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/bise xual men's patterns of combining alcohol or drugs with sex, their motivatio n to use drugs to cognitively "escape" awareness of HIV risk, and their use of bars as social and sexual settings. Methods: We conducted extensive int er-views among African-American (n = 139) and White (n = 112) gay and bisex ual men who were attending a behavioral intervention for safer sex results. Those who frequently combined drugs with sex reported higher rates of sexu al risk and Hepatitis B infection than did men who infrequently combined su bstances with sex, or who combined only alcohol with sex. Sexual risk was p ronounced among more frequent drug users who also reported strong expectanc ies that alcohol or drugs facilitate sex and cognitively escape from awaren ess of HIV risk. Frequenting bars per se was not an important factor in sex ual risk. Implications: Men who use alcohol or drugs to enhance sexuality a nd escape self-awareness of HIV risk have a significantly diminished capaci ty to avoid sexual risk. (C) 2001 Elsevier Science Inc. All rights reserved .