Alcohol and sexual risk among women recently involved in the corrections system: Findings from event-level analyses

Introduction: Heterosexual sex is the most common route of HIV transmission among women, and alcohol use has been associated with both HIV infection and sexual risk behavior. Understanding the nature of this relationship is crucial for HIV prevention. Methods: Daily alcohol use and sexual behavior were measured during four 30-day intervals over the course of one year among 530 women recently involved in the corrections system. Analyses include two multilevel models with days nested within months nested within individuals. Day-level outcomes include any intercourse and condom use on days with intercourse. Results: Intercourse was independently associated with alcohol use at the day-level (odds ratio [OR] = 3.16; 95% confidence interval [CI] = 2.69, 3.72), month-level (OR = 1.09; 95% CI = 1.05, 1.12), and person-level (OR = 1.02; 95% CI = 1.01, 1.03). Condom use was not significantly associated with any measure of alcohol use. Discussion: In this sample, alcohol use was associated with unprotected intercourse through changes in the likelihood of intercourse but not through changes in the likelihood of condom use. Alcohol myopia, alcohol expectancies, and personality trait theories do not account for the association between alcohol use and sexual risk behavior. Courtship, place-based, social network, and stressful life circumstance perspectives are more consistent with associations between alcohol use and sexual risk behavior.