Alcohol use and condom use motivation among MSM: an ecological momentary assessment study of motivational processes underlying sexual risk
Date
2022
DOI
Authors
Luehring-Jones, Peter Theodore
Version
OA Version
Citation
Abstract
INTRODUCTION: Alcohol consumption significantly increases the risk of HIV infection among men who have sex with men (MSM). Discounting processes have been proposed as candidate mechanisms of sexual risk, such that the subjective value of a reward (e.g., condom-protected sex) becomes reduced when it can be obtained only after a delay or by expending effort. The present study sought to extend research on discounting as a potential mechanism of alcohol-involved sexual risk among MSM by using a repeated-measures, ecological momentary assessment (EMA) framework in the natural environment to examine within-subjects effects of alcohol consumption on sexual discounting processes.
METHODS: Fifty-five binge-drinking MSM completed baseline surveys and then enrolled in a 32-day EMA study period. Each evening, participants completed two of three discounting tasks: (1) a novel effort discounting task to assess how alcohol affects motivation to expend effort to obtain condoms prior to sex; (2) a condom delay discounting task based on Johnson and Bruner’s (2012) sexual delay discounting task; and (3) a novel monetary equivalence task to estimate the monetary value of an episode of condomless anal intercourse (CAI). Participants also reported on alcohol consumption prior to task completion as well as other contextual factors related to sexual risk-taking, including sexual arousal and potential partner attractiveness.
RESULTS: Supporting primary hypotheses, multilevel analyses indicated that within-subjects, alcohol consumption significantly predicted reduced likelihood of expending effort to obtain condoms prior to having sex. Contrary to hypotheses, however, alcohol did not significantly decrease the likelihood that participants would wait to have condom-protected sex, nor did it increase the likelihood that participants would choose to have an episode of CAI over earning money. Secondary analyses revealed (1) significant within-subjects effects of partner attractiveness on both the condom discounting and monetary equivalence tasks, and (2) significant within-subjects effects of alcohol consumption on individual discounting points for the effort discounting task only.
CONCLUSION: Results suggest that effort discounting may be a viable candidate mechanism for alcohol-influenced sexual risk behavior among MSM. These findings have important implications for intervention development, which may benefit from a focus on increasing motivation to use condoms when drinking.