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The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda

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Abstract

HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.

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Funding

Manuscript preparation was partially supported by the National Institute of Alcohol Abuse and Alcoholism: K99AA028777 (PI: Blayney); 2R37AA025212 (PI: Davis); R01AA016281 (PIs: George, Davis); K08AA021745 (PI: Stappenbeck).

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Authors and Affiliations

  1. Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA

    William H. George

  2. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Jessica A. Blayney

  3. Department of Psychology, Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA

    Cynthia A. Stappenbeck

  4. Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA

    Kelly Cue Davis

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  1. William H. George
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  2. Jessica A. Blayney
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  3. Cynthia A. Stappenbeck
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  4. Kelly Cue Davis
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All authors contributed to all aspects of manuscript preparation.

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Correspondence to William H. George.

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George, W.H., Blayney, J.A., Stappenbeck, C.A. et al. The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda. AIDS Behav 25 (Suppl 3), 347–364 (2021). https://doi.org/10.1007/s10461-021-03351-4

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