ARA

Alcohol & Sexually Transmitted Diseases

The Issue

A general association between alcohol abuse and an increased risk for sexually transmitted diseases (“STDs”) is reported in the scientific literature. But the studies do not establish a causal relationship, only an association between alcohol abuse and STDs. (1) There are simply too many other factors associated with individuals who engage in such risk-taking behaviour.

The fact that an association is reported is not surprising, however. People drink in taverns and bars, and people make social connections in these outlets. In many countries, they also smoke in these outlets, but although smoking thus may be associated with an increased risk of STDs, it can hardly be said to be the cause of that increased risk. Similarly, if a person goes to a tavern with the intent of meeting a partner for casual (or even high risk) sex, alcohol is not the cause of the consequences of that intended behaviour.

The existing studies have serious limitations that prevent them from establishing a causal relationship. Their measures of alcohol consumption are crude and do not differentiate, for example, between one drink and intoxication. And these studies also do not take into account other factors that may cause an increase in risk for STDs.

Limitations of Existing Research

Studied separately, drinking patterns and human sexual behaviour are among the most complex of human behaviours. Attempting to study any interaction between the two presents difficult challenges in controlling for variables such as personality traits (e.g. impulsivity, excitement seeking, (2) (3) and proclivity for social deviance), 4 gender differences, and other situational cues that have a disinhibiting, or even inhibiting effect on sexual activity. (5)

The studies to date have not adequately controlled for the role personality traits may play in the association between alcohol abuse and STDs. Personality traits are a strong predictor of who drinks, how they drink, and the outcomes they expect from their drinking. (6) For example, people who are high novelty-seekers and low harm-avoiders are more likely than others to drink heavily and also, whether or not they are intoxicated, to engage in risky behaviours. (7)

This is thought to be due, in part, to the fact that they do not weigh negative consequences as others do. Similarly, the literature shows that individuals who are sensation seekers are much more likely than the general population to engage in high-risk sexual behaviour and heavy drinking. (8) (9)

Unsafe sexual practices among sensation seekers appear to be linked to their views about their own unsusceptibility to STDs, even when their partner is known to be HIV-positive. (10)

Many studies use only very general measures of the amount of alcohol consumed, for example, “any alcohol consumption,” or “ever drank alcohol.” By not distinguishing between moderate drinking and patterns of excessive consumption or alcohol abuse, these studies are of dubious utility for the purpose of setting public health policy.

In the eleven articles identified by Cook and Clark that actually included specific measures of alcohol abuse, eight found an association with an increased risk of at least one STD among abusive drinkers, and the other three studies found no statistically significant increase or decrease in the risk of STDs. (11)

Temporality also is difficult to assess in the literature, i.e., whether the alcohol was consumed immediately prior to sexual activity or the STD-transmitting event. Other methodological issues remain. For example, a subject’s level of knowledge about STDs and how they are transmitted is critical to decisions about high-risk sexual behaviour.

People who are not knowledgeable about risks may have unprotected sex regardless of whether they drink. In many cases (particularly in the developing world), knowledge about STDs (including HIV/AIDS) and how they are transmitted is low. (12) (13) Also, social stigma and lack of knowledge may prevent many people with STDs from disclosing their health status to sexual partners. (14 )

Finally, socioeconomic and cultural disparities also may play an important role in the disproportionate spread of STDs (including HIV/AIDS) among certain populations in both developed and developing countries. (15) (16)

Policy Considerations

Targeted interventions aimed at risk-taking personalities are needed to decrease the incidence of STDs. For example, screening to identify alcohol abuse, high risk sex and other risk-taking behaviors can occur in a variety of settings, including clinics and other venues where health may be assessed in populations who do not receive regular medical care. Brief instructions can then be used to reduce high-risk situations and consequences.

Education is key to preventing the transmission of STDs. Such education, however, must be conducted in a culturally-sensitive manner.

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