Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR

Abstract

Background Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited. Methods In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex. Results Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P < 0.001). Transactional sex was strongly associated with combination methamphetamine and opiate use as well as condomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low. Conclusions In a sample of women of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.

Sexually Transmitted Infection Epidemiology and Care in Rural Areas: A Narrative Review

“…25 Finally, these behaviors are often congregated, as transactional sex is commonly reported among both PWUD and homeless individuals. 8,26,27 It is estimated that 2.9% to 3.8% of rural residents identify as sexual and gender minorities (SGMs) and may face increased STI risk. 28 In part, this is because rural SGMs (especially transgendered individuals) face substantial stigma and are less likely to use health care.…”

Challenges of sexually transmitted infections and sexual health among people who inject drugs

“…In a sample of people who used stimulants recruited through respondent-driven sampling in North Carolina [46], the majority (73%) reported at least one sexual behavior, and only 38% used condoms consistently, although sex risk factors were not associated with HIV prevalence. Polysubstance injecting (both opioids and methamphetamine) was associated with transactional and condomless sex among women of low socioeconomic status in Oregon [47]. The analysis of 2013–2017 case reporting of syphilis in the United States concluded that a substantial percentage of heterosexual syphilis transmission is occurring among persons who use drugs, particularly methamphetamine [48 ▪ ].…”

Evidence for the Role of State-Level Economic Policy in HIV Risk Reduction: State Earned Income Tax Credit Generosity and HIV Risk Behavior Among Single Mothers

“…As such, there may be an important opportunity to influence the trajectory of HIV in this population through increased uptake of state earned income tax credit laws, changes in the way the laws are implemented and increases in benefit generosity. Lastly, the HIV risk behaviors reflected in our composite HIV risk variable are implicated in a number of other infections that may have long-term health sequela such as pelvic inflammatory disease, cervical cancer and liver cancer [24]. Consequently, the long-term health and healthcare costs implications of more generous state earned income tax credit laws may be sizable.…”