HIV infection is currently the 6th leading cause of death among American women aged 25-34 years, and heterosexual contact accounts for 80% of HIV infections in women. Highly controlled laboratory experiments have indicated that alcohol intoxication fosters HIV-related risk behaviors;this may be particularly true among women with a history of child sexual abuse (CSA) or later sexual assault (SA), who it is estimated comprise over 20% of all women. Research has also shown CSA-positive (CSA+) and SA-positive (SA+) women are at higher risk of HIV infection than those without such a history. This heightened risk may in part be related to alcohol use. Because the bulk of the extant research has been descriptive and correlational, virtually nothing is known about how alcohol and contextual factors such as partner characteristics operate in-the-moment to affect sexual decision-making (SDM) processes of CSA+/SA+ women, potentially increasing their risk of contracting HIV. The present project addresses this knowledge gap. Two large scale alcohol administration experiments will examine risky SDM processes among female social drinkers, aged 21-30, with and without victimization histories, in an experimental dating analogue. Drawing on existing theory, one type of partner characteristic will be manipulated in each experiment: a recent partner's relationship potential (low v. high);and an ongoing partner's pressure to have unprotected intercourse (low pressure vs. high pressure). Alcohol myopia theory will be employed as a potentially useful theoretical framework. Possible mediators of the risky SDM-alcohol connection that will be investigated in-the-moment include risk perception, self-efficacy, and anticipated partner reaction to condom negotiation. Potential moderating influences of background characteristics will also be explored, including alcohol expectancies and drinking habits, sensation seeking, traumatic sexualization, condom attitudes and sexual experiences, as well as prior victimization factors, such as type, age, and severity. Relevance: The proposed studies will advance our understanding of in-the-moment dynamics of risky HIV-related decision-making and behavior in intoxicated and sober binge-drinking women who have and have not been sexually victimized. Findings will greatly inform designers of prevention programs, who remain frustrated in their efforts to stem the spread of HIV in women and eager to learn of new and promising targets for intervention. The information gleaned from the proposed studies could be used to design HIV prevention programs that work for social-drinking women, particularly those with a history of victimization, a substantial but underserved population.
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