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Association Between Alcohol Use and STDs
Although some studies have failed to find a correlation between alcohol use and unprotected heterosexual intercourse (Leigh and Stall, 1993; Leigh et al., 1994), most studies show that both average and extreme alcohol use are associated with greater risk of STDs. From 1988 to 1990, 2,896 adults completed the General Social Survey, a nationally representative household survey of U.S. adults (Anderson and Dahlberg, 1992). Respondents who reported that they sometimes drink ''more than they should" were more likely to have had the following three outcome variables compared to those who did not: sexual intercourse with two or more partners, intercourse with five or more partners, and intercourse with a stranger in the past year. A household survey in the San Francisco Bay area showed that having ever had an STD was associated with nonmonogamous behavior; with having more than five sex partners in the last five years; and, at a minimum with, three kinds of drinking behavior: going to a bar at least monthly, getting drunk at least annually, and having five or more drinks at one sitting in the last year (Ericksen and Trocki, 1992). In addition, a large nationwide survey in 1991 and 1992 showed that persons who occasionally drank five or more drinks at one sitting were significantly more likely to have multiple partners, be nonmonogamous, and participate in other high-risk sexual activities (Caetano and Hines, 1995).
A number of studies have reported that for men who have sex with men, drug and alcohol use are risk factors for relapse into unsafe sexual behaviors (Stall et al., 1986; Siegel et al., 1989). Alcohol use among adolescents has also been found to be associated with high-risk sexual behaviors (Hingson et al., 1990; Shafer et al., 1993; Lowry et al., 1994). In addition, alcohol use has been found to be a risk factor for HIV-related sexual behaviors among runaway youth (Koopman et al., 1994), the mentally ill (Kalichman et al., 1994), and seronegative female partners of HIV-seropositive men (Kennedy et al., 1993). In a survey of attendees at an STD clinic, drug and alcohol use was found to correlate with unprotected sex during their most recent sexual intercourse (CDC, 1990). In a multiple logistic regression analysis controlling for age, race, income, number of sex partners, and other variables, failure to use condoms was significantly associated with drug and alcohol use at the last sexual encounter for heterosexual men.
Sexual Abuse and Violence
Sexual violence against women and sexual abuse of children are societal problems of enormous consequences. Approximately 500,000 women were raped annually in 1992 and 1993 in the United States (U.S. Department of Justice, 1994), and studies suggest that approximately one in three young girls and one in six young boys may experience at least one sexually abusive episode by the time they reach adulthood (Guidry, 1995). Women who have been sexually abused