Sex-Related Alcohol Expectancies and Condomless Sex: A Scoping Review of Quantitative Studies.

Abstract

Correct and consistent male condom use can help prevent transmission of sexually transmitted infections and unintended pregnancy. Although alcohol is a risk factor for condomless sex, the relationship between alcohol and condomless sex is not fully understood, suggesting additional factors should be considered. Alcohol Expectancy (AE) Theory suggests that people's beliefs about the effects of alcohol might influence people's behaviors while intoxicated. Although research has investigated the relationship between sex-related AE and condomless sex, there is a lack of evidence synthesis. In this scoping review, 28 quantitative studies that assessed the relationship between sex-related AE and condomless sex were summarized. Results suggested that holding stronger beliefs that alcohol increases sexual risk-taking, disinhibition, sexual coercion, sexual aggression, enhances sexual experiences, and increases difficulty for condom use are positively associated with condomless sex, but this relationship has only been demonstrated consistently among community heterosexual men. Findings suggest that sex-related alcohol expectancies play multiple roles in alcohol-involved sexual decision-making, including acting as mediators and moderators of condomless sex risk, as well as being mediated by other cognitive and emotional factors. This scoping review also revealed limitations of extant research, such as homogeneity of samples and inconsistent operationalization of sex-related AE and male condom use. Current evidence partially supports AE theory in the context of condom use and highlights the need to further investigate inconsistent findings across populations.