Alcohol Use and Unintended Sexual Consequences among Women Attending an Urban Sexually Transmitted Infections Clinic

Background: Although alcohol use has been linked with a variety of sexual behaviors, we lack an understanding of what precise events occur when women drink that may lead to emotional or physical harms. Methods: To fill this gap, we qualitatively explored the unintended sexual events occurring while drinking among a particularly at-risk clinic population: urban women attending a public sexually transmitted infections (STI) clinic. This was a secondary data analysis of 20 semistructured, in-depth interviews conducted between December 2009 and August 2010 with 20 sexually active adult women attending the Baltimore City Health Department STI Clinic. We purposively sampled women presenting for care in the STI clinic who reported either binge drinking in the past 6 months or engaging in vaginal or anal intercourse while under the influence of alcohol. Interviews were analyzed using a grounded theory approach. Results: Five major unintended sexual events emerged: sex with new partners; alternative sexual activities, including anal sex and "rough" sex; unprotected sex; blacked out sex or sex occurring during alcohol-related amnesia; and rape. Themes often overlapped, and sexual victimization was a common thread throughout multiple themes. An additional theme, alcohol and prey, largely occurring in bars and nightclubs, emerged as an important precursor to many of the unintended events described. Conclusions: Alcohol use was associated with a variety of-often dangerous-unintended sexual events. Our results highlight the link between alcohol use and sexual victimization and the need for intervention development to reduce the emotional and physical harms resulting from the unintended consequences of alcohol use.