Risky sex in men who have sex with men: what is the role of substance use in sexual health?

Abstract

This paper contributes to a growing body of economic literature that seeks to attribute a causal interpretation to the endogenous relationship between alcohol use and sexual risk behavior. Using 2018 data from individuals attending a Madrid community center for free HIV testing, I employ an instrumental variables estimation strategy to gauge the causal effect of heavy drinking on STI outcomes and other measures of sexual risk behavior in sexually active men who have sex with men. Specifically, I exploit exogenous variations in patients’ nightlife exposure in their respective neighborhoods as an instrument for alcohol consumption. The corresponding IV results reveal that OLS regressions undershoot the ‘true’ effect that alcohol has on risky sexual behavior. These findings support the conjecture that heavy drinking induces behavioral responses that increase the likelihood of inconsistent condom use and exposure to STIs.