More than 2.7 million people are newly infected with HIV per year. Alcohol use has been implicated as a contributor to the HIV epidemic. Nonetheless, the evidence linking alcohol consumption to risky sexual behavior has been mixed. Studies assessing the association vary considerably in their approach measuring global associations, situational associations, or alcohol and sexual behavior at the event-level. Researchers have suggested that inconsistent findings in the literature are related to the assessment methods used and underlying "third variables" that may moderate the association. To date, the alcohol-risky sex relation at the global, situational, and event levels has not been simultaneously meta-analyzed nor have moderators (or mediators) of the relation been systematically evaluated. Furthermore, noticeably higher patterns of hazardous alcohol consumption prevail in regions experiencing the heaviest HIV burden. Because negative consequences associated with alcohol use differ by country, modeling geographical region is critical in our understanding of the alcohol-risky sex relation. Therefore, the proposed research will use meta-analytic methodology to gauge the state-of-the-science, identify gaps, and advance HIV prevention science and practice. We will examine whether alcohol is directly associated with sexual behavior, and we will evaluate the efficacy of HIV-related interventions to improve behavioral and biological outcomes. A cultural-specific conceptual model of the association between alcohol consumption and risky sexual behavior will be used to guide the meta-analysis. Thus, the proposed research will examine the extent to which alcohol directly or indirectly undermines sexual health. Determining the extent to which alcohol interferes with sexual behavior will guide future intervention development to reduce the incidence of HIV. The extant literature suggests the association between alcohol consumption and sexual behavior is complex and multidimensional. To fully explore these complexities and resolve inconsistencies in the scientific literature, multilevel meta-analytic methods will be used to examine the association between alcohol consumption and behavioral and/or biological health outcomes among global, situational, and event-level studies. Moderators of the alcohol-risky behavior association will be identified. Using state-of-the-art geographical information systems, the proposed research will literally map geographical regions where alcohol and sexual risk behavior converge. The proposed study will be the first to systematically and comprehensively investigate the association between alcohol consumption and sexual risk behaviors. The conclusions drawn from this meta-analysis will be used to identify geographic-specific prevention opportunities targeted to geographical region.
The association between alcohol consumption and sexual behavior is complex and multidimensional. The proposed research will provide an overview of the state-of-the-science regarding the extent to which alcohol consumption undermines sexual health behavior using four levels of study (global, situational, event-level, and intervention). Th conclusions drawn from this meta-analysis will be used to identify geographic-specific prevention priorities and will assist others in the development and implementation of contextual sexual risk reduction interventions to reduce the global incidence of HIV.