1. The Relationship between Recent Alcohol Use and Sexual Behaviors/STDs: Gender Differences among STD Clinic Patients
Heidi E. Hutton PhD, Mary E. McCaul PhD,
Patricia B. Santora PhD, Emily J. Erbelding MD, MPH
Depts. Psychiatry and Medicine, Johns Hopkins University School of Medicine, and Baltimore City Health Department, Baltimore, MD

2. Background
Purpose of study: investigate the relationship between binge drinking and risky sexual behaviors/ STDs by gender among urban STD clinic patients
Binge drinking (>5 drinks on 1 occasion) is associated with risky sexual behaviors & STDs
Preliminary evidence for high rates of binge drinking among adolescent STD clinic patients
Role of gender in binge drinking-high risk sexual behaviors is understudied despite greater risks of binge drinking and STDs for women
Binge drinking is more common than alcohol abuse/dependence & assoc. with adverse health outcomes

3. Demographics and Method
671/795 STD clinic patients enrolled were: 52% female; 95% African-American; 73% never married; 83% heterosexual; 77% never married
Tested for gonorrhea, chlamydia, syphilis
Assessed alcohol use, drug use, and sexual behaviors in last 30 days
using audio computer-assisted self-interview (ACASI) of the NIDA Risk Behavior Assessment

4. Data analysis
Based on alcohol use of past 30 days, study participants were divided into 3 groups :
No alcohol use
Alcohol use but no binge drinking
Binge drinking
Association between alcohol use group and sexual risk behaviors/STDs was examined using logistic regression, adjusting for age, employment, and drug use.

5. Substance use characteristics of women STD clinic patients
30% binge drinking
32% drank alcohol; no binge
38% no alcohol
Compared to women who drank but did not binge and women who abstained from alcohol, women binge drinkers were more likely to have:
higher rates of illicit drug use
sex when high on illicit drugs

6. Substance use characteristics of men STD clinic patients
42% binge drinking
24% drank alcohol; no binge
34% no alcohol
Compared to men who drank but did not binge and men who abstained from alcohol, men binge drinkers were more likely to have:
higher rates of illicit drug use
sex when high on illicit drugs
Men’s rates of risky sexual behaviors were high but did not differ as a function of alcohol use

7. Women’s sexual behaviors as a function of recent alcohol use
No alcohol Drank Alc Binged
% % %
Oral sex*
Vaginal sex
Anal sex**
Unprotected sex
Multiple sex
partners*
Traded sex
*p<.05; **p<.01

8. Gender differences in anal sex as a function of recent alcohol use
Percent Reporting
Anal Sex
(last 30 days)

9. Gender differences in gonorrhea diagnosis as a function of recent alcohol use
Percent
Having
Gonorrhea
Diagnosis at
Clinic Visit

10. Summary of findings
Women binge drinkers are more likely to have anal sex, multiple sex partners, and gonorrhea than non-binge drinkers and nondrinkers
Their rate of anal sex (33%) is nearly double the rate reported by women from three STD clinics nation-wide (18%)
High rates of binge drinking among women & men STD clinic patients

11. Conclusions
Rates of anal sex among STD clinic patients have more than doubled in last 5 years
Binge drinking and risky sexual behaviors are an intersection of two significant and increasing health problems among women
Women have a greater risk of future negative health consequences from STDs and hazardous alcohol use than men

12. Recommendations
Routine screening for hazardous alcohol use and interventions that jointly address binge drinking and risky sexual behaviors are recommended
Interventions are needed for women that address sexual safety, condom negotiation, & perceived consequences of changing high-risk behaviors