Alcohol, drug, and sexual risk behavior correlates of recent transactional sex among female black South African drug users

Abstract

Transactional sex among black South African women has become a mode of economic survival putting them at higher risk for HIV and other infectious disease. In order to inform HIV interventions, drug and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black, South African women in Pretoria were examined using log binomial regression. Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use (Adjusted Prevalence Ratio (APR)=1.3, 95% CI=1.1, 1.5) and knew of anyone who died of AIDS (APR =1.5, 95% CI 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR =0.6, 95% CI= 0.4, 0.8), condom use in their first sexual encounter (APR =0.7, 95% CI=0.6, 1.0) or reported a recent steady sexual partnership (APR =0.8, 95% CI=0.7, 0.9). Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.

Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users

“…In addition, individuals in the MJ+Cig and MJ+Her group were more likely to use drugs before or during sex with steady partners than the Crack group. As previous work has identified the possible success of educational interventions that target sex workers in South Africa (Hedden et al, 2011), the current study suggests that interventions be tailored to substance users who do not engage in transactional sex, but engage in high-risk behaviors with steady partners. For example, the MJ+Cig group was less likely to engage in transactional sex than the Crack group, but more likely to use alcohol and drugs before/during steady sex and more likely to use alcohol before or during casual sex than the Crack group.…”

“…This finding supports previous research that identifies successful outcomes in educational interventions that target increasing condom use among high-risk populations. Specifically, Hedden et al (2011) found that women in South Africa who traded sex were more likely to use condoms at last sex than at their first sexual encounter. However, the MJ+Cig group was more likely to use alcohol before or during sex with casual partners than the Crack group.…”

“…General sexual risk behaviors included condom use at last sex and transactional sex. Transactional sex is defined as ever having traded sex for money or drugs (Floyd et al, 2010; Hedden et al, 2009, 2011). Specific sexual risk behaviors were identified with steady and casual partners that included alcohol use before or during sex and drug use before or during sex.…”

“…Research suggests that the increase in the use of “sugars” in South Africa, low quality heroin and cocaine mixed with marijuana, (Pluddemann et al, 2008), use of cocaine prior to sex work (Hedden et al, 2011) for coping or increased energy (Needle et al, 2008), and heroin and marijuana after sex work for relaxation (Needle et al, 2008; Floyd et al, 2010) contributes to unsafe sex and HIV in South Africa. As the risk of contracting infectious disease may increase with the use of substances (Friedman et al, 2009; Neblet et al 2011; Pilowsky et al, 2007; Somlai et al, 2000), it is imperative to elucidate patterns of drug use and their associated risk behaviors among this population.…”

“…Although several noteworthy studies have focused on substance use, risk behavior, and HIV infection in South Africa (Floyd et al, 2010; Hedden et al, 2009, 2011; Kalichman et al, 2006; Peltzer et al, 2009; Weschberg et al, 2006), research has yet to examine patterns of substance use and risk among drug users in this population. Despite the high prevalence of substance use and high potential for exposure to, and transmission of, blood-borne illnesses, to our knowledge, no studies have explored patterns of polysubstance use, sexual risk behavior, and infectious disease in this region.…”