Patterns of Exchange Sex and HIV Infection in High-Risk Heterosexual Men and Women

Abstract

Heterosexual partnerships involving the trade of money or goods for sex are a well-described HIV risk factor in Africa and Southeast Asia, but less research has been conducted on exchange partnerships and their impact on HIV infection in the United States. In our study, men and women were recruited from high-risk risk neighborhoods in New York City through respondent-driven sampling in 2006-2007. We examined the factors associated with having an exchange partner in the past year, the relationship between exchange partnerships and HIV infection, and the risk characteristics of those with exchange partners by the directionality of payment. Overall, 28% of men and 41% of women had a past-year exchange partner. For men, factors independently associated with exchange partnerships were older age, more total sexual partners, male partners, and frequent non-injection drug use. For women, factors were homelessness, more total sexual partners, more unprotected sex partners, and frequent non-injection drug use. Exchange partnerships were associated with HIV infection for both men and women, although the relationships were substantially confounded by other behavioral risks. Those who both bought and sold sex exhibited the highest levels of risk with their exchange and non-exchange partners. Exchange partnerships may be an HIV risk both directly and indirectly, given the overlap of this phenomenon with other risk factors that occur with both exchange and non-exchange partners.

Correlates of selling sex among male injection drug users in New York City

“…To our knowledge, this is one of the only U.S. studies to examine factors associated with men selling sex to women. Although women may be more likely to sell sex than men (Jenness et al, 2011), the frequency of men selling sex to women found in this study challenges the conventional perception of the gendered direction of exchange sex. Other research has found that men who have sex with both men and women are more likely to sell sex, compared to those who only have sex with men (Dyer et al, 2013;Weber et al, 2001).…”

“…Exchange sex has previously been found to be associated with HIV infection among high-risk heterosexual men in NYC (Jenness et al, 2011). Those who sell sex may be incentivized to not use condoms (Jie et al, 2012) may have greater numbers of sex partners (Edwards et al, 2006), and may have more risky sex partners (Weber et al, 2002).…”

Unmet Healthcare Need Among Women Who Use Methamphetamine in San Francisco

“…Women who engage in transactional sex may be at increased risk for STIs as well as unintended pregnancy (Jenness et al, 2011;Reuben, Serio-Chapman, Welsh, Matens, & Sherman, 2011). Having a healthcare provider was associated with a decreased odds of having unmet need for women's preventive healthcare.…”

Adapting an Evidence-Based Intervention for Homeless Women: Engaging the Community in Shared Decision-making

“…2-4 Homeless women are most often at risk of HIV infection through engagement in risky sexual behaviors with men. 5,6 Because of these behaviors and the increased likelihood of homeless women to engage in transactional sex, 7,8 adapting evidence-based interventions (EBIs) focused on HIV risk reduction among homeless women is imperative.…”