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Alcohol not only increases the likelihood of risky sexual behaviour, it also affects HIV treatment adherence.
Booze and HIV do not mix, in more ways than we think.
During the SA Aids Conference in Durban last week, Dr Paul Shuper, an expert scientist in the field of alcohol and HIV, said that “when you consume alcohol, you might forget to take your medication or may not even have it with you”.
“There is evidence from a number of studies that link alcohol to non-adherence to antiretroviral drugs (ARVs). What they found was that alcohol use was the strongest predictor of non-adherence, and another study showed that, in binge drinkers, the likelihood of non-adherence increased ninefold,” he said.
But Shuper also dispelled the myth that ARVs should not be taken while drinking.
“We need to change perceptions about antiretroviral therapy and alcohol toxicity. We need to work with healthcare professionals to ensure nonjudgemental attitudes when it comes to drinking and taking ARVs,” he said.
“Instead, we need to create an environment where people can come and talk about their alcohol use, and providers can help them take their medication even when drinking.”
So while alcohol increases the likelihood of engaging in risky sexual behaviour and getting infected with HIV, it also affects adherence to HIV treatment, which then negatively affects the spread of HIV. Drinking alcohol is the main driver of risky sexual behaviour and there are many theories around alcohol’s causal role in sexual risk-taking.
Limited cognitive capacity
However, it’s not just alcohol that leads to unprotected sex – the person’s personality traits and their sexual expectations after drinking also contribute.
“There are other arguments, such as that it might not be alcohol that causes risky behaviour, but the individual’s personality. For example, as a risky person, I might like to go out and drink a lot; on the other hand, I may like to go out and meet partners and have sex without a condom,” Shuper said.
“It might look like alcohol is causing risky behaviour, but, in fact, both of those things are stemming from me as a risky person.
“There are also expectations surrounding alcohol use. Some people believe that when they consume alcohol, they will engage in risky sexual behaviours and those thoughts end up contributing to this,” he explained.
Shuper and his colleagues tested this theory on a group of 140 men who have sex with men, who were recruited from a clinic specialising in HIV care in Toronto, Canada, and they looked at the theory of alcohol, sexual arousal, personality traits and in-the-moment risk factors in sexual decision making.
They then took the participants to a specialised laboratory that resembled a bar. To ensure that it met “bar standards”, researchers poured 30ml of vodka into a shallow container out of sight behind the bar about 20 minutes before the participants arrived. This provided a strong alcohol olfactory cue that could be sensed immediately upon entering the bar.
Half of the participants were given real alcohol, a quarter got placebo alcohol, which smells and tastes like alcohol, but isn’t, and the other quarter were just given water to drink. Shuper said what was surprising was that the group that received placebo alcohol believed that they were drunk after the experiment.
Afterwards, participants were presented with hypothetical scenarios of imaginary partners and were asked if they would engage in condomless sex with these partners. Many indicated that they would.
“The theory behind this suggests that, when we consume alcohol, it’s not that we become completely uninhibited, but rather that our cognitive capacity becomes very constrained. Because of this, we focus on the cues that drive us towards risky behaviour – being sexually aroused at the time and being presented with an attractive sexual encounter,” Shuper said.
“We focus on those aspects and, with limited cognitive capacity, we disregard the prospects of becoming infected with HIV or passing on the virus.”
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