Why Some but Not Others? Exploring Factors That Determine Whether Alcohol Intoxication Increases Sexual Risk Behavior Among Men Who Have Sex with Men

Abstract Background Experimental research demonstrates that alcohol intoxication can increase likelihood of condomless anal sex (CAS) among men who have sex with men (MSM), and qualitative research indicates MSM generally perceive this to be true. However, event-level quantitative research suggests alcohol does not affect likelihood of CAS for all MSM in all circumstances, and factors that may moderate this relationship have yet to be explored with qualitative methods. Methods The current study sought to explore such moderating factors by conducting qualitative interviews with N = 26 MSM who reported frequent casual sex and alcohol use. Interview transcripts were coded using thematic analysis. Results Two main themes were identified. First, participants who perceived alcohol to affect sexual risk ( n = 12) identified its effects on CAS, but also noted effects on other behaviors relevant to sexual risk (i.e., communication about sexual risk with partners, partner selection). Second, a major difference between participants who reported alcohol effects and those who did not was perception of sexually transmitted infection (STI) risk. Participants who perceived alcohol to affect sexual risk generally expressed concern about STI risk and indicated that alcohol primarily affects sexual risk decisions with new sexual partners because these partners are perceived as riskier for STIs. Participants that perceived no alcohol effects ( n = 14) generally perceived minimal STI risk associated with their sexual behavior. Because of this, being intoxicated did not change their perception of risk and therefore did not affect the types of sexual behavior they engage in. Conclusions The results of the present study suggest future research on alcohol use and sexual risk should focus on behaviors beyond CAS and should explore moderating factors like partner familiarity and perceived STI risk.