Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women.

Despite the decline in the incidence of HIV transmission in the United States for males during the 1990s, the rates increased for heterosexual women in the young adult age range (18–30 years; Karon, Fleming, Steketee, & De Cock, 2001; Logan, Cole, & Leukefeld, 2002). Although there have been major advances in pharmacological management of HIV disease in recent years, this disease has no known cure. Accordingly, emphasis continues to be placed on the prevention of HIV transmission (Centers for Disease Control, 2000). Because of the importance of prevention of HIV infection, many studies of the hypothesized determinants of condom use, including alcohol use, have been conducted. The large majority of these studies have been cross-sectional, interview or survey studies of a variety of population subgroups. The most useful of these studies for describing the association between acute alcohol intoxication and failure to use condoms or other risky (for transmission of HIV) sexual practices are event-level studies (Leigh, 2002; Weinhardt & Carey, 2001). Both Leigh’s and Weinhardt and Carey’s reviews show that there is no general, negative association between acute alcohol intoxication and the use of condoms during sex, as global association studies have implied. Instead, the relationship between acute alcohol intoxication and the likelihood of the occurrence of risky sexual behavior seems to be dependent on characteristics of the individuals involved and contextual factors. The correlational research literature on the determinants of HIV/AIDS risky sexual behavior has helped to advance knowledge about factors associated with such behavior, with consequent improvement in the effectiveness of primary prevention efforts. The effectiveness of empirically-based prevention programs could be advanced further by identifying causal mechanisms underlying the relationship between alcohol and risky sexual behavior, but correlational data do not allow causal inferences. Accordingly, experimental studies have been done to complement correlational research on HIV/AIDS risky sex determinants. Only a few of the experiments on the relationship between acute alcohol intoxication and other factors and risky sex have involved young adult females. Because of gender differences (Peplau, 2003), it is essential to conduct research on both men and women if HIV prevention interventions are to be developed and targeted effectively. In Murphy, Monahan, and Miller’s (1998) experimental study of young adult women, they manipulated both beverage content (alcohol or no alcohol) and instructions (i.e., expectancy set) regarding beverage content (alcohol or no alcohol). Their data showed that alcohol consumption increased ratings of the potential to have a sexual relationship in the context created by a male video actor rated as physically attractive and higher risk for unsafe sex. Furthermore, expectancies about beverage content were important, as participants who were told that they drank alcohol perceived less risk and more relationship potential in this same experimental context. Data from this same experiment showed that instructions regarding beverage content, but not actual beverage content, were a determinant of confidence in detecting if a potential partner was HIV+ (Monahan, Murphy, & Miller, 1999). Participants who expected to drink alcohol reported more confidence in being able to detect HIV than participants who did not drink alcohol. Confidence in the ability to judge HIV serostatus and acting on such judgments implies occasions of risky sexual behavior. Experimental studies of alcohol and risk perception relevant to HIV have shown a balanced representation of male and female participants. These studies showed that young adults who have consumed alcohol perceive less risk than individuals who have not, and individuals who believe more strongly that alcohol consumption has positive effects on sexual arousal and performance tend to perceive less risk (Fromme, D’Amico, & Katz, 1999; Fromme, Katz, & D’Amico, 1997). The importance of these findings is that individuals who perceive less risk in a situation (in this case, a HIV risky sexual encounter) are less motivated to avoid it. This research team (Gordon & Carey, 1996; Gordon, Carey, & Carey, 1997; Maisto, Carey, Carey, & Gordon, 2002) has conducted research on the relationship of alcohol consumption and alcohol sex expectancies on several hypothesized antecedents of the occurrence safer (or riskier) sexual behavior according to the Information-Motivation-Behavioral Skills (IMB) model, which has been the basis of creating a number of HIV prevention interventions (J. Fisher & Fisher, 1992; W. Fisher & Fisher, 1998). These experiments investigated the constructs of risk perception, attitudes toward condom use, and behavioral intentions to engage in risky sex as indicators of motivation to engage in safer sex, and verbal skills in negotiating condom use as an indicator of behavioral skills needed to engage in safer sex. Only the Maisto et al. (2002) experiment involved heterosexual women, who were randomly assigned to one of three conditions: water control, placebo, or alcohol in a dose designed to raise blood alcohol concentration (BAC) to .070% – .075% (gm alcohol/100 ml blood). Following their beverage consumption, participants completed a measure of risk perception, and then completed a role-play measure of condom use negotiation skills. The participants also rated their hypothetical intentions to engage in risky sex with the male character depicted in the role-play measure. The results showed that alcohol sex expectancies were directly related to the degree of positive consequences perceived to follow from engaging in unprotected sex with a new partner. Furthermore, beverage content did not affect behavioral skills. However, perceived degree of intoxication, alone or in interaction with expectancies, was negatively related to performance on the measure of condom use negotiation skills. In contrast to these findings, only beverage condition affected intentions: individuals who drank alcohol reported a higher likelihood of engaging in unprotected sex compared to participants in the other two beverage conditions, which did not differ from each other. The purpose of this experiment was to replicate and extend Maisto et al.’s (2002) study. The absence of a beverage condition effect on all of the dependent variables except intentions was surprising, given the findings in the literature reported for males and for experiments on risk perception. Maisto et al.’s results may have been due to an inadvertent under-dosing of alcohol; although the dose administered was designed to raise participants’ BAC to .070% – .075%, they in fact reached an average BAC of only .060%. Therefore, in this experiment, a higher dose of alcohol was administered in an effort to induce the desired BAC. This experiment also added a lower alcohol dose condition, designed to raise participants’ BACs to .035%. This dose was chosen because it marks the lower end of the continuum of alcohol doses that might affect information processing capabilities, which have been argued to underlie alcohol’s effects on sexual risk (e.g., Finnegan & Hammersley, 1992; MacDonald, MacDonald, Zanna, & Fong, 2000). Therefore, this experiment’s multi-dose design allowed a dose-response specification of alcohol’s acute effects on theoretical antecedents of safer sex. Such specification has not been possible, as previous published experiments all have included only a single dose of alcohol. Based on our own and others’ previous findings, it was hypothesized that both beverage condition and alcohol sex expectancies would be negatively related to risk, as women who consumed the higher dose of alcohol were expected to perceive less risk, as were individuals with stronger alcohol sex expectancies. Only beverage condition was hypothesized to affect intentions, as participants who consumed the higher dose of alcohol were expected to show a greater degree of intentions to engage in unprotected sex. Finally, it was hypothesized that perceived degree of intoxication and expectancies separately, or in interaction, would be negatively related to condom use negotiation skills.