Network-Level Correlates of Sexual Risk Among Male Sex Workers in the United States: A Dyadic Analysis

Abstract

Background: Male sex workers (MSWs) are at increased risk of HIV infection in the United States. Research is limited on sexual and drug use network characteristics of MSWs. Setting: Community-based organization and health center in 2 US Northeast cities. Methods: One hundred MSWs completed a behavioral assessment and sexual and drug network inventory. Using dyadic analyses, we assessed whether network characteristics, including sex worker-male client age, race, and HIV status homophily and risk multiplexity (ie, overlap in drug-use and sex networks), were associated with condom use. Results: MSW participants' mean age was 33.6. Two-thirds identified as Black or Latino, 12% identified as heterosexual, and 90% reported recent drug use. Participants reported an average of 5.3 male clients in the past month (SD = 3.4), and having anal sex with 74% of these clients, at a rate of 2.2 times per month (SD = 4.6). Participants reported inconsistent condom use during anal sex with 53% of clients. In multivariable models, inconsistent condom use was more common in relationships with presumed HIV status homophily [odds ratio (OR): 1.25; 95% confidence interval (CI): 1.07 to 1.46] and sexual and drug network multiplexity (OR: 1.19; 95% CI: 1.09 to 1.30); and less common within relationships where the client is older than the MSW participant (OR: 0.83; 95% CI: 0.74 to 0.93). Number of multiplex relationships was positively associated with number of condomless anal sex acts with male clients (incidence rate ratio: 1.35; 95% CI: 1.19 to 1.54). Conclusions: Network characteristics may contribute to disproportionate HIV risk among MSWs. Modeling studies should include network characteristics when simulating HIV transmission, and future HIV interventions should address the role of networks.

Transactional sex among rural, justice‐involved Appalachian women who use drugs

“…2,5,14 Furthermore, research has suggested that women who experience greater economic instability may be more vulnerable to victimization within transactional sex relationships, 15,16 while drug use may increase the likelihood of engaging in higherrisk transactional sex. 17,18 Though this underscores the importance of examining the intersection of gender, poverty, culture, and other structural inequalities in the study of substance use and transactional sex, 8,[19][20][21] there remain gaps in the literature, including a limited understanding of transactional sex among populations who are from structurally disadvantaged rural communities-particularly among women, who are more likely to experience poverty and other vulnerabilities given traditional gender role expectations. 22 Considering recent concerns regarding a potential HIV outbreak in rural Appalachia, 23 coupled with a recent finding that rural females who inject drugs were nearly 4 times more likely than their male counterparts to report having recently engaged in transactional sex, 24 further examination of transactional sex among rural women who may be at higher risk is warranted.…”

“…), increase the likelihood of engaging in transactional sex 2,5,14 . Furthermore, research has suggested that women who experience greater economic instability may be more vulnerable to victimization within transactional sex relationships, 15,16 while drug use may increase the likelihood of engaging in higher‐risk transactional sex 17,18 . Though this underscores the importance of examining the intersection of gender, poverty, culture, and other structural inequalities in the study of substance use and transactional sex, 8,19–21 there remain gaps in the literature, including a limited understanding of transactional sex among populations who are from structurally disadvantaged rural communities—particularly among women, who are more likely to experience poverty and other vulnerabilities given traditional gender role expectations 22…”

Perceived risk and condomless sex practice with commercial and non-commercial sexual partners of male migrant sex workers in London, UK

“…Among the contextual factors driving this behaviour, one of the most frequent reported was the use of recreational drugs with clients. [60][61][62] Drug use has been described as a social aspect of this type of work 63 which makes difficult to avoid with clients who are regular drug users, 61 and they are also used to improve sexual performance. 64 About the latter, recreational drugs initiate sexual interaction, 52,65-67 causing sexual arousal that facilitates sexual acts.…”

Perceived risk and condomless sex practice with commercial and non-commercial sexual partners of male migrant sex workers in London, UK

“…One of main factors was the use of recreational drugs with clients. [48][49][50] Authors describe the use of drugs with clients as a social aspect of their occupation, 51 while improving their performance. 52 Further, some argue that this is a difficult aspect to avoid with clients who are regular drug users.…”