Abstract
BackgroundWomen who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited.MethodsIn 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex.ResultsOf 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P < 0.001). Transactional sex was strongly associated with combination methamphetamine and opiate use as well as condomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low.ConclusionsIn a sample of women of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.
Highlights
Women who report transactional sex are at increased risk for Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs)
Research on social and structural forces that increase vulnerability for HIV and other sexually transmitted infections (STIs) among women has demonstrated that a multitude of factors, including minority status, low socioeconomic status (SES), and adverse experiences, intersect to create milieus of risk where women, especially women of color, are at a disadvantage when it comes to avoiding HIV and STI [2, 3]
Women who engage in transactional sex may be at high risk for HIV infection
Summary
Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). Research on social and structural forces that increase vulnerability for HIV and other sexually transmitted infections (STIs) among women has demonstrated that a multitude of factors, including minority status, low socioeconomic status (SES), and adverse experiences, intersect to create milieus of risk where women, especially women of color, are at a disadvantage when it comes to avoiding HIV and STI [2, 3]. A 2016 metaanalysis of 14 studies of women who reported exchanging sex for money or drugs in the U.S found a pooled HIV prevalence of 17.3% [5], compared to a prevalence of 0.16% in U.S women [1]
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