Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California

Walters, Suzan M.; Kral, Alex H.; Lamb, Shona; Goldshear, Jesse L.; Wenger, Lynn; Bluthenthal, Ricky N.

doi:10.1007/s11524-020-00494-y

Cited by 13 publications

(13 citation statements)

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“…A key to ecosocial theory is that health disparities reflect power distributions in society and societal systems, and thus the deficits reported by rural people who use drugs are actually health inequities, since the lack of employment, housing and food options are avoidable [ 35 ]. Thus, interventions should target root causes of health inequities associated with overdose, such as providing affordable housing, living-wage jobs, and food supports [ 68 , 69 ]. Importantly, stable housing that is not contingent on substance use or mental health treatment is effective and does not increase alcohol or drug use [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Walters

Bolinski

Almirol

et al. 2022

Addict Sci Clin Pract

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Background Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. Methods The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. Results Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. Conclusion The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3

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Section: Discussionmentioning

confidence: 99%

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Walters

Bolinski

Almirol

et al. 2022

Addict Sci Clin Pract

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“…MWUO identifying as gay or bisexual were significantly more like to report transactional sex compared to their heterosexual-identifying counterparts. Because the procurers of transactional sex are overwhelmingly cisgender men, gay and bisexual MWUO may be more willing than heterosexual MWUO to sell sex because these transactional sex partnerships are likely concordant with their sexual orientations [ 20 – 22 ]. Elevated transactional sex involvement among gay and bisexual MWUO could also reflect underlying histories of social exclusion and isolation attributed to the sexual identities of gay and bisexual men, particularly among Black men.…”

Section: Discussionmentioning

confidence: 99%

“…Little is known about men’s transactional sex in the context of opioid use, as studies of transactional sex in men tend to focus exclusively on MSM [ 15 – 18 ], whose substance use patterns and associated vulnerabilities may be distinct from other men who use opioids (MWUO), both heterosexual and non-heterosexual. The available literature links transactional sex among MWUO to polysubstance use, injecting drugs, receptive syringe sharing, housing instability, and violence victimization [ 19 – 22 ]. Importantly, these insights are gleaned predominantly from studies conducted internationally and may, thus, have limited relevance to the US context.…”

Section: Introductionmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

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Background Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men’s selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. Methods Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. Results Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97–0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81–7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05–3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02–3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. Conclusions Synergistic sources of social and structural marginalization—from sexuality to hunger, homelessness, and injection drug use—are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.

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“…For example, overdose, hepatitis C, and HIV tend to cluster among communities that use drugs (Perlman & Jordan, 2018; Singer & Clair, 2003). Stigmatizing policies that criminalize drug use have made it more challenging for persons who use drugs to access health supports and harm reduction as well as to secure and maintain stable well-paying jobs, both of which impact health outcomes (Walters, Kral, et al, 2021).…”

Section: Intersectional Stigma As a Fundamental Cause: A Case Study O...mentioning

confidence: 99%

Intersectional stigma as a fundamental cause of health disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time.

Walters¹,

Kerr²,

Cano³

et al. 2023

Stigma and Health

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Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities, the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.

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Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California

Cited by 13 publications

References 82 publications

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

Intersectional stigma as a fundamental cause of health disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time.

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