Expectancies of sexual “escape” and sexual risk among drug- and alcohol-involved gay and bisexual men

Purpose: We tested the hypotheses that sexual risk would relate to gay/bisexual men's patterns of combining alcohol or drugs with sex, their motivation to use drugs to cognitively “escape” awareness of HIV risk, and their use of bars as social and sexual settings. Methods: We conducted extensive interviews among African–American (n=139) and White (n=112) gay and bisexual men who were attending a behavioral intervention for safer sex results. Those who frequently combined drugs with sex reported higher rates of sexual risk and Hepatitis B infection than did men who infrequently combined substances with sex, or who combined only alcohol with sex. Sexual risk was pronounced among more frequent drug users who also reported strong expectancies that alcohol or drugs facilitate sex and cognitively escape from awareness of HIV risk. Frequenting bars per se was not an important factor in sexual risk. Implications: Men who use alcohol or drugs to enhance sexuality and escape self-awareness of HIV risk have a significantly diminished capacity to avoid sexual risk.