Booze and Sex: A Real Downer
by Paul Galatowitsch, Ph.D.
and Brad Thomason, Ph.D.

"I don’t have a drinking problem. I just hit the bars a couple of times a week for some drinks. What’s wrong with that?" Nothing, unless those two or three drinks facilitate or lead to unsafe sex. You don’t have to have a drinking problem to have a problem with drinking and unsafe sex. Drinking helps some people relax and can make socializing easier -- but it can also lead us to do things we might not ordinarily do when we are sober. And unsafe sex is a dangerous endeavor, putting you at risk for several sexually transmitted diseases (STDs) including HIV.

In addition to numerous studies about the connection between alcohol and sex in the general population, there has been gay-specific research on this topic. A report from the National Institute on Alcohol Abuse and Alcoholism, from a Subcommittee of the National Advisory Council on Alcohol Abuse and Alcoholism in May of 1999 in Washington, DC, found a link between risky sex practices, alcohol use and STDs. According to Leigh & Stall from an IC4M grant about HIV-risk and alcohol use, 1993, "One identified subgroup that appears at especially high-risk are MSM with alcohol use disorders. Many studies have demonstrated that heavy drinking MSM tend to have more sexual partners and to engage in less consistent condom use, although the mechanisms linking drinking and unsafe sex behaviors are unclear." More studies are needed to determine exactly what the level of risk is. However, Stall et al. (1994) estimated that gay men who sought treatment for a chemical dependency problem were five times more likely than other gay men to engage in unsafe sex.

Unsafe sex is not the only consequence of drinking alcohol. For men who have serious problems with drinking, especially around the holidays, drinking can contribute to depression and other negative health effects, especially for those who are HIV-positive. Depression has also been linked to unsafe sex among men who have sex with men (MSM). According to a recent study presented in October, gay men with dysthymia, a long-term, low-grade depression, are almost twice as likely to have unsafe, casual sex than gay men without this condition. (Link to an article about this study in the sidebar.)

Drinking even small amounts of alcohol affects our thinking and emotions. Sexual behaviors, in turn, are usually influenced by these alcohol-induced changes in our brain. First, alcohol lowers our inhibitions and clouds our judgments. Alcohol is also a mood enhancer. The buzz we get from a few drinks tends to exaggerate emotions we are already feeling. If we are sad, it makes us sadder. If we are happy it can put us in a state of bliss. When a person experiences an enhanced negative mood state, sexual opportunity may be viewed as a remedy. Depressed individuals are especially vulnerable to making risky sexual decisions because sex is sometimes used to elevate self-esteem. As inhibitions are lowered, we may engage in behaviors we otherwise would not if we were sober, such as thinking we really don’t need to use a condom with the man we just met because he is attractive and looks like he’s probably HIV-negative. For many, this combination of lowered inhibitions and poor judgment too often results in unsafe sexual practices. In fact, alcohol intoxication is considered one of the biggest factors in the transmission of STDs, including HIV.

For men who are HIV-positive, alcohol can weaken their immune system and interact poorly with HIV medications. Alcohol also can damage the liver where most medications are metabolized. Also, an STD can pose more serious health problems for the HIV-positive individual.

There are about 15 STDs that you can get from oral sex alone. The common ones are chlamydia, gonorrhea, syphilis, herpes and genital warts. If you are drinking and think you're being safe just by getting or giving head, think again. Look carefully at what your going down on if you want to reduce your risk. If you see a sore or discharge don’t assume its precum, take precautions -- use a condom. Remember, it’s easier to catch HIV if you have an STD.

(Paul Galatowitsch, PhD., and Brad Thomason, Ph.D., are from the Center for HIV/AIDS Educational Studies and Training)

Updated: Friday, December 15th 2000