Psychology of Addictive Behaviors Copyright 1998 by the Educational Publishing Foundation

1998. Vol. 12, No. 4,262-271 0893-164X/98/$3.00

Personality and Cognitive Factors Influencing Substance

Use and Sexual Risk for HIV Infection Among
Gay and Bisexual Men

Seth C. Kalichman Libby Tannenbaum and

Medical College of Wisconsin Dena Nachimson
Georgia State University

Substance use reliably predicts sexual risk behavior, and sensation-seeking person-
ality characteristics have been found to covary with these associations. In a study of
289 gay and bisexual men attending a large gay pride event, the authors examined
the role of substance use sexual outcome expectancies in explaining associations
between sensation seeking, substance use, and risky sex. Consistent with previous
research, alcohol and other drugs were associated with sexual behavior. However,
path analyses showed that sensation seeking accounted for variance in sexual
behavior over and above substance use before sex and that sensation seeking
predicted substance use expectancies that in turn predicted substance use before sex.
It was concluded that altering substance use outcome expectancies may be an
important strategy for HTV risk reduction for individuals high in sensation seeking.

Since the beginning of the AIDS crisis, gay
and bisexual men living in U.S. HTV epicenters
have demonstrated significant reductions in
sexual practices that confer high risk for HIV
infection (Fordyce et al., 1995). However,
among the many men who have reduced their
numbers of sexual partners, ceased practicing
unprotected anal intercourse, and increased dieir
use of condoms, a significant number have not
Seth C. Kalichman, Center for AIDS Intervention
Research, Medical College of Wisconsin; Libby
Tannenbaum and Dena Nachimson, Department of
Psychology, Georgia State University.
We thank Our Common Welfare, Inc., Atlanta,
Georgia; the Atlanta Gay Pride Committee; and the
gay community of Atlanta for their support of this
study and Charsey Cherry, Ernestine Williams, Tsila
Abush-Kirsh, and Marco T. Sanders for assisting with
data collection. This research was supported by
National Institute of Mental Health Grant R01-
MH57624.
Correspondence concerning this article should be
addressed to Seth C. Kalichman, Center for AIDS
Intervention Research, Medical College of Wiscon-
sin, 8701 Watertown Plank Road, Milwaukee, Wiscon-
sin 53226. Electronic mail may be sent to sethk@
mcw.edu.
successfully changed dieir behavior and many
men who had reduced their risks have reverted
to unsafe sexual practices (Ekstrand & Coates,
1990; Kelly, Kalichman, et al., 1991; Kelly, St.
Lawrence, & Brasfield, 1991). Continued prac-
tice of unsafe sex is complicated by multiple
social, interpersonal, and individual influences.
Among the most widely studied factors influenc-
ing sexual risk behavior is the use of alcohol and
other drugs in conjunction with sex.
Substance use is closely associated with
high-risk sexual practices in gay and bisexual
men. For example, research with over 500 men
from the Multicenter AIDS Cohort Study
showed that use of alcohol and nitrite inhalants
significantly contributed to practicing unpro-
tected anal intercourse and numbers of sexual
partners (Davidson et al., 1992), with similar
findings reported in other studies (McCusker et
al., 1990; Ostrow et al., 1990, 1993; Temple,
Leigh, & Schafer, 1993). Alcohol is related to
sex with new and casual partners (Temple &
Leigh, 1992; Temple et al., 1993), and other
drugs are associated with sexual risk across a
broader range of relationships (Ostrow et al.,
1993). Such factors as social disinhibition,
substance-using networks, and economics may

262
 SUBSTANCE USE EXPECTANCIES AND RISK FOR HIV
account for the relationship between substance
use and sexual risk, but these relationships have
not been well explained.
Use of mood-altering substances as a part of
sexual encounters is firmly embedded in West-
ern culture (Goldman & Roehrich, 1991). In
some cases, the association between substance
use and sexual risk behavior is at least partly
pharmacological, such as the case of nitrite
inhalants used to relax anal musculature for
increasing the ease of anal intercourse (Ostrow
et al., 1993). Most substances, however, become
associated with sex through psychological
factors such as attributions and expectancies for
sexual enhancement, disinhibition, and social
facilitation. Substance use may also be associ-
ated with sexual behavior through a third, often
unmeasured, variable (Halpern-Felsher, Mill-
stein, & Ellen, 1996; Leigh, 1990b; Leigh &
Stall, 1993), such as personality dispositions
that motivate an array of risky practices.
Studies have demonstrated an association
between sexual behavior and sensation seeking,
defined as the propensity for an individual to
seek optimal arousal and sensory stimulating
experiences. Individuals who score high on
measures of sensation seeking report greater
frequencies of sex with a greater number of
partners (Fisher & Misovich, 1990; Newcomb
& McGee, 1991; Zuckerman, 1994). In research
with gay and bisexual men, sensation seeking
predicts frequencies of unprotected anal inter-
course and numbers of sex partners (Kalichman
et al., 1994; Kalichman & Rompa, 1995).
Sensation seeking may also explain the associa-
tion between substance use and risky sex.
Kalichman, Heckman, and Kelly (1996), for
example, found that sensation seeking signifi-
cantly predicted sexual risk behavior over and
above alcohol and other drug use in conjunction
with sex. In addition, sensation seeking predicts
sexual behavior through alcohol and other drug
use, indicating that sensation seeking may
account for at least part of the relationship
between substance use and sexual behavior.
Similarly, causal modeling in a study of college
students showed the association between behav-
ioral disinhibition and a propensity to abuse
alcohol was accounted for by sensation seeking
263
(Earlywine & Finn, 1991). In addition, Ostrow,
DiFranchesco, and Kalichman (1997) showed
that sexual adventurism—a construct adapted
from sensation seeking—significantly predicted
contracting HIV infection in a cohort of gay and
bisexual men over and above substance use.
This study was the first to link a personality
disposition to an HIV-disease relevant outcome.
Unfortunately, a mechanism relevant to interven-
tions that would explain sensation seeking as a
predictor of substance use and sexual risk
behaviors has not been explicated.
Among cognitive mechanisms that may link
sensation seeking to substance use and risk
behavior are alcohol and other drug outcome
expectancies and beliefs about the effects of
various substances on thoughts, moods, and
behaviors. In a study of gay and bisexual men,
for example, McKirnan and Peterson (1988)
found that tension reduction expectancies for
outcomes of alcohol use were associated with
alcohol abuse. Alcohol-related outcome expect-
ancies have been tied to the use of alcohol
before engaging in sex. Consistent with research
on alcohol expectancies for social facilitation
(Hittner, 1997; Smith, Goldman, Greenbaum, &
Christiansen, 1995), Leigh (1990a) found that
expectations for alcohol use to enhance and
disinhibit sexual activity were related to initiat-
ing sexual activity as well as using alcohol
before sex. Sexual outcome expectancies for
alcohol and other drugs may therefore function
as the cognitive processes through which
sensation seeking is linked to substance use and
sexual behavior.
In the current study, we sought to replicate
previous research showing that sensation seek-
ing predicts sexual risk behavior over and above
alcohol and other drug use before sex. In
addition, we examined the hypothesis that
sensation seeking would predict substance use
before sex through sexual outcome expectan-
cies. For both alcohol and other drug use, we
tested a model where sensation seeking predicts
sexual behavior as an independent factor over
and above substance use and where sensation
seeking functions through outcome expectan-
cies to predict substance use before sex, which
in turn predicts risky sex.
264 KALICHMAN, TANNENBAUM, AND NACHIMSON
Method
Participants, Setting, and Procedures
To investigate the association between sub-
stance use and high-risk sexual behavior, we
surveyed 289 men attending an annual gay pride
festival in Atlanta, GA. We chose to survey men
at this festival because of the over 300,000 men
who attend this event and because previous
research has shown that men who attend gay
pride festivals report significant rates of high-
risk sexual behaviors (Hickson et al., 1996;
Kalichman, Kelly, Morgan, & Rompa, 1997).
Potential participants were asked to complete
a survey concerning HIV and AIDS as they
passed through the area of the festival grounds
where retail merchandisers and community
organizations occupied display booths, one of
which we rented for the purposes of this study.
Research staff were placed in the walk area to
actively recruit potential participants. Persons
were approached and told that the survey was
about AIDS, contained personal questions about
their behavior, was anonymous, and required
approximately 10 min to complete. Over 90% of
men approached agreed to complete the survey.
Men who refused to participate were tabulated
by surveyors and combined to calculate the
participation rate. Participant names were not
collected with the survey at any time. Partici-
pants were offered $4 for completing the survey,
of which half could be donated to a local AIDS
service organization. Forty percent of the
sample chose to donate their entire incentive
payment.
Ninety-two percent of the sample self-
identified as gay and 8% identified as bisexual.
One hundred thirteen men (39%) reported that
they were in an exclusive sexual relationship
with one man for 6 months or longer. Because
men who are in long-term monogamous relation-
ships are only placed at-risk when their partner
is either nonmonogamous or injecting drugs, we
limited our further analyses to the 176 men
(61%) whose potential risk for HIV stemmed
from short-term, serial, or nonmonogamous
sexual relationships. With respect to substance
use history, 150 (85%) men reported having
used alcohol in the past 6 months, 64 (37%)
used marijuana, 16 (9%) used powder cocaine, 9
(5%) used crack cocaine, and 7 (4%) used
methamphetamine in that time period. Partici-
pants completed measures of demographic
characteristics, sensation seeking, substance use
sexual outcome expectancies, substance use
before sex, and sexual behaviors.
Measures
Demographics. Participants were asked then-
age, years of education, ethnicity, whether they
self-identified as gay, bisexual, or heterosexual,
and whether they had been tested for HIV
antibodies and, if so, their most recent HIV test
results. We also asked if they were in a partnered
relationship, defined as being in a relationship
with a man for at least 6 months. To assess HTV
risk history, we also asked participants if they
had ever been treated for a sexually transmitted
disease, given someone money or drugs for sex,
or received money or drugs for sex.
Sexual sensation seeking. On the basis of
Zuckerman's (1994) Sensation Seeking Scales,
Kalichman and Rompa (1995), developed a
measure of sensation seeking to assess this
construct specifically related to sexual interests
and activities—sexual sensation seeking. The
Sexual Sensation Seeking Scale is therefore
domain specific, providing information in paral-
lel to but not overlapping with the measures of
sexual outcome expectancies for substance use.
This scale is void of items that reflect substance
use and does not address specific sexual
practices. The Sexual Sensation Seeking Scale
was developed by revising several of Zucker-
man's items to reflect sexually relevant themes.
For example, the item / like wild "uninhibited"
parties was revised to read / like wild "uninhib-
ited" sexual encounters; I enjoy watching many
of the sexy scenes in movies was revised to /
enjoy watching "X-rated" videos; and / like to
try new foods that I have never tasted before was
revised to / am interested in trying out new
sexual experiences. Items were responded to on
a 4-point response format (1 = not at all like me
to 4 = very much like me). Scores were
computed by calculating the mean endorsement
(total score/number of items). This scale has
been found to significantly correlate with both
substance use and high-risk sexual behavior
(Kalichman et al., 1996). Kalichman et al.
(1994) demonstrated acceptable levels of inter-
nal consistency and 2-week test-retest reliabil-
 SUBSTANCE USE EXPECTANCIES AND RISK FOR HIV
ity for the Sexual Sensation Seeking Scale
(a = .75, test-retest r = .78), and the alpha
coefficient was .83 for an 8-item version of this
scale used in the current study.
Alcohol and drug use outcome expectancies.
To assess substance use outcome expectancies,
we asked participants to complete two separate
measures for alcohol and other drug use. First,
participants who had ever drank alcohol (94%)
completed eight items reflecting sexual enhanc-
ing outcome expectancies for drinking. Items
were adapted from a widely used alcohol
outcome expectancies measure (Brown, Gold-
man, Inn, & Anderson, 1980). We specifically
selected sexual expectancy items to parallel the
sexual specificity of the sensation-seeking and
substance use measures without overlapping
content. Example items include I feel horny or
sexual after I have been drinking, lama better
lover after I have been drinking, Sex is better
after I have been drinking, and I get turned on
sexually easier after drinking. Items were
responded to on 4-point scales (1 = strongly
disagree to 4 = strongly agree). The alcohol
outcome expectancy measure was internally
consistent in this study (a = .93).
We used a parallel measure to assess drug use
sexual outcome expectancies. Participants were
first asked to report which of the following
drugs they liked using the most: marijuana,
crack cocaine, other forms of cocaine, nitrite
inhalants (poppers), speed/uppers, or other
drugs. Men who circled at least one of these
drugs (« = 114, 65%) completed eight items
that paralleled the same content as the alcohol
expectancy scale but with reference to the
participant's most used drug. For example, items
included I feel homy or sexual after I have been
using this drug, I am a better lover after I have
been using this drug, Sex is better after I have
been using this drug, and Using this drug helps
me have better sex. Again, with the same 4-point
response format as the alcohol expectancy scale,
the drug use outcome expectancy scale demon-
strated an alpha of .95.
Substance use in conjunction with sex. Use
of alcohol and other drugs in relation to
unprotected and protected anal sex encounters
over the past 6 months was assessed. Partici-
pants were asked to report the number of times
in the past 6 months they drank alcohol before
engaging in anal intercourse with and without
265
condoms. The same format was used to assess
use of other drugs before protected and unpro-
tected anal intercourse. Assessing the use of
substances in relation to sexual behavior links
the two activities and therefore provides a more
exact assessment of the substance use-sexual
behavior relationship than does an assessment of
global substance use over a given time period
(Leigh, 1990b; Leigh & Stall, 1993). The
retrospective time frame was 6 months and
therefore matched the time frame used to assess
sexual behavior. Open response formats were
used, asking participants to recall the frequency
of sexual acts that occurred in conjunction with
alcohol or other drug use in the past 6 months.
Participants were encouraged to think back over
the previous 6 months, using seasonal and other
time-related cues to assist recall.
Sexual behavior. Sexual behavior was mea-
sured by asking participants to report the
number of times and the number of partners
with whom they had engaged in anal inter-
course, as the insertive and receptive partner, as
well as the number of times and partners for
occasions when they used or did not use
condoms during anal intercourse in the past 6
months. Men were also asked to report their
total number of male sex partners for the past 6
months. Similar to the measure of substance use
before sex, open response formats with instruc-
tions to think back over time markers were used
for the sexual behavior measures to reduce
response bias and to minimize measurement
error (Catania, Gibson, Chitwood, & Coates,
1990; Kauth, St. Lawrence, & Kelly, 1991).
Data Quality Assurances
and Statistical Analyses
Several steps were taken to assure that
surveys included in the data analyses were
accurately coded. First, each survey was indi-
vidually inspected for internally consistent
response patterns, with inconsistencies treated
as missing data. Second, all entered data were
verified by using a double entry procedure.
Finally, frequencies of each variable were
inspected for possible outliers or miskeyed
entries, with potential errors checked against the
original surveys.
To examine the relationships among sensa-
tion seeking, substance use expectancies, sub-
266 KALICHMAN, TANNENBAUM, AND NACHIMSON
stance use before sex, and risky sexual behavior,
we performed correlational and path analyses
for alcohol use and drug use separately. Path
analyses were performed using procedures
described by Asher (1983). Analyses were
conducted to identify associations between the
number of male sex partners men reported in the
previous 6 months with three predictor vari-
ables: alcohol use before sex, alcohol outcome
expectancies, and sexual sensation seeking. The
following path analyses were performed enter-
ing sensation seeking (SS), substance use
expectancies (Exp), substance use before sex
(Subst), and number of male sex partners:
SS, Exp, Subst => Partners
and SS (Subst, Partners) => Exp
and Exp (SS, Partners) => Subst
and Subst (SS, Exp) => Partners.
Using the above equations, we examined
direct and indirect effects of variables on
numbers of sex partners. These analyses were
repeated for drug use variables predicting
numbers of partners.
We used the number of reported male sex
partners as the dependent variable in the
analyses for several reasons. First, because our
measure of substance use before sex specified
anal intercourse in conjunction with alcohol and
other drug use, specifying unprotected anal
intercourse as the dependent variable would
have been circular. Second, although HIV
transmission risk occurs in monogamous rela-
tionships, serial monogamy and multiple sex
partners remain independent predictors of HIV
risk among men who have sex with men
Table 1
Means, Standard Deviations, and Distribution Statistics for Measures Included in Path Analyses
Measure M SD
No. male partners 4.1 7.6
Alcohol use before sex 1.9 6.8
Drag use before sex 1.7 7.0
Alcohol expectancies 14.4 5.6
Drag expectancies 16.7 7.1
Sensation seeking 17.6 4.8
(Osmond et al., 1994). Finally, recall for
numbers of sex partners is more reliable than
frequencies of sexual acts over 6-month time
frames (Kauth et al., 1991). All variables were
inspected for skewness and those that demon-
strated significant divergence from normality
were transformed using the formula Logw[X+ 1]
(Winer, 1971). Table 1 presents the means,
standard deviations, skewness, and kurtosis for
each of the measures. As shown, substance use
before sex and numbers of partners were highly
skewed and therefore transformed for regression
analyses. Table 2 presents the intercorrelations
among measures. As shown in the table,
correlations were small to moderate in magni-
tude, suggesting that the scales tapped related
but different constructs.
Results
Results showed that among the 176 men who
were not in long-term exclusive relationships,
114 (65%) reported 2 or more male sex partners
in the previous 6 months. The mean number of
male partners for these men was 6.0 (SD = 8.8,
range = 2-70). Fifty (44%) men with multiple
male partners engaged in unprotected anal
intercourse compared to 9 (25%) men who
reported one partner, x20, N= 150) = 4.08,
p < .05, demonstrating increased risk for HIV
infection among men with multiple sex partners.
Table 3 presents the demographic, substance
use, and sexual behaviors for men with and
without multiple male partners. The majority of
men (95%) reported lifetime use of alcohol and
therefore completed the alcohol outcome expec-
tancy measure, and 64% reported use of other
drugs, therefore completing the drug use out-
come expectancy measure. The following sec-
Skewness SE Kurtosis SE
5.5 0.2 38.1 0.3
5.7 0.2 38.3 0.3
5.9 0.2 39.2 0.4
0.8 0.2 0.2 0.4
0.2 0.2 -1.0 0.4
0.5 0.2 -0.1 0.3
 SUBSTANCE USE EXPECTANCIES AND RISK FOR fflV 267

Table 2
Correlations Among Sensation Seeking, Substance Use Expectancies, Substance Use Before Sex,
and Numbers of Sex Partners
No. male Substance use Substance use Sensation
Variable sex partners before sex expectancies seeking Expectancies
Sensation seeking .26** .18* .42**
Expectancies .07 .30** .49** —
Substance use before sex .45** .25** .17
No. male partners .47** .17 .30**
Note. Correlations for alcohol use appear above the diagonal and correlations for other drag use appear below
the diagonal.
*p < .05. **p < .01 (two-tailed).

tions test models predicting number of sex
partners from substance use before sex, sub-
stance use expectancies, and sensation seeking.
Alcohol Use and Sexual Risk Behavior
Multiple regression analyses testing the path
SS, Exp, Subst => Partners, showed that alcohol
use before sex, alcohol use sexual outcome
expectancies, and sensation seeking predicted
number of male sex partners, R = .51,
F(3, 155) = 18.52, p < .01, accounting for
24.9% of the variance in numbers of sex
partners (see Table 4). Analyses of the path SS
(Exp, Subst) => Partners, showed that sensation

Table 3
Demographic, Substance Use, and Sexual Behavior Characteristics of Men Reporting and Not
Reporting Multiple Male Sexual Partners
Men not reporting Men reporting multiple
multiple male male sex partners
sex partners (N = 62) (N = 114)
Characteristic M SD M SD
Age 32.7 7.6 32.4 8.7
Education 14.5 2.1 14.6 2.1
Frequency of unprotected receptive acts 1.3 5.5 1.4 4.7
Frequency of unprotected insertive anal acts 0.7 3.8 1.1 3.3
N % N %
White 52 87 96 88
Income under $30,000 42 68 73 64
Gay identified 56 90 101 89
Bisexual identified 6 10 13 11
Relationship for 6+ months 13 21 24 21
Tested for HIV 44 71 100 89
HIV + (of those tested) 10 22 23 23
Treated for an STD 21 34 26 23
Received money for sex 8 13 19 17
Paid money for sex 5 8 18 16
Substance use in the past 6 months
Alcohol 51 82 99 88
Marijuana 21 34 43 39
Powder cocaine 8 13 18 17
Crack cocaine 3 5 6 6
Amphetamine 2 3 5 5
Treated for alcohol abuse 6 10 5 4
Treated for drug abuse 5 8 8 7
Note. STD = sexually transmitted disease.
268 KALICHMAN, TANNENBAUM, AND NACHIMSON
Table 4
Standardized Betas and Percentage of Variance Accounted for in Multiple Regressions for Sexual
Sensation Seeking, Substance Use Expectancies, and Substance Use Before Sex as Predictors of
Number of Male Sex Partners
Variable Adjusted
Substance use before sex .45**
Substance use outcome expectancies -.18*
Sexual sensation seeking .19*
*p < .05. **p < .01 (two-tailed).
seeking contributed 5% of unique variance in
number of sex partners over and above alcohol
use and alcohol expectancies, F= 11.2, p < .01.
In addition, analyses of the path SS (Subst,
Partners) => Exp showed that sensation seeking
accounted for 15% of the variance in alcohol
outcome expectancies; in turn, alcohol expectan-
cies predicted alcohol use before sex, Exp
(Partners, SS) => Subst, AJ?2 = .07, F = 15.7,
p < .01. As shown in Figure 1, sensation
seeking explained variance in sexual risk
behavior over and above the substance use
variables, but also predicted substance use
before sex through outcome expectancies,
Other Drug Use and Sexual Risk Behavior
Among the 114 men who reported lifetime
use of drugs other than alcohol, 76 (67%) had
used marijuana, 31 (27%) used cocaine, 28
(25%) used poppers, and 14 (12%) had used
other drugs. Twenty six men (22%) reported
preferential use of two or more of these drugs.
For men who used both alcohol and other drugs,
Sensation
Seeking
.25*'
.41*
Alcohol
Expectancies
Figure 1. Path coefficients for the model predicting number of male sex partners from alcohol use, alcohol
outcome expectancies, and sensation seeking. **p < .01.
Alcohol Other drugs
ft R2 Adjusted ft R2
.47**
-.05
.249 .23** .267
alcohol (M = 14.9, SD = 5.6) was viewed as
producing lower sexual outcome expectancies
than other drugs (M = 16.7.SD = 6.9),f(117) =
2.93, p < .01. Men who reported preferring
marijuana, cocaine, or other drugs did not differ
from those who did not prefer these drugs on
outcome expectancies. However, men who had
used poppers (Af = 19.5, SD = 6.5) reported
greater sexual outcome drug expectancies than
men who did not use poppers (Af = 15.9,
SD = 7.0), r(119) = 2.41, p < .01.
Multiple regression analyses for the path SS,
Exp, Subst => Partners showed that drug use
before sex, drug outcome expectancies, and
sensation seeking significantly predicted num-
ber of male sex partners, R = .52, F(3, 110) =
13.38, p < .01, accounting for 26.7% of the
variance in number of sex partners (see Table 4).
Analysis of the path SS (Exp, Subst) => Partners
showed that sensation seeking accounted for 5%
of the variance in number of sex partners over
and above the substance use variables, F - 7.2,
p < .01. The path SS (Subst, Partners) => Exp
Number of Male
Sex Partners
 SUBSTANCE USE EXPECTANCIES AND RISK FOR HIV
Sensation
Seeking
.25*'
.47** Drug Use
Before Sex
Drug
Expectancies
Figure 2. Path coefficients for the model predicting number of male sex partners from other drag use, drag
outcome expectancies, and sensation seeking. *p < .05. **p < .01.
showed that sensation seeking also accounted
for 20% of the variance in drug outcome
expectancies, F = 30.1, p < .01. The associa-
tion between drug expectancies and drug use
before sex tested in the path Exp (SS, Partners) =*
Subst was also significant, A/?2 = .03, F = 4.8,
p < .01. These findings therefore parallel those
for the alcohol use variables. Figure 2 presents
the coefficients for significant paths predicting
number of male sex partners from sensation
seeking and drug use variables.
Discussion
Substance use is among the most consistent
behavioral markers for HTV-related sexual risk
behavior. The current study once again found
that alcohol and other drug use in the context of
sex occurs more frequently among gay and
bisexual men at relatively higher risk for HTV
infection than men at lower risk. Furthermore,
the association between substance use and risky
sex was again related to sensation seeking. In
addition to providing evidence for sensation
seeking as a third variable accounting for the
substance use-risky sex connection, we sup-
ported our hypothesis that sexual outcome
expectancies for substance use may serve as a
cognitive mechanism through which sensation
seeking influences substance use before sex. To
our knowledge, this is the first report of
cognitions identified to explain sensation seek-
ing as a predictor of substance use and risky sex.
We observed similar patterns of associations
between alcohol use variables and risky sex as
we did other drug use variables. These findings
269
Number of Male
Sex Partners
contrast with previous research that showed
alcohol use to function quite differently in
predicting sexual risk compared with other
drugs (Kalichman et al., 1996). Potential expla-
nations for these discrepancies include both
sampling and measurement differences between
studies. First, our sample was not selected from
a substance use treatment setting, suggesting
that alcohol and other drugs may have served
similar functions in nonaddicted men. Second,
we studied mostly middle-class men, minimiz-
ing me role sex can play in accessing drugs as it
may in lower income samples. Third, our
measurement strategy required that only men
who used substances complete the outcome
expectancy measures, therefore not representing
men who may hold the lowest expectancies for
sexual outcomes. Our study is also limited by
the potential overlap of sexual sensation-
seeking and sexual outcome expectancies, as
well as their associations to sexual behavior.
However, because there was no direct content
overlap across measures and the intercorrela-
tions among measures were small to moderate,
our measures appear to tap independent con-
structs. Still, the potentially inflated associations
between measures due to overlap should be
considered when interpreting these results.
These limitations to the study, along with our
reliance on a convenience sample of men
attending a gay pride event, which probably
overrepresents men who are open about their
sexuality, and use of self-report measures, must
be considered when interpreting these findings.
Alcohol and drug use expectancies serve as
an underlying architecture for beliefs about the
270 KALICHMAN, TANNENBAUM, AND NACHIMSON
incentives for vising substances in relation to sex
(Hittner, 1997). Substance use outcome expect-
ancies are embedded in culture as well as
personal experience. Expectations are rein-
forced by the ubiquitous connection between
substance use and sex in commercial advertise-
ments; music, film, and other forms of popular
culture; the role that bars and clubs play in
meeting potential sex partners; and issues of
economics and power. Cognitive influences
such as outcome expectancies offer opportuni-
ties for prevention that are not apparent when
one considers personality dispositions such as
sensation seeking alone (Goldman, 1994). How-
ever, complex constructs like sensation seeking
are unlikely to be explained by a single
cognitive dimension such as outcome expectan-
cies. Biological, experiential, and context spe-
cific influences on behavior interact with
dispositions to predict sexual behavior and
substance use. Research is therefore needed to
further examine factors that explain the associa-
tions between sensation seeking, substance use,
and sexual risk behavior in populations vulner-
able to HIV infection.
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Received June 9, 1997
Revision received October 8,1997
Accepted December 29, 1997