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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

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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.

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References

  1. Bryant KJ, Nelson S, Braithwaite RS, Roach D. Integrating HIV/AIDS and alcohol research. Alcohol Res Health. 2010;33(3):167–78.

    PubMed  PubMed Central  Google Scholar 

  2. Woolf-King SE, Maisto SA. Alcohol use and high-risk sexual behavior in Sub-Saharan Africa: a narrative review. Arch Sex Behav. 2011;40(1):17–42.

    Article  PubMed  Google Scholar 

  3. Shuper PA, Joharchi N, Irving H, Rehm J. Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: review and meta-analysis. AIDS Behav. 2009;13(6):1021–36.

    Article  PubMed  Google Scholar 

  4. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr (1999). 2009;52(2):180.

    Article  Google Scholar 

  5. Pandrea I, Happel KI, Amedee AM, Bagby GJ, Nelson S. Alcohol’s role in hiv transmission and disease progression. Alcohol Res Health. 2010;33(3):203–18.

    PubMed  PubMed Central  Google Scholar 

  6. Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retroviruses. 2010;26(5):511–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Molina PE, Bagby GJ, Nelson S. Biomedical consequences of alcohol use disorders in the HIV-infected host invited review. Curr HIV Res. 2014;12(4):265–75.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. UNAIDS. Word AIDS day report fact sheet 2014: UNAIDS. 2014. [cited 2015 February 12]. http://www.unaids.org/en/resources/campaigns/World-AIDS-Day-Report-2014/factsheet.

  9. Organization WH. Global status report on alcohol and health. Geneva: WHO; 2011.

    Google Scholar 

  10. Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health. 2010;55(3):159–66.

    Article  PubMed  Google Scholar 

  11. Scott-Sheldon LJ, Walstrom P, Carey K, Johnson B, Carey M. Alcohol use and sexual risk behaviors among individuals infected with HIV: a systematic review and meta-analysis 2012 to early 2013. Current HIV/AIDS Rep. 2013;10(4):314–23.

    Article  Google Scholar 

  12. Kiene SM, Simbayi LC, Abrams A, Cloete A, Tennen H, Fisher JD. High rates of unprotected sex occurring among HIV-positive individuals in a daily diary study in South Africa: the role of alcohol use. J Acquir Immune Defic Syndr. 2008;49(2):219–26.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kiene S, Subramanian SV. Event-level association between alcohol use and unprotected sex during last sex: evidence from population-based surveys in sub-Saharan Africa. BMC Public Health. 2013;13:583.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV: issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035–45.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Weinhardt LS, Carey MP. Does alcohol lead to sexual risk behavior? Findings from event-level research. Annu Rev Sex Res. 2000;11:125–57.

    PubMed  CAS  PubMed Central  Google Scholar 

  16. Morojele NK, Kachieng’a MA, Mokoko E, Nkoko MA, Parry CD, Nkowane AM, et al. Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa. Soc Sci Med. 2006;62(1):217–27.

    Article  PubMed  Google Scholar 

  17. Kalichman SC, Simbayi LC, Jooste S, Cain D. Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa. Am J Drug Alcohol Abuse. 2007;33(5):687–98.

    Article  PubMed  Google Scholar 

  18. Kalichman SC, Simbayi L, Jooste S, Vermaak R, Cain D. Sensation seeking and alcohol use predict HIV transmission risks: prospective study of sexually transmitted infection clinic patients, Cape Town, South Africa. Addict Behav. 2008;33(12):1630–3.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Goldman MS, Del Boca FK, Darkes J. Alcohol expectancy theory: The application of cognitive neuroscience. In: Leonard KE, Blane HT, editors. Psychological theories of drinking and alcoholism. 2nd ed. New York: Guilford; 1999. p. 203–46.

    Google Scholar 

  20. Steele CM, Josephs RA. Alcohol myopia. Its prized and dangerous effects. Am Psychol. 1990;45(8):921–33.

    Article  PubMed  CAS  Google Scholar 

  21. Moss AC, Albery IP. A dual-process model of the alcohol-behavior link for social drinking. Psychol Bull. 2009;135(4):516–30.

    Article  PubMed  Google Scholar 

  22. Corbin WR, Fromme K. Alcohol use and serial monogamy as risks for sexually transmitted diseases in young adults. Health Psychol. 2002;21(3):229–36.

    Article  PubMed  Google Scholar 

  23. Dermen KH, Cooper ML. Inhibition conflict and alcohol expectancy as moderators of alcohol’s relationship to condom use. Exp Clin Psychopharmacol. 2000;8(2):198–206.

    Article  PubMed  CAS  Google Scholar 

  24. Dermen KH, Cooper ML, Agocha VB. Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. J Stud Alcohol. 1998;59(1):71–7.

    Article  PubMed  CAS  Google Scholar 

  25. Kalichman SC, Weinhardt L, DiFonzo K, Austin J, Luke W. Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men. Ann Behav Med. 2002;24(3):229–35.

    Article  PubMed  Google Scholar 

  26. Maisto SA, Carey MP, Carey KB, Gordon CM, Schum JL. Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women. Exp Clin Psychopharmacol. 2004;12(4):288–97.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gordon CM, Carey MP, Carey KB. Effects of a drinking event on behavioral skills and condom attitudes in men: implications for HIV risk from a controlled experiment. Health Psychol. 1997;16(5):490–5.

    Article  PubMed  CAS  Google Scholar 

  28. Fromme K, D’Amico EJ, Katz EC. Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation? J Stud Alcohol. 1999;60(1):54–63.

    Article  PubMed  CAS  Google Scholar 

  29. MacDonald TK, MacDonald G, Zanna MP, Fong GT. Alcohol, sexual arousal, and intentions to use condoms in young men: applying alcohol myopia theory to risky sexual behavior. Health Psychol. 2000;19(3):290–8.

    Article  PubMed  CAS  Google Scholar 

  30. Wray TB, Simons JS, Maisto SA. Effects of alcohol intoxication and autonomic arousal on delay discounting and risky sex in young adult heterosexual men. Addict Behav. 2015;42:9–13.

    Article  PubMed  Google Scholar 

  31. Kiene SM, Fisher WA, Shuper PA, Cornman DH, Christie S, Macdonald S, et al. Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: an information–motivation–behavioral skills model analysis. Health Psychol. 2013;32(8):860–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull. 2001;127(1):142–61.

    Article  PubMed  CAS  Google Scholar 

  33. Geter A, Crosby R. Condom refusal and young Black men: the influence of pleasure, sexual partners, and friends. J Urban Health. 2014;91(3):541–6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kiene SM, Tennen H, Armeli S. Today I’ll use a condom, but who knows about tomorrow: a daily process study of variability in predictors of condom use. Health Psychol. 2008;27(4):463–72.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tennen H, Affleck G. Daily process in coping with chronic pain: methods and analytic strategies. In: Ziedner M, Endler NS, editors. Handbook of coping: theory, research, applications. New York: Wiley; 1996. p. 151–77.

    Google Scholar 

  36. Kiene SM, Christie S, Cornman DH, Fisher WA, Shuper PA, Pillay S, et al. Sexual risk behaviour among HIV-positive individuals in clinical care in urban KwaZulu-Natal, South Africa. AIDS. 2006;20:1781–4.

    Article  PubMed  Google Scholar 

  37. Simbayi LC, Kalichman SC, Cain D, Cherry C, Jooste S, Mathiti V. Alcohol and risks for HIV/AIDS among sexually transmitted infection clinic patients in Cape Town, South Africa. Subst Abus. 2006;27:37–43.

    Article  PubMed  Google Scholar 

  38. Kiene SM, Barta WD, Zelenski JM, Cothran DL. Why are you bringing up condoms now? The effect of message content on framing effects of condom use messages. Health Psychol. 2005;24:321–6.

    Article  PubMed  Google Scholar 

  39. Barta W, Portnoy D, Kiene S, Tennen H, Abu-Hasaballah K, Ferrer R. A daily process investigation of alcohol-involved sexual risk behavior among economically disadvantaged problem drinkers living with HIV/AIDS. AIDS Behav. 2008;12(5):729–40.

    Article  PubMed  Google Scholar 

  40. Dermen KH, Cooper ML. Sex-related alcohol expectancies among adolescents: II. Prediction of drinking in social and sexual situations. Psychol Addict Behav. 1994;8(3):161–8.

    Article  Google Scholar 

  41. Lopez A, Stockwell T, Chikritzhs T. International guide for monitoring alcohol consumption and related harm. Geneva: World Health Organization; 2000.

    Google Scholar 

  42. Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sex Transm Infect. 2007;83:29–34.

    Article  Google Scholar 

  43. Meyer-Weitz A, Reddy P, Van Den Borne HW, Kok G, Pietersen J. Determinants of multi-partner behaviour of male patients with sexually transmitted diseases in South Africa: implications for interventions. Int J Mens Health. 2003;2:149–62.

    Article  Google Scholar 

  44. Wojcicki JM, Malala J. Condom use, power and HIV/AIDS risk: sex-workers bargain for survival in Hillbrow/Joubert Park/Berea, Johannesburg. Soc Sci Med. 2001;53(1):99–121.

    Article  PubMed  CAS  Google Scholar 

  45. Wojcicki JM. She drank his money: survival sex and the problem of violence in taverns in Gauteng province, South Africa. Med Anthropol Q. 2002;16(3):267–93.

    Article  PubMed  Google Scholar 

  46. Eaton LA, West TV, Kenny DA, Kalichman SC. HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection. AIDS Behav. 2009;13(2):185–95.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Stone AA, Broderick J, Porter L, Krupp L, Gyns M, Paty J, et al. Fatigue and mood in chronic fatigue syndrome patients: results of a momentary assessment protocol examining fatigue and mood levels and diurnal patterns. Ann Behav Med. 1994;16:228–34.

    Google Scholar 

  48. Hayes SC, Cavoir N. Multiple tracking and the reactivity of self-monitoring: I. Negative behaviors. Behav Ther. 1977;8:819–31.

    Article  Google Scholar 

  49. Nelson RO, Hayes SC. Theoretical explanations for reactivity in self-monitoring. Behav Modif. 1981;5:3–14.

    Article  Google Scholar 

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Acknowledgments

Supported by the National Institutes of Mental Health (F31MH072547-01 to S.M.K.) by a research development grant from the Center for Health, Intervention and Prevention at the University of Connecticut, a Grant-in-Aid from the Society for the Psychological Study of Social Issues, and by the Clarence J. Rosecrans Research Scholarship from the American Psychological Foundation.

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Authors and Affiliations

  1. Department of Community Health Care, University of Connecticut School of Medicine, Farmington, CT, USA

    Susan M. Kiene

  2. Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA

    Susan M. Kiene

  3. Human Sciences Research Council, Social Aspects of HIV/AIDS and Health, Cape Town, South Africa

    Leickness C. Simbayi & Allanise Cloete

  4. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Leickness C. Simbayi

  5. Department of Social Anthropology, University of Cape Town, Cape Town, South Africa

    Amber Abrams

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  1. Susan M. Kiene
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  4. Allanise Cloete
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Correspondence to Susan M. Kiene.

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Kiene, S.M., Simbayi, L.C., Abrams, A. et al. 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. AIDS Behav 20 (Suppl 1), 60–73 (2016). https://doi.org/10.1007/s10461-015-1157-0

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