Exchange Sex and HIV Infection Among Women Who Inject Drugs—20 US Cities, 2009

Abstract

Background Women who inject drugs and who also exchange sex are at increased risk for HIV infection, but data on this population in the United States remain sparse. Methods This study assessed the prevalence of exchanging sex for money or drugs among women who inject drugs using data from the 2009 US National HIV Behavioral Surveillance (NHBS) system. Prevalence of being HIV-positive (testing positive in NHBS), HIV-positive–unaware (reporting being HIV-negative or unknown status but testing positive in NHBS), and risk behaviors and use of services were compared between women who did and did not exchange sex. The association between exchange sex and being HIV-positive–unaware of the infection was examined using multivariate Poisson models with robust standard errors. Results Among 2305 women who inject drugs, 39% reported receiving things like money or drugs from ≥1 male partners in exchange for oral, vaginal, or anal sex in the previous 12 months. Women who exchanged sex were more likely to be unemployed, homeless, lack health insurance, have multiple condomless vaginal or anal sex partners, and receptively share syringes. In multivariate analysis, exchange sex was associated with being HIV-positive–unaware (adjusted prevalence ratio 1.97, 95% confidence intervals: 1.31 to 2.97). Conclusions Prevalence of exchange sex was high in this population. Women who exchange sex were more likely to be socially disadvantaged, report sexual and injection risk, and be HIV-positive–unaware. They represent an important group to reach with HIV prevention, testing, and care services.

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

“…Rural transactional sex work in the United States is an understudied area although, from urban studies, research has shown that injection drug use is common among individuals who engage in transactional sex [32,47]. Data from the 2009 National HIV Behavior Surveillance on 20 US cities found that the prevalence of RSS in the past 12 months among women who inject drugs was significantly higher in women who exchanged sex (56%) than women who did not exchange sex (33.4%) [48]. These vulnerabilities, engagement in sex work and injection drug use compound risks for HIV and other bloodborne diseases as well as violence and RSS; individuals who engage in both transactional sex and injection drug use may experience risk environments that exceed those of their counterparts who only engage in one activity [48–51].…”

Interest in linkage to PrEP among people who inject drugs accessing syringe services; Miami, Florida

“…suggested that there was a link between sexual and injection-related HIV risk [20,21]. Several recent reports indicate the growing prevalence of sex work as a component of money-generating strategies among PWID [24,25], and as a risk factor for HIV infection [26][27][28]. In the outbreak in Scott County, Indiana, transactional sex was suggested in the earliest HIV infection [29].…”

Awareness and use of HIV pre-exposure prophylaxis among people who engage in sex work presenting to a sexually transmitted infection clinic

“…Among women in the US, an estimated 20-40% of women living in lower socioeconomic and higher HIV incidence communities reported engaging in sex work. [8][9][10] In 2015, 34% of women who injected drugs reported exchanging sex for money or drugs. 8 In addition, there is considerable overlap between histories of sex work, substance use, and incarceration among women.…”