title: Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies.
abstract: OBJECTIVE
  To review and analyse in experimentally controlled studies the impact of alcohol consumption on intentions to engage in unprotected sex. To draw conclusions with respect to the question of whether alcohol has an independent effect on the incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled studies examined the association between blood alcohol content (BAC) and self-perceived likelihood of using a condom during intercourse. The systematic review and meta-analysis were conducted according to internationally standardized protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: PRISMA). The meta-analysis included an estimate of the dose-response effect, tests for publication bias and sensitivity analyses.
  
  
  RESULTS
  Of the 12 studies included in the quantitative synthesis, our pooled analysis indicated that an increase in BAC of 0.1 mg/ml resulted in an increase of 5.0% (95% CI: 2.8-7.1%) in the indicated likelihood (indicated by a Likert scale) of engaging in unprotected sex. After adjusting for potential publication bias, this estimate dropped to 2.9% (95% CI: 2.0-3.9%). Thus, the larger the alcohol intake and the subsequent level of BAC, the higher the intentions to engage in unsafe sex. The main results were homogeneous, persisted in sensitivity analyses and after correction for publication bias.
  
  
  CONCLUSIONS
  Alcohol use is an independent risk factor for intentions to engage in unprotected sex, and as risky sex intentions have been shown to be linked to actual risk behavior, the role of alcohol consumption in the transmission of HIV and other STIs may be of public health importance.
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Shield
authors.forename: Narges
authors.initials: N
authors.lastname: Joharchi
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D004305:Dose-Response Relationship, Drug; D000431:Ethanol / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D033182:Intention; D016014:Linear Models; D008297:Male; D009042:Motivation / Q000187:drug effects*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D047568:Unsafe Sex / Q000187:drug effects / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D000431:Ethanol