An Event-Based Analysis of Sex Under Influence of Alcohol Among African American Men Who Have Sex with Men in Baltimore, MD

Introduction: In the United States, the highest rates of HIV infection are among African American men who have sex with men (MSM).  Many challenges remain in preventing the spread of the HIV infection, one of which is the acute or chronic alcohol use of people who are at risk for infection. The goal of the current study is to analyze event-level data to explore factors associated with sex under influence of alcohol among a sample of African American MSM in Baltimore, MD 

Methods: Study participants were 226 African American MSM in Baltimore recruited through street and venue-based outreach and active internet-based recruitment. In face-to-face interviews, participants reported characteristics of two most recent male sex partners, including age, race/ethnicity and where they first met. They were also asked to describe circumstances of the last anal sex with each partner, including whether any of them were drunk or using drugs. Condom use during the last anal sex with each partner was also assessed. Multilevel analyses were conducted by fitting repeated measures logistic regression models using Generalized Estimating Equations (GEE) to assess factors associated with sex under influence of alcohol.

Results: A total of 418 anal sex events were reported. Participant or/and his partner was drunk in 48% of the anal sex events. Having sex under influence of alcohol was not associated with condom use. Results from the adjusted GEE logistic regression model indicated that participants engaged in heavy episodic drinking at least once a week were significantly more likely to have sex under influence of alcohol (AOR:2.38, 95%CI:1.14,4.98). Meeting partner at bar/night club or at a party/friend’s house was more likely to have sex under influence of alcohol with this partner (AOR: 1.98, 95%CI: 0.95, 4.13; AOR: 1.74, 95%CI: 0.97, 3.11). Having sex with partner with same race/ethnicity, i.e., African American was more likely have sex under influence of alcohol than having sex with partners with different race/ethnicity (AOR: 1.87, 95%CI: 0.93, 3.77). Finally, participant or/and partner using drug during the last anal sex was significantly associated with having sex under influence of alcohol (AOR: 7.52, 95%CI: 4.54, 12.44).

Conclusions: Results of this study highlight social and environmental factors that associate with having sex under influence of alcohol among African American MSM. Lack of association between condom use and sex under influence of alcohol might be due to the reliability and accuracy of retrospective self-reports of highly sensitive information. Future interventions should target to venues where MSM seek sex and where drinking occurs (e.g., gay bars, party).