Understanding the Relationship Between Alcohol Consumption and HIV Risk Behaviors in U.S. Adolescents: A Systematic Review of Youth Risk Behavior Survey Findings (2005–2021).

Background/Objectives: Alcohol use is a significant public health concern for adolescents, not only for its direct health impacts but also for its association with other health risk behaviors. In particular, alcohol use has been linked to sexual behaviors that may increase the risk of HIV transmission. This systematic review aims to provide a deeper understanding of the relationships between various alcohol- and HIV-related risk behaviors among adolescents by synthesizing existing literature that exclusively uses Youth Risk Behavior Survey (YRBS) data. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in PubMed, Web of Science, and PsycINFO. Eligible studies were peer-reviewed, published in English, and analyzed associations between alcohol use (age at first drink, alcohol use, binge drinking) and HIV risk behaviors (number of sexual partners, condom use, HIV testing) using YRBS data from the 2005-2021 collection years. Two authors independently screened 1133 records for eligibility, with 17 studies included in the final review. Results: The included studies consistently found a significant positive association between the frequency of alcohol use and binge drinking and a greater number of sexual partners. However, the evidence for an association between alcohol use and condom non-use was mixed. Limited evidence suggests that age of first alcohol use is not correlated with condom non-use. A key finding was the wide variation in study methodology, including the use of lifetime versus recent and dichotomized versus ordinal measures. Additionally, few studies were guided by a theoretical framework. Conclusions: The findings support a consistent link between alcohol use and having a greater number of sexual partners but highlight mixed evidence regarding condom use and little evidence for an association with HIV testing. This review demonstrates a need for more nuanced, theory-driven analyses that better utilize the multidimensional data available in the YRBS to capture the complex nature of risk behaviors.