Assessing gay and bisexual men's outcome expectancies for sexual risk under the influence of alcohol and drugs.

Alcohol and substance use plays a complex role in sexual behavior among gay and bisexual men. Data from 779 gay and bisexual men who reported sex with a casual partner in the past 3 months were collected in November 2002 at two large lesbian, gay, and bisexual community events in New York City. Participants reporting any unprotected anal receptive or insertive sex scored significantly higher in outcome expectancies for sexual risk taking while using drugs or alcohol, as did HIV-positive men and men with a higher rate of lifetime sexually transmitted infections. Sexual compulsivity, romantic obsessions, drug use, unprotected anal receptive sex, and HIV serostatus successfully predicted outcome expectancies for sexual risk while under the influence. Therapists and other health and social service providers working with gay and bisexual men should explore the connection between sexual risk and being under the influence to uncover psychosocial mechanisms related to this phenomenon.