Alcohol and "Heat of the Moment" Sexual Decision Making among MSM: Identifying Mechanisms of Sexual Risk and Promoting Behavior Change Through Brief Intervention

PROJECT SUMMARY/ABSTRACT This application is in response to two objectives of RFA-AA-21-016: HIV Prevention and Alcohol to translate basic behavioral science findings about alcohol’s effects on sexual decision-making to 1). Test an intervention designed to address sexual decision-making in the “heat-of-the-moment” (i.e., when intoxicated and sexually aroused), and 2). Extend laboratory research to test cognitive and motivational within-person mechanisms underlying alcohol and arousal effects on sexual decision-making in the natural environment. The application is informed by our previous alcohol challenge laboratory research on factors contributing to condomless intercourse (CI) among MSM. This research showed that intoxication was associated with heightened sexual arousal and increased CI intentions. Consistent with dual process theories, intoxication and arousal were associated with a shift in decision-making process characterized by an increased role of sexual reward motivation relative to condom use motivation and a corresponding decrease in the role of executive functioning. This pattern suggests that prevention interventions may be effective in reducing CI by targeting strategies that enhance condom use motivation and reduce the reliance on effortful / controlled processing in the “heat-of-the-moment.” We piloted an intervention that integrates motivational interviewing, personalized cognitive counseling, and text messaging that decreased alcohol consumption and CI in MSM. The intervention is designed, in part, to foster increased condom-related planning and increase the use of implementation scripts to foster use of condoms in the “heat-of-the-moment.” In AIM 1, we extend the pilot work on the intervention to a larger sample and an intensive longitudinal design comprised of 3-weeks of experience sampling method (ESM) pre- and post- intervention to test the intervention’s mechanisms of action. Specifically, we hypothesize that: A. the intervention will be associated with reduced alcohol intoxication and CI, and B. the intervention will reduce within-person associations of intoxication and arousal with CI, and C. intoxication and condom-related planning will mediate associations between intervention condition and CI at 4-month follow-up. Of particular importance is hypothesis B, which tests whether the intervention affects sexual decision-making in the “heat-of-the-moment” when compelling cues are prominent. Aim 2 extends to the natural environment our laboratory research to test dual-process theory derived mechanisms linking intoxication, arousal, and CI. Here, we test if sexual delay discounting and working memory mediate, within-person, associations of intoxication and arousal with CI and if changes in these effects underlie the intervention effects during the 3-week post-intervention period. The proposed study will advance understanding of within-person processes affecting sexual decision-making in the “heat-of-the-moment” when drive for immediate gratification peaks, test the effectiveness of a brief intervention, and identify the intervention’s effects on both within-person processes proximal to CI as well as between-person mechanisms of behavior change.