (mean age 49 years) and 710 HIV-negative male veterans (mean age 55 years) who were participating in the Veterans Aging Cohort 5-Site Study (VACS 5). Participants completed a written questionnaire that included measures of alcohol and drug use and risky sexual behavior.

Results: Compared with HIV-negative veterans, HIV-positive veterans were more likely to report 5 or more sexual partners in the past year (14% vs. 4%, P < 0.01), less likely to report not using a condom at last intercourse (25% vs. 75%, P < 0.01), and similarly likely to report having 2 or more partners and inconsistent condom use (10% vs. 10%). Among sexually active HIV-positive veterans, intoxication before intercourse was significantly associated with having 5 or more sexual partners in the past year (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–2.8), inconsistent condom use (OR 1.8, 95% CI 1.2–2.7), and the combined measure of 2 or more partners and inconsistent condom use (OR 1.8, 95% CI 1.1–3.0). Intoxication before intercourse was not significantly associated with these behaviors in HIV-negative veterans, although similar trends were noted.

Conclusion: Risky sexual behavior was common among male veterans attending outpatient clinics and is more common among HIV-positive veterans who use alcohol and drugs in sexual situations. Asking HIV-positive men a single question about intoxication before intercourse could help to identify men at increased risk of engaging in risky sexual behavior, and specific advice to avoid intoxication in sexual situations could help to reduce risky sexual behavior.

From the *Department of Medicine and †Center for Urban and Social Research, University of Pittsburgh and ‡Center for Health Equity Research and Promotion, VA Medical Center, Pittsburgh, Pennsylvania; §Department of Medicine, University of Kentucky, Lexington, Kentucky; ¶Department of Psychology, Syracuse University, Syracuse, New York; ∥Department of Medicine, Boston University School of Medicine, Boston Massachusetts; **Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, ††Department of Medicine, Emory University School of Medicine and ‡‡VA Medical Center, Atlanta, Georgia; §§National Institute on Alcohol Abuse and Alcoholism, Bethesda Maryland; and ¶¶Department of Medicine, Yale University and ∥∥West Haven VA Medical Center, New Haven, Connecticut.

Primary study funding was from National Institute on Alcohol and Alcohol Abuse (3U01 AA 13566), National Institute of Aging (K23 AG00826), Robert Wood Johnson Generalist Faculty Scholar Award, an Interagency Agreement between National Institute on Aging, National Institute of Mental Health and the Veterans Health Administration, and the Veterans Health Administration Office of Research and Development and Public Health Strategic Health Care Group.

Data were presented in part at the 2003 Annual Meeting of the Research Society on Alcoholism, Ft. Lauderdale, Florida.

Reprints: Robert L. Cook, MD, MPH, 230 McKee Place, Suite 600, University of Pittsburgh, Pittsburgh, PA 15213. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.