Alcohol and Sexually Transmitted Disease

Introduction:

Consumption of alcohol carries inherent risks. We will hear of many of these as they relate to the individual’s health and risk of addiction. Alcohol has been associated with increased rates of cancer, particularly of the breast (in females), liver disease, accidental death, and domestic violence.

Alcohol is also consumed by many, particularly adolescents and college students, in “binge” drinking, which carries with it its own set of complications. Such drinking has been labeled “risky alcohol consumption”, and in some communities (e.g. Australia) up to 85 percent of the alcohol consumed is taken in this “risky” fashion. This paper will discuss the factors that may underlie such “risky” alcohol consumption. The relationship between “risky” alcohol consumption and “risky” sexual behavior will also be discussed.

At-Risk Behaviors:

Sexual behavior that carries with it the risk of unwanted pregnancy or sexually transmitted disease has been categorized as unprotected intercourse.

There are two principal types of at-risk behaviors that relate to sexual intercourse discussed in the literature. They are:

1. Without condom usage; and
2. Sex with multiple partners.

“Safe sex” is described as that between a monogamous couple in a secure relationship, where both partners are disease-free and committed. Sex between others is less secure, safe, and its danger increases exponentially in relationship to the lack of condom usage and the prevalence of multiple partners.

Whether the use of alcohol in a “risky” way and the engaging in “risky” sexual behaviors have a common causal base, or the effect of alcohol carries its own inherent risk does not complicate matters for those desirous of helping, provided they place an emphasis on the individual to be helped rather than a substance to be studied.

It is clear, multiple factors influence the risky behaviors – both sexual and alcohol usage. Many of the factors are common to both, but alcohol usage has its own direct effects, as we shall see.

“At-risk” alcohol consumption is defined differently by different groups. Within the consensus of the ICPA constituency, any alcohol consumption is “at-risk”. This is based upon the statistics that show up to 15 percent of persons consuming alcohol for the first time will become problem drinkers, and 7 percent, alcoholics.

Such a risk is of sufficient magnitude to convince ICPA members that abstinence is the safest policy.

For others, “at-risk” drinking is at any level that leads to measurable impairment of response times or judgment calls. The level of intoxication clearly parallels the level of incompetency of the individual with risk increasing proportionately. In this scenario of “acute at-risk” problems, “binge” dinking clearly is an extreme in the spectrum of effects.

The advocacy role played by the ICPA seeks to prevent the complications of alcohol usage. To do this, it is necessary to comprehend that the underlying motivators of “at-risk” drinking may also motivate “at-risk” sexual behavior. In other words, until such underlying problems are tackled, the symptomatic behaviors will persist. It does not serve us well to treat symptoms and ignore root causes; nevertheless, the augmentative feedback of one behavior upon another has to be measured if we are to have a fuller comprehension of the interactive forces at work in these “at-risk” behaviors.

Alcohol and Sexually Transmitted Disease:

The relationships between the consumption of alcohol and sexually transmitted disease prevalence and incidence are definite, but more complex than generally appreciated. Though a direct causal relationship between alcohol consumption and “at-risk” behavior appeals to our need for a clear-cut and aesthetically pleasing model, such a postulate has been shown to be simplistic and implausible.

Factors Contributing to “Risky” Behavior:

Attitudes:

In a study examining the attitudes and behaviors displayed publicly by 16- to 17-year-olds using the MySpace website, 142 available profiles were analyzed. 

Studying Air Force recruits[2] Cooper TV, et al explored demographics and risky lifestyle behaviors associated with a willingness to risk sexually transmitted infection. 32,144 Air Force recruits beginning basic military training completed a questionnaire. One question asked was, “Sex without condoms is sometimes worth the risk of possibly getting AIDS or sexually transmitted diseases.” Other questions covered areas such as risk taking, rebelliousness, seatbelt use, smoking, alcohol and binge drinking, etc.

Sixteen percent stated willingness to “risk STI to have sex without a condom.” Women and white/non-Hispanic participants were less likely to agree with this statement.

However, this 16 percent were more likely to binge drink, had more positive views of illicit drugs, were less likely to use seatbelts, and reported poor dietary habits. The “perceived risk” was important as a mediator of alcohol use, as well as involvement in sports, for both males and females.

Perceived risk also mediated the involvement in sports and the number of sexual partners for women, but to a lesser degree for men.

Unsafe sexual activity (defined as not using condoms) was also mediated by the perception of risk in both males and females.[3]

In a study on 210 students at East Carolina University in North Carolina, participants were categorized as follows:

Religious Belief:

Women with strong religious beliefs:

• Consumed less alcohol; and
• Were less likely to engage in risky sexual behavior

Than women with weaker religious convictions.

Men did not have a significant co-relationship between religious beliefs and alcohol consumption or risky sex.

Alcohol consumption was significantly related to inconsistence of condom usage and having multiple sex partners.

Men had higher rates of alcohol consumption and unprotected sexual activity than women, though the frequency of sexual activity was not different between the two groups.

Clearly, further study is required into the correlation between religion, alcohol consumption, and risky sexual behaviors. To those with a religious affiliation, these statistics will be of interest and, possibly, concern.[4]

Gender:

Males, in many studies, appear to be less averse to risk-taking than females. This holds true for contraceptive use, where male gender and alcohol use appeared to be the most important contributing risk factors among Swedish high school students.[5]

In fact, the harassment of female co-workers relates to the drinking habits of their male co-workers, and is gender related. Using 1,301 workers in 58 work units,[6] demonstrated a significant association between the number of heavy, or “at-risk” male drinkers and the probability of gender harassment.

Athletic Involvement:

Prowess in athletics may magnify the adolescent sense of invincibility in high school students. Athletes exhibited more frequent behavioral risks than the non-athletic students. Alcohol use and sexual activity were assessed in relationship to athletic involvement. Studying 2,247 high school graduates, Notherill and Fromme found athletes reported greater alcohol use, more sexual partners, and a lowered perception of risk.

Relationships that Influence Risky Behaviors:

In the Report to the Nation from the Commission on Children at Risk entitled Hardwired to Connect: The New Scientific Case for Authoritative Communities, by the YMCA of the United States, Dartmouth Medical School, and the Institute for American Values (2003)[7], deteriorating mental and behavioral health of U.S children is documented.

Anxiety, depression, attention deficit, conduct disorders, suicide ideology, and other serious problems are outlined.

Connections to other people and to moral and spiritual meaning are identified as two deficiencies in modern American youth.

When considering “risky” behaviors, it is imperative that our attention be directed not only at individuals at risk, but at the context in which they live, grow, and exist. The context is the family, school, church, and community. These problems are not the sole concern of individuals at risk; they affect us all, and we all affect the problems.

The environment of life can, through feedback pathways, significantly influence and change the very neuronal structures of our brain, creating a milieu for the expression or suppression of genetic potential.

Environments affect:

1. Gene transcription and development of brain;
2. Risk taking and novelty seeking tendencies;
3. Meaning of gender in childhood and adolescence;
4. Spiritual development and religiosity.
5. Families, neighborhoods, and workplaces are the dominant molding influences on adolescents.

Drug Usage:

STD/HIV related sexual risk behaviors were also noted, in US rural adolescents, to be associated with six independent variables, which included alcohol, marijuana, tobacco, and cocaine use. The correlations  showed the following associations:

1. Smoking was associated with unprotected sex;
2. Alcohol or drug use before intercourse: Ever having used marijuana or cocaine or drinking alcohol during the past 30 days was associated with multiple sexual partners.[8]

Family Structure:

Family structure also plays a role in sexual risk.[9] Peres, CA, et al, in the Journal of Adolescent Health (February 2008) studied 296 young people in Sao Paulo, Brazil.

Rates of crime, violence, drug and alcohol usage, and sexual risk correlated with family structure:

Sexual Orientation:

While male sexual orientation showed no consistent relationship with alcohol consumption, females with bisexual identity or behavior showed a consistently greater use of alcohol.[10]

Lesbian women consumed more alcohol in their senior year at high school than their heterosexual peers; whereas gay men increased their alcohol consumption during their early college experience.[11]

Heterosexual women have lower rates of hazardous drinking compared with all groups studied, including mostly heterosexual, bisexual, mostly lesbian, and exclusively lesbian subgroups.[12]

Correlations Between Alcohol and Risky Sexual Behavior

When studying 330 sexually active college students (which survey included 67 percent females), it was found that alcohol consumption did not influence the rate of unprotected vaginal sex (UVS) among steady partners, but non-study partner sex was more likely to be UVS when alcohol was consumed.[13]

This study demonstrates that, while individual social demographics, personality differences, and family dynamics clearly play a role in the use of substances such as alcohol, tobacco, marijuana, cocaine, and others, the same profile or personality to use such substances may be active in the “at-risk” or “risky” sexual behaviors. These substances do have their own role in risky sexual behaviors.

Alcohol consumption and sexual behaviors in middle school and high school students in North Carolina were found to be correlated. Considering condom usage, it was found that none of the measured factors, including AIDS education, significantly influenced condom usage among sexually active students. Despite strong association between overall drinking patterns and sexual behavior, current education methods on both appear to require re-evaluation.[14] These findings agree with the theme of this conference – that education as a stand-alone methodology is inadequate. Relationships bring a more open communication and permit transmission of values.

In a study considering the use of condoms between HIV-discordant couples in Rwanda and Zambia, alcohol consumption was shown to be associated with an increase in self-reported failure to use condom protection. Recommendations about alcohol usage clearly need to be part of the counseling of HIV-infected persons.[15] Anderson and Mathieu, reporting in the Journal of Sexual and Marital Therapy, [16] followed up on 1,902 students attending 12 colleges, and found that when people were asked whether they drank “more than normal in order to make it easier for them to have sex with someone”, 33.2 percent of the men and 17.4 percent of the women acknowledged this action. This means planned sexual activity led to increased alcohol consumption.

In such circumstances, 76.3 percent of the men and 77.1 percent of the women had initiated condom use for vaginal intercourse – probably a high estimate of actual use.

This study demonstrates alcohol usage for sexual priming. However, unplanned sexual activity is often a consequence of alcohol consumption.[17]

In a study from Chennai, India,[18] S. Sivaram et al surveyed 1,196 male patrons of wine shops in Chennai. They reported:

• 43 percent of respondents had unprotected sex with non-regular partners;
• 24 percent had four or more recent sexual partners;
• 85 percent reported using alcohol at least ten (10) days a month;
• 17 percent reported daily drinking;
• 49 percent reported five or more drinks on a typical drinking day;
• 89 percent reported alcohol use before sex.

Unprotected sex with non-regular partners was higher among unmarried men, those with irregular income, and those who used alcohol before sex.

Clearly, such findings indicate areas of concern for those working in the area of sexually transmitted disease.

J S Santelli et al[19] demonstrated that, as the number of reported alcohol-related behaviors increased, the adjusted proportion of respondents who had recently had multiple partners rose from 8 percent to 48 percent among females, and rose from 23 percent to 61 percent among men.

This strong association between alcohol use and multiple partners highlights the seriousness of the role played by alcohol in the HIV containment programs.

A study from the United Kingdom also demonstrated that binge drinking was associated with increased attendance at a sexually transmitted disease clinic.

Additionally, 77 percent had been drinking before sex with a new partner; of these, 65 percent were usually or occasionally very drunk.

Of the 29 percent diagnosed with a bacterial STD, binge drinking was increased over the others.

Of the women, 19 percent reported an unwanted pregnancy, with 28 percent drinking beforehand.[20]

Alcohol dependency and conduct disorders also increase the risk of a larger number of sexual partners with attendant risk of sexually transmitted disease.[21]

The harmful effects of alcohol in risky sexual behavior may well be a consequence of the diminished perception of risk of consequences that alcohol induces.[22]

The loss of inhibitions and its consequences was followed up in a New Zealand university community, where hazardous drinking is rather prevalent. Responses from 1,564 students cataloged the following as a result of drinking by women and men, respectively, in the preceding three months: 

When HIV rates of the general population of men in Southern India are compared to those populating alcohol venues, it becomes apparent that the latter have statistically very significant, higher result. But this extends to other STDs as well.

These associations seem intuitive and self-evident, but have eluded careful study. T hey are corroborated in a United Kingdom study by Standerwick, already quoted. An interesting statistic from Kenya, reporting on female sex workers in Mowbassa, found 22.4 percent were lifetime abstainers, 44.7 percent were non-binge drinkers, and 33 percent were binge drinkers. Binge drinkers were more likely to report unprotected sex, sexual violence, and sexually transmitted diseases.

HIV prevalence was higher among the women who had ever taken alcohol (39.9 percent) than among lifetime abstainers (23.2 percent), but did not correlate with actual patterns of drinking.[25]

Summary:

Individuals engaging in risky alcohol intake and risky sexual practices have many underlying factors that play into their behavior. Alcohol itself has an effect on the pattern of risky sexual behavior, and has a corresponding effect on the prevalence of sexually related infections.