Does being drunk or high cause HIV sexual risk behavior? A systematic review of drug administration studies

Meredith S. Berry, Matthew W. Johnson

Research output: Contribution to journalReview articlepeer-review

26 Scopus citations


HIV sexual risk behavior is broadly associated with substance use. Yet critical questions remain regarding the potential causal link between substance use (e.g., intoxication) and HIV sexual risk behavior. The present systematic review was designed to examine and synthesize the existing literature regarding the effects of substance administration on HIV sexual risk behavior. Randomized controlled experiments investigating substance administration and HIV sexual risk behavior (e.g., likelihood of condom use in a casual sex scenario) were included. Across five databases, 2750 titles/abstracts were examined and forty-three total peer reviewed published manuscripts qualified (few were multi-study manuscripts, and those details are outlined in the text). The majority of articles investigated the causal role of acute alcohol administration on HIV sexual risk behavior, although one article investigated the effects of acute THC administration, one the effects of acute cocaine administration, and two the effects of buspirone. The results of this review suggest a causal role in acute alcohol intoxication increasing HIV sexual risk decision-making. Although evidence is limited with other substances, cocaine administration also appears to increase sexual risk, while acute cannabis and buspirone maintenance may decrease sexual risk. In the case of alcohol intoxication, the pharmacological effects independently contribute to HIV sexual risk decision-making, and these effects are exacerbated by alcohol expectancies, increased arousal, and delay to condom availability. Comparisons across studies showed that cocaine led to greater self-reported sexual arousal than alcohol, potentially suggesting a different risk profile. HIV prevention measures should take these substance administration effects into account. Increasing the amount of freely and easily accessible condoms to the public may attenuate the influence of acute intoxication on HIV sexual risk decision-making.

Original languageEnglish (US)
Pages (from-to)125-138
Number of pages14
JournalPharmacology Biochemistry and Behavior
StatePublished - Jan 2018


  • Acute effects
  • Alcohol
  • Buspirone
  • Cannabis
  • Cocaine
  • Condom use
  • Decision-making
  • Delay discounting
  • HIV sexual risk behavior
  • HIV/AIDS transmission
  • Substance use
  • Unprotected sex

ASJC Scopus subject areas

  • Biochemistry
  • Toxicology
  • Pharmacology
  • Clinical Biochemistry
  • Biological Psychiatry
  • Behavioral Neuroscience


Dive into the research topics of 'Does being drunk or high cause HIV sexual risk behavior? A systematic review of drug administration studies'. Together they form a unique fingerprint.

Cite this