Transactional Sex among Men and Women in the South at High Risk for HIV and Other STIs

Abstract

Transactional sex refers to selling sex (exchanging sex for money, drugs, food, shelter, or other items) or purchasing sex (exchanging money, drugs, food, shelter, or other items for sex). These activities have been associated with a higher risk for HIV and other sexually transmitted infections in a variety of populations and settings. This paper examines correlates of purchasing and selling sex in a large sample of drug users, men who have sex with men, and sex partners of these groups. Using respondent-driven sampling, participants were recruited between 2005 and 2008 in two urban and two rural counties in North Carolina. We used multiple logistic regressions to examine separate models for selling and purchasing sex in men and women. In addition, we estimated direct and indirect associations among independent variables in the logistic regression models and transactional sex using structural equation models. The analysis shows that factors associated with women selling and buying sex include being homeless, use of stimulants, bisexual behavior, and neighborhood disorder. There was also a significant difference by race. For men, the factors associated with selling and buying sex include being homeless, bisexual behavior, and not being in a relationship. Although neighborhood violence and disorder show significance in bivariate associations with the outcome, these associations disappear in the structural equation models.

The Unanticipated Benefits of Behavioral Assessments and Interviews on Anxiety, Self-Esteem and Depression Among Women Engaging in Transactional Sex

“…Transactional sex, selling or purchasing sex in exchange for money, drugs, food, shelter, or other items (Bobashev et al 2009), has been linked to disproportionally high rates of mental health morbidity in women (Ward et al 1999). Poor mental health has been associated with sexual and drug-seeking behaviors that increase susceptibility to sexually transmitted infection (STI) and human immunodeficiency virus (HIV) (Boyle et al 1997; Centers for Disease Control & Prevention [CDC] 2005; Hutton et al 2004).…”

Sexual Minority Status and Violence Among HIV Infected and At-Risk Women

“…Substance use may be a risk factor for and a reaction to violence; 10,12,58 substance use or poverty may have led women to engage with partners of a gender they would not otherwise have sex with. 22,59 Strengths of this study include its multisite, longitudinal design and long follow-up period spanning mid-life for most women. Due to the large sample size, we were able to examine both sexual identity and behavior within the same sample, as well as distinguish differences among sexual minority women.…”

“…Transactional sex is associated with increased physical and sexual violence, from clients and intimate partners, 9,[16][17][18][19][20][21] as well as higher numbers of sex partners [22][23][24][25] and increased substance use. 22,24,26 Substance use may also contribute to poor decision-making and aggressive behaviors of both victims and perpetrators that increase violence, as well as participation in risky activities to obtain drugs. 7,10 Substance use can also lead to and stem from transactional sex 21 and is associated with multiple partners.…”

“…Studies have shown that women identifying as lesbian, bisexual or WSMW have increased odds of binge drinking and drug use. [22][23][24][25] WMSW have been associated with high-risk sex; in two studies at sexually transmitted infection (STI) clinics, WSMW reported more transactional sex compared to heterosexual or WSW women. 28,29 Among drug using women, those who had sex with women had increased transactional sex and numbers of sex partners.…”

Physical Victimization and High-Risk Sexual Partners among Illicit Drug-Using Heterosexual Men in New York City

“…[8][9][10][11] Fewer studies have examined the association between physical victimization and sexual risk behavior in heterosexual men or illicit drug users. 12 Drug users are more likely to have high-risk sexual partners (e.g., IDUs 13 or those who engage in transactional sex, [14][15][16] ) which confers increased HIV risk. [17][18][19][20] However, to our knowledge, no prior studies have examined if violent victimization in adulthood is associated with having a high-risk sexual partner or precedes acquisition of high-risk partner in illicit drug-using men.…”