Drinking settings, alcohol consumption, and sexual risk behavior among gay men

Abstract

We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: “home” “social,” “bar/social,” and “general” drinkers (i.e., drinks in all settings). Regression models showed that “general” drinkers were more likely than “social” drinkers to engage in frequent heavy drinking. Compared to ‘social’ drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior.

Introduction

Alcohol use among men who have sex with men (MSM) is pervasive (Ostro & Stall, 2008) and a cause for concern. MSM comprise the majority of HIV infections (CDC, 2011), and studies have shown that heavy alcohol use is associated with HIV risk behaviors, HIV transmission (Baliunas et al., 2010, Celentano et al., 2006, Geibel et al., 2008, Trocki and Leigh, 1991, VanDevanter et al., 2011), and other health problems including cardiovascular disease, diabetes mellitus, liver cirrhosis, and several cancers (Corrao et al., 2004, Rehm et al., 1997, Rehm et al., 2003).

Drinking settings refer to the places where individuals consume alcohol, and include both public milieus (bars, restaurants, night clubs, sporting and outdoor events, parks) and private milieus (e.g., one's own home). Given the prevalence of both drinking and HIV risk behavior among MSM (Centers for Disease Control, 2011, Ostro and Stall, 2008) and the association between alcohol use and risk behavior (Baliunas et al., 2010, Celentano et al., 2006), identifying the settings where MSM typically consume alcohol can elucidate the way drinking settings contribute to heavy drinking and sexual risk behavior.

Several studies have investigated the association between drinking settings and alcohol use (Caswell et al., 2002, Curran et al., 1996, Kairouz and Greenfield, 2007), but few of these studies have focused exclusively on MSM (Greenwood et al., 2001, Stall et al., 2001, Wong et al., 2008). These studies suggest that the social context in which drinking occurs can influence both the amount of alcohol an individual consumes as well as their subsequent health risk. Some studies have reported a positive relationship between frequency of drinking in bars and higher levels of alcohol consumption (Caswell et al., 2002, Curran et al., 1996, Kairouz and Greenfield, 2007, Trocki and Drabble, 2008), as well as problems such as drinking and driving, injuries, and fights (Stockwell et al., 1993, Usdan et al., 2005). Other studies have reported that settings such as parks, sporting events, and parties are also associated with increased alcohol consumption and drinking problems (Clapp et al., 2006, Harford et al., 2002, Jones-Webb et al., 1997, Wells et al., 2005). Still, other studies have found the relationship between drinking settings and alcohol use differs by important demographic variables such as age, gender, and education (Clapp et al., 2006, Harford et al., 2002, Usdan et al., 2005, Wells et al., 2005).

Studies of drinking settings and alcohol use among MSM have primarily examined gay bar settings (Greenwood et al., 2001, Wong et al., 2008). This is not surprising given gay bars historically have served as an important social institution in gay community life (Wolitski, Stall, & Valdiserri, 2008). Wong et al. (2008) examined the relationship between frequency of gay bar attendance and alcohol consumption among 526 young adult MSM in Los Angeles and found that gay bar attendance was associated with greater frequency of drinking and binge drinking. Greenfield, Midanik, and Rogers (2000) also reported that frequency of gay bar attendance was associated with heavy alcohol use among MSM and bisexual men living in San Francisco. In contrast, Trocki, Drabble, and Midanik (2005) reported that drinking in bars was not associated with heavy drinking among gay, bisexual, and heterosexual men; however this study did not focus exclusively on gay bars or MSM. While studies of gay bar attendance and alcohol use have provided valuable insight into the social context surrounding heavy alcohol use among MSM, these studies have a number of limitations. First, studies in this area have focused solely on gay bars to the exclusion of other drinking settings where heavy drinking might occur such as parties. Thus, little is known about the settings where MSM consume alcohol and if certain settings are associated with higher levels of alcohol consumption than other settings. Second, despite high rates of alcohol use and HIV infection among MSM (Centers for Disease Control, 2011, Stall et al., 2001), studies of gay bar attendance and alcohol use have not explored whether drinking settings are associated with sexual risk behavior. Lomba et al. (2009) examined the relationships between drinking settings, alcohol use, and sexual risk behavior among teens and young adults in Portugal. About 3% of Lomba's sample included respondents who self-identified as gay or lesbian. Lomba found that frequency of attending night clubs/bars was associated with higher levels of alcohol consumption and that higher levels of alcohol consumption were associated with sexual risk behaviors, such as drinking while engaging in sex. The study by Lomba, Apóstolo, and Mendes (2009) did not directly test whether drinking settings were associated with sexual risk behavior. To date, no studies have investigated whether certain drinking settings or groups of settings are associated with sexual risk among MSM or other populations.

The aims of our study were to 1) describe the settings or groups of settings where MSM consume alcohol in 16 U.S. metropolitan statistical areas (MSAs), and 2) investigate whether certain drinking settings or groups of settings (e.g., bars, restaurants, parties) are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior.