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

Abstract

PurposeTransactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high‐risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice‐involved Appalachian women who use drugs.MethodsParticipants (N = 400) were randomly selected, screened, and interviewed face‐to‐face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex.FindingsOn average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration.ConclusionsResults suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice‐involved and may signal other HIV‐related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk‐reduction interventions, including jail‐based interventions, to educate vulnerable, hard‐to‐reach populations on the risks associated with HIV.

Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids

“…Similar to previous research, women who engaged in transactional sex were more likely to experience sociostructural risk factors such as violence (Dickson et al, 2023;Dunkle & Decker, 2013), homelessness (Jenness et al, 2011;Kaljee & Chen, 2011), and criminal justice involvement (Sherman et al, 2018). These results are consistent with previous literature that details how cyclical police contact and homelessness create barriers to employment and other income-generating ventures (Menza et al, 2020;Rosen et al, 2022).…”

“…Gendered disempowerment coupled with financial need may compromise the women’s ability to negotiate for increased condom use and avoid unsafe sex practices. Similar to research on incarcerated White women (Dickson et al, 2023), women in the current study also had more economic motivations for engaging in transactional sex; therefore, it is possible that economic dependence on sexual partners contributes to the increased risk of HIV among Black women who report opioid misuse.…”

“…In recent years, research has examined structural factors that increase HIV risk among high-risk populations, including injection drug use and transactional sex. In a study of incarcerated White women in Kentucky who use drugs, participants who engaged in transactional sex were more likely to report financial problems prior to incarceration (Dickson et al, 2023). However, little is known about what places Black women or men who misuse opioids at higher risk of engaging in transactional sex.…”

Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review

“…53,54 For example, one study of incarcerated women in rural Appalachian, more than one-quarter reported having traded sex for drugs, money, or other services in the year before incarceration. 55 There is also evidence to support a correlation between arrest and/or incarceration and number of different sexual partners, occurrences of unprotected sex, and concurrent partners. 56 Among justice-involved women who use substances, risky sexual practices appear to be even more common.…”