Substance Use during Sex and Sensation Seeking as Predictors of Sexual Risk Behavior among HIV+ and HIV- Gay Men

Substance use (i.e., use of recreational drugs and alcohol) has been associated with HTV-related sexual risk behavior in several studies involving gay men. One explanatory hypothesis proposes that substance use and sexual risk behavior are both a function of underlying personality traits. This paper examines sensation seeking and alcohol and drug use during sex as predictors of unprotected anal and oral sex and of a sexual risk index. The sample includes 117 predominantly gay-identified men (73 HIV+ and 44 HIV-) who participated in a 5-year natural history study of HIV disease in New York City. Repeated measures regression analyses tested predictor variables individually and in models including all predictor variables simultaneously. Alcohol use, drug use, and sensation seeking were each significantly associated with all sexual risk behavior variables when entered individually. When predictor variables were entered simultaneously in analyses involving unprotected receptive and insertive anal sex, sensation seeking remained a significant predictor, with substance use typically falling to marginal significance. However, significant associations between substance use and the other sexual risk behavior variables (oral sex and a risk index) are maintained even when controlling for sensation seeking. The results suggest that sensation seeking may partially account for the association between substance use and sexual risk behavior, but substantial independent associations also exist.