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Factors Associated with Exchange Sex Among Cisgender Persons Who Inject Drugs: Women and MSM—23 U.S. Cities, 2018

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Abstract

Persons who inject drugs (PWID) and exchange sex face disproportionate HIV rates. We assessed prevalence of exchange sex (receiving money/drugs for sex from ≥ 1 male partner(s) during the past year) among cisgender PWID, separately for women and men with a history of sex with men (MSM). We examined factors associated with exchange sex, including sociodemographic characteristics, sexual and drug use behaviors, and healthcare access/utilization. Over one-third of the 4657 participants reported exchange sex (women: 36.2%; MSM: 34.8%). Women who exchanged sex (WES) were significantly more likely to test HIV-positive than other women. Men who exchanged sex with men (MESM) showed a similar trend. WES and MESM shared many characteristics, including being uninsured, experiencing recent homelessness, condomless sex, polydrug use, and receptive/distributive needle sharing. These findings highlight a need to strengthen prevention interventions and address structural determinants of HIV for WES and MESM, particularly PWID who exchange sex.

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Data Availability

Please send data use requests to NHBS@cdc.gov. A summary of the data is available via a recent CDC surveillance report: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.

Code Availability

SAS code available upon request to the corresponding author.

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Acknowledgements

National HIV Behavioral Surveillance participants; CDC National HIV Behavioral Surveillance Team; National HIV Behavioral Surveillance Study Group. Atlanta, GA: Pascale Wortley, Jeff Todd, David Melton; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Monina Klevens, Rose Doherty, Conall O’Cleirigh; Chicago, IL: Antonio D. Jimenez, Thomas Clyde; Dallas, TX: Jonathon Poe, Margaret Vaaler, Jie Deng; Denver, CO: Alia Al-Tayyib, Daniel Shodell; Detroit, MI: Emily Higgins, Vivian Griffin, Corrine Sanger; Houston, TX: Salma Khuwaja, Zaida Lopez, Paige Padgett; Los Angeles, CA: Ekow Kwa Sey, Yingbo Ma, Hugo Santacruz; Memphis, TN: Meredith Brantley, Christopher Mathews, Jack Marr; Miami, FL: Emma Spencer, Willie Nixon, David Forrest; Nassau-Suffolk, NY: Bridget Anderson, Ashley Tate, Meaghan Abrego; New Orleans, LA: William T. Robinson, Narquis Barak, Jeremy M. Beckford; New York City, NY: Sarah Braunstein, Alexis Rivera, Sidney Carrillo Newark, NJ: Abdel R. Ibrahim, Afework Wogayehu, Luis Moraga; Philadelphia, PA: Kathleen A. Brady, Jennifer Shinefeld, Chrysanthus Nnumolu; Portland, OR: Timothy W. Menza, E. Roberto Orellana, Amisha Bhattari; San Diego, CA: Anna Flynn, Onika Chambers, Marisa Ramos; San Francisco, CA: Willi McFarland, Jessica Lin, Desmond Miller; San Juan, PR: Sandra Miranda De León, Yadira Rolón-Colón, María Pabón Martínez; Seattle, WA: Tom Jaenicke, Sara Glick; Virginia Beach, VA: Jennifer Kienzle, Brandie Smith, Toyah Reid; Washington, DC: Jenevieve Opoku, Irene Kuo; CDC: Monica Adams, Christine Agnew Brune, Amy Baugher, Dita Broz, Janet Burnett, Susan Cha, Johanna Chapin-Bardales, Paul Denning, Dafna Kanny, Teresa Finlayson, Senad Handanagic, Terence Hickey, Kathryn Lee, Rashunda Lewis, Elana Morris, Evelyn Olansky, Taylor Robbins, Catlainn Sionean, Amanda Smith, Anna Teplinskaya, Lindsay Trujillo, Cyprian Wejnert, Ari Whiteman, Mingjing Xia. Funding was provided by the Centers for Disease Control and Prevention.

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The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA

    Julie Rushmore & Michelle L. Johnson Jones

  2. Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA

    Julie Rushmore, Kate Buchacz, Dita Broz, Christine B. Agnew-Brune & Susan Cha

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Consortia

for the NHBS Study Group

  • Pascale Wortley
  • , Jeff Todd
  • , David Melton
  • , Colin Flynn
  • , Danielle German
  • , Monina Klevens
  • , Rose Doherty
  • , Conall O’Cleirigh
  • , Antonio D. Jimenez
  • , Thomas Clyde
  • , Jonathon Poe
  • , Margaret Vaaler
  • , Jie Deng
  • , Alia Al-Tayyib
  • , Daniel Shodell
  • , Emily Higgins
  • , Vivian Griffin
  • , Corrine Sanger
  • , Salma Khuwaja
  • , Zaida Lopez
  • , Paige Padgett
  • , Ekow Kwa Sey
  • , Yingbo Ma
  • , Hugo Santacruz
  • , Meredith Brantley
  • , Christopher Mathews
  • , Jack Marr
  • , Emma Spencer
  • , Willie Nixon
  • , David Forrest
  • , Bridget Anderson
  • , Ashley Tate
  • , Meaghan Abrego
  • , William T. Robinson
  • , Narquis Barak
  • , Jeremy M. Beckford
  • , Sarah Braunstein
  • , Alexis Rivera
  • , Sidney Carrillo
  • , Abdel R. Ibrahim
  • , Afework Wogayehu
  • , Luis Moraga
  • , Kathleen A. Brady
  • , Jennifer Shinefeld
  • , Chrysanthus Nnumolu
  • , Timothy W. Menza
  • , E. Roberto Orellana
  • , Amisha Bhattari
  • , Anna Flynn
  • , Onika Chambers
  • , Marisa Ramos
  • , Willi McFarland
  • , Jessica Lin
  • , Desmond Miller
  • , Sandra Miranda De León
  • , Yadira Rolón-Colón
  • , María Pabón Martínez
  • , Tom Jaenicke
  • , Sara Glick
  • , Jennifer Kienzle
  • , Brandie Smith
  • , Toyah Reid
  • , Jenevieve Opoku
  • , Irene Kuo
  • , Monica Adams
  • , Christine Agnew Brune
  • , Amy Baugher
  • , Dita Broz
  • , Janet Burnett
  • , Susan Cha
  • , Johanna Chapin-Bardales
  • , Paul Denning
  • , Dafna Kanny
  • , Teresa Finlayson
  • , Senad Handanagic
  • , Terence Hickey
  • , Kathryn Lee
  • , Rashunda Lewis
  • , Elana Morris
  • , Evelyn Olansky
  • , Taylor Robbins
  • , Catlainn Sionean
  • , Amanda Smith
  • , Anna Teplinskaya
  • , Lindsay Trujillo
  • , Cyprian Wejnert
  • , Ari Whiteman
  •  & Mingjing Xia

Contributions

JR, KB, SC, DB conceived of study concept and design. JR and SC analyzed data. JR drafted the manuscript. SC, KB, CAB, DB, and MJJ offered critical revisions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Julie Rushmore.

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Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

Activities for NHBS were approved by the Centers for Disease Control and Prevention; NHBS was determined to be a routine disease surveillance activity, and thus exempted from ongoing CDC IRB review. NHBS was reviewed by applicable local institutional review boards in each participating project area.

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Informed consent was obtained from all individual participants included in the study.

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Rushmore, J., Buchacz, K., Broz, D. et al. Factors Associated with Exchange Sex Among Cisgender Persons Who Inject Drugs: Women and MSM—23 U.S. Cities, 2018. AIDS Behav 27, 51–64 (2023). https://doi.org/10.1007/s10461-022-03743-0

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