Sex For Money Research Articles

Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drugusing populations in Cape Town, Durban and Pretoria, South Africa

This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known ‘hotspots’ for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.

Core group approach to identify college students at risk for sexually transmitted infections

To analyze the core group for sexually transmitted infections (STI) among college students. Cross-sectional study carried out in a convenience sample comprising 711 college students of the public university of Morelos, Mexico, between 2001 and 2003. Sociodemographic and sexual behavior information were collected using self-applied questionnaires. Herpes simplex 2 (HSV-2) infection was tested in the blood. The number of sexual partners in the last year and cocaine consumption were used as indicators to construct the dependent variable "level of STI risk" in three categories: low, medium and high risk (core group). A multinomial analysis was conducted to evaluate whether different sex behaviors were associated with the variable "level of STI risk". There was significant association between HSV-2 seroprevalence and the variable "level of STI risk": 13%, 5.6% and 3.8% were found in high (core group), medium and low categories, respectively. There were gender differences regarding the core group. Men started having sexual intercourse earlier, had more sex partners, higher alcohol and drug consumption, higher frequency of sex intercourse with sex workers, exchanging sex for money, occasional and concurrent partners compared to women. The study findings suggest existing contextual characteristics in the study population that affect their sex behavior. In Mexico, the cultural conception of sexuality is determined mainly by gender differences where men engage in higher risky sexual behavior than women.

T01-O-19 The analysis of sexual lifestyles of adult Poles. Comparison of an internet-based survey and paper-based survey

The internet-based sexual studies are becoming more and more popular. This study offers a comparison of internet-based survey and paper-based survey on sexual activities of adult Poles thus contributing to the international discussion about biases in internet-based samples. Objectives • to compare results of internet-based and paper-based surveys on sexual life styles in Poland • to investigate attitudes to various forms of sexual expression and sexually related issues. Design and Method A questionnaire containing 136 items was developed and validated by the authors and was made available to volunteers either online or in paper form. The online questionnaire was administered through a university website to volunteers recruited online through search engines or e-mailing lists. The paper version was distributed among volunteer students of two large cosmopolitan universities and among employees of six randomly selected companies in western Poland. Results There were 691 responses with 46.4% males and 53.6% females (internet ample) and 48.3% males and 51.7% females (paper-based sample). • Both samples consisted mostly of young (aged 22-28), well educated and living in big cities people. • Higher percentage of people identified themselves as attracted to the same sex or both sexes in web-based survey (12%) than paper-based sample (6%) • There was no significant difference in reference to oral and anal sex, casual sex, sex for money. Conclusions • There were many similarities in sexual biography and current sexual behaviour between internet-based and paper-based samples. • The internet-based and paper-based samples presented similar behavioural characteristics toward different sexual activities • However, this Internet sample revealed more permissive attitudes toward different sexually related issues than the paper-based sample.

HIV and HCV Prevalence and Gender-Specific Risk Profiles of Crack Cocaine Smokers and Dual Users of Injection Drugs

The present analysis compares HIV and HCV prevalence and associated gender-specific risk patterns of dual users (i.e., crack smokers who inject drugs) and never injectors. Two logistic models, one restricted to female and the other to male crack smokers, were constructed to identify gender-specific risk factors associated with dual use (p < 0.05). Of 437 crack smokers, 246 (56%) were dual users while 191 (44%) were never injectors. In a fitted logistic regression model, dual use among female crack smokers was associated with HCV infection (adjusted OR = 4.65, 95% CI: 1.92–9.70), exchanging sex for money, drugs, or shelter while using crack (aOR = 4.47, 95% CI: 1.56–12.80), having a casual partner who injects (aOR = 4.13, 95% CI: 1.05–16.26), having equipment broken or confiscated by police without being arrested (aOR = 3.66, 95% CI: 1.43–9.34), and HIV infection (aOR = 2.07, 95% CI: 1.18–5.96). Among male crack smokers, dual use was associated with HCV infection (aOR = 5.34, 95% CI: 2.10–13.18), exchanging sex for money, drugs, or shelter (aOR = 3.25, 95% CI: 1.59–6.65), crack use history ≥ 5 years (aOR = 2.16, 95% CI: 1.29–3.63), and smoking in a group of unknown people (such as crack houses, alleys; aOR = 1.70, 95% CI: 1.10–2.81). These findings highlight the need for evidence-based prevention and harm reduction initiatives that directly targeting crack cocaine smokers, with particular attention given to female dual users of injection drugs.

Longitudinal Effects of Perceived Maternal Approval on Sexual Behaviors of Asian and Pacific Islander (API) Young Adults

Data were obtained from the National Longitudinal Study of Adolescent Health to examine the longitudinal association between Asian and Pacific Islander (API) adolescents’ perceptions of maternal approval of their sexual activity and contraception use, and four sexual outcomes during young adulthood. The study includes a nationally representative sample of 1,195 API adolescents. Logistic regression analyses were used to estimate the associations between predictors (Wave I) and outcomes (Wave III), controlling for covariates. API adolescents who perceived that their mothers approved of their sexual activities were more likely to have engaged in sex before age 15, contracted HIV/Sexually Transmitted Diseases, had multiple sex partners, and paid money for sex during young adulthood. Findings highlight the need for parent–adolescent communication and parental involvement in preventing negative sexual health outcomes among API adolescents transitioning to young adulthood.

Skinning the goat and pulling the load: transactional sex among youth in Dar es Salaam, Tanzania

Transactional sex has been associated with risk of HIV infection in a number of studies throughout sub-Saharan Africa. Urban young women are economically vulnerable and at heightened risk of HIV infection in Tanzania; yet there are few studies that have explored relationship dynamics, including transactional sex, in this setting. This paper sheds light on the broader context of sexual relationships among youth at risk for HIV, how transactional sex plays out in these relationships, and how the transactional nature of relationships affects women's risk for HIV. We conducted 60 in depth interviews and 14 focus group discussions with young men and women, 16–24 years old, in Dar es Salaam, Tanzania. These data guided the development of a community based HIV and violence prevention intervention for young men. Youth described the exchange of sex for money or other material goods in all types of sexual relationships. While the exchange was explicit in casual relationships, young women voiced material and monetary expectations from their committed partners as well. Young men described their pursuit of multiple partners as sexually motivated, while women sought multiple partners for economic reasons. Young men were aware of the expectations of material support from partners, and acknowledged that their ability to provide for a partner affected both the longevity and exclusivity of their relationships. Youth described a deep mistrust of the motivations and commitment of their sexual partners. Furthermore, young women's financial dependence on men impacted their ability to negotiate safe sexual behaviors in both casual and committed relationships. Programs designed to reduce HIV risk among Tanzanian youth need to take into account the transactional component of sexual relationships and how such exchanges differ according to partner type.

Crystal methamphetamine use among young adults in the USA

To examine the prevalence and correlates of crystal methamphetamine use among young adults in the USA. Cross-sectional analyses of nationally representative data of young adults from the National Longitudinal Study of Adolescent Health (Add Health). In-home interviews conducted in 2001-02. A total of 14,322 respondents aged 18-26 years. Past year and 30-day crystal methamphetamine use; crime/violence (ever arrested, past year drug selling, past year violent behavior) and sexual risk behaviors (multiple partners, poor condom use, regretted sex, sex for money). Prevalence of past year crystal methamphetamine use was 2.8%; past month was 1.3%. White or Native American race, residence in the west or south, having an ever-incarcerated father, marijuana, cocaine, intravenous drug use and high novelty seeking were associated with greater likelihood of past year use in multivariate analyses. Compared to marijuana and cocaine users, crystal methamphetamine users were more likely to be male, unemployed, reside in the west or south, have an ever-incarcerated father and less likely to be black or Hispanic. Frequent users were no different from occasional users, except being more likely to have dropped out of school. Although crystal methamphetamine use was associated with crime and risky sex, controlling for covariates greatly diminished this relationship. Most users are occasional users, but any past year use is associated with risky and antisocial behaviors, including other illicit drug use. Further research is needed to examine how other drug addiction is associated with methamphetamine use, and to identify longitudinal antecedents for prevention.

A Comparison of Risk Factors for HCV-mono-infection, HIV-mono-infection, and HCV/HIV-co-infection in a Community Setting

The prevalence of HIV infection in HCV patients is much lower than the prevalence of HCV infection in HIV patients. Whereas the higher prevalence of HCV infection in HIV is clearly related to drug abuse, the reasons for the lower prevalence of HIV infection in HCV patients has not been reported. The prevalence of non-sexual and sexual risk factors associated with acquisition of hepatitis C and HIV were studied in HIV-mono-infected, HCV-mono-infected, and HCV/HIV-co-infected individuals. None of the 114 HCV-mono-infected patients tested positive for HIV and this finding was associated with a significantly lower number of men who have sex with men (MSM) among the HCV-mono-infected subjects than among either the HIV-mono-infected or HCV/HIV-co-infected individuals. Unprotected anal intercourse and sex for money or drugs were reported less often by HCV-mono-infected individuals than by HIV-mono-infected and HCV/HIV-co-infected subjects. Having sex with an intravenous-drug user (IVDU) was reported more frequently by both HCV-mono-infected and HCV/HIV-co-infected individuals than by HIV-mono-infected individuals. Sub-analysis of the group of MSM revealed that IVDU differentiated between HIV-mono-infected and HCV/HIV-co-infected subjects. These results reveal that the lower prevalence of HIV in HCV patients is related to a lower number of MSM in this group and that sex with an IVDU is a surrogate marker for drug abuse related to acquiring HCV but not HIV. The guidelines should include strategies for testing for HCV and HIV in patients with these infections.

Prevalence of Risk Factors for Hepatitis C Virus in HIV-Infected and HIV/Hepatitis C Virus-Coinfected Patients

A sample of patients with HIV completed a questionnaire identifying their demographic characteristics and risk factors for hepatitis C virus (HCV). A chart review was conducted to confirm the information obtained using the questionnaire. Risk factors associated with coinfection status at alpha level of 0.1 in univariate analysis were entered into a multivariate Cox regression model. Of the 242 HIV-positive patients analyzed, 168 were HIV-infected and 74 were HIV/HCV-coinfected. Risk factors that were significantly different between HIV-monoinfected and HIV/HCV-coinfected subjects included intravenous drug use, snorting drugs, sharing razors or toothbrushes, being in prison, the presence of one or more tattoos, sex for money or drugs, sex with an intravenous drug user and man who has sex with men. In a multivariate regression model, only intravenous drug use remained as a significant risk factor/predictor of HCV/HIV coinfection. A subanalysis identified risk factors more prevalent among coinfected men who have sex with men, including intravenous drug use, sharing razors/toothbrushes, tattoos, sex for money or drugs, sex with an intravenous drug user, and a history of having 11 or more sexual partners. A history of having had a sexually transmitted disease and 11 or more sex partners was more prevalent among HIV-monoinfected men who have sex with men. HIV/HCV coinfection was associated with intravenous drug use but not with sexual risk factors.

Alcohol and Risks for HIV/AIDS Among Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This paper reports a study of the association between alcohol use and HIV risk-related behavior among 134 men and 92 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results showed that problem drinking was common among STI clinic patients; 58% of men and 28% of women scored above a cut-off of 9 on the Alcohol Use Disorders Identification Test (AUDIT) suggesting possible problem drinking and 46% of men and 19% of women scored above 12 on the AUDIT indicating probable drinking problems. For men, heavier alcohol use was associated with having multiple sex partners in the past month, less condom use, and having a history of sexually assaulting women. Among women, higher scores on the AUDIT were also related to having multiple sex partners as well as a history of exchanging sex for money or materials. The association between alcohol use and sexual risk behaviors in a population at high-risk for HIV transmission demonstrates the need for integrating alcohol risk reduction counseling with HIV prevention counseling among STI clinic patients in South Africa.

Codeine Cough Syrup Use Among African-American Crack Cocaine Users

While studies show evidence of a clear problem with the prevalence of crack cocaine and codeine cough syrup use separately, the relationship between these substances of abuse and concurrent polydrug use is unknown. In an attempt to ascertain beyond anecdotal evidence, the authors carried out a cross-sectional study among 482 Mrican-American crack users to investigate the differences between those who were concurrently codeine cough syrup users and those who were not codeine cough syrup users in Houston, Texas. Logistic regression indicated that codeine use was significantly associated with lower participant age and lower education; codeine cough syrup users were significantly more likely than nonusers to not have a main sexual partner. in addition, codeine users had significantly higher odds of ever trading sex for money, marijuana use, and fry use. These findings are important in determining the “cultural novelties” relative to crack and codeine use among younger Mrican Americans.

Association of educational attainment with HIV risk in African American active injection drug users

This study explored the association between educational attainment and HIV/AIDS risk among African American active injection drug users (IDUs) in Chicago, US. Using snowball sampling techniques, 813 African American active IDUs were recruited for semi-structured interviewing and HIV counseling, testing and partner notification. Logistic regression examined the relationship between level of education attained (three categories: less than high school; equivalent to high school; and greater than high school) and HIV risk behaviors (12 unsafe sex and drug-related practices) and HIV serostatus (positive or negative). Compared with the reference category (less than high school education), those with education equal to high school were less likely to share water, p = 0.044, OR = 0.70 (95%CI: 0.50–0.99). Compared with the reference category, those with education greater than high school were less likely to receive money for sex, p = 0.048, OR = 0.62 (95%CI: 0.38–0.99); share needles with person having HIV or AIDS, p = 0.015, OR = 0.58 (95%CI: 0.37–0.90); and test positive for HIV, p = 0.027, OR = 0.58 (95%CI: 0.36–0.94). The significant associations found between educational attainment and certain HIV risk behaviors and HIV serostatus have implications for tailoring HIV prevention efforts for less educated African American IDUs.

Characteristics, Drug Use, and Sex Partners of a Sample of Male Sex Workers

Some male sex workers (MSWs) are also engaging in a significant amount of illicit drug use and other high risk behavior. The purpose of this study was to examine demographic characteristics, HIV risk behaviors, and sex partner characteristics in a sample of MSW. Data were collected from 179 men who were trading sex for money in Houston, TX. In the past 30 days they reported an average of 56 male partners and 5 female partners. Of the 179 men, 152 had been tested for HIV and knew their status. Twenty-six percent of those tested had tested positive.

Childhood Sexual Abuse and HIV Risk Among Men Who Have Sex with Men: Initial Test of a Conceptual Model

Childhood sexual abuse has been associated with HIV transmission risk behavior in men who have sex with men. This study examined an adapted model that was originally developed to explain the relationship between childhood sexual abuse and HIV risk behavior among women in a sample of men who have sex with men. Men attending a large gay pride event (n=647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse, symptoms of dissociation, trauma-related anxiety, borderline personality characteristics, hopelessness, substance use, and sexual risk behavior. A latent variable partial least squares analysis was conducted to test the interrelationships between childhood sexual abuse, exchanging sex for money or drugs, emotional disturbances, drug use, substance use in the context of sexual behavior, and sexual risk behavior. The model fit the data well and accounted for 10% of the total variance in sexual risk behavior. History of childhood sexual abuse predicted exchanging sex for money or drugs and this relationship was partly accounted for by active drug use. Substance use proximal to sexual behavior also emerged as a key factor in predicting sexual risk behavior. Findings from this study, therefore, indicate a direct association between history of child sexual abuse and high risk for HIV infection related to engaging in sex trade.

The experience of condom use and other sexual risk practices among male brewery employees who recently migrated in Nigeria

Objective To identify factors that predict condom use and sexual practices of brewery employees who had recently been on short- and longterm migration in the course of their jobs in Nigeria. Design A cross-sectional survey design was adopted to investigate the relationship between sexual practices and condom use of migrant employees, and to determine the predictors of condom use at last intercourse during migration. Setting The study was conducted in a large multinational brewery in Nigeria with operational locations in various parts of the country. Method A sample of 936 male employees was selected consecutively in the brewery in 2002. They were independently invited to respond to a questionnaire consisting of items that covered background characteristics, condom use and sexual experiences. Results The findings showed that 40 per cent of participants reported they were using alcohol occasionally prior to sex and 54 per cent reported that they either received or paid money for sex. Forty-seven per cent of men indicated that they used condoms at their last intercourse during migration, while 62 per cent had had one to three sexual partners during their last migration. The odds of using a condom at last intercourse were significantly lower for married than for single participants (odds ratio, 0.57). Compared with participants without the intention to use a condom in next intercourse during migration, those with the intention were significantly more likely to report condom use (odds ratio, 9.7). The odds of condom use were significantly higher for participants who perceived that a condom prevents HIV transmission than those who either did not have the perception or were not sure (odds ratio, 0.30-1.80). Conclusion Steps are needed to promote condom use among brewery employees on migration. Intervention programmes aimed to enhance condom use among prospective migrant employees may be more effective if they provide opportunities for the employees to think about the advantages of condoms in sexual encounters under migration conditions.

The evaluation of the JEWEL project: An innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution

The JEWEL (Jewellery Education for Women Empowering Their Lives) pilot study examined the efficacy of an economic empowerment and HIV prevention intervention targeting illicit drug-using women (n=50) who were involved in prostitution in Baltimore, Maryland. The intervention was comprised of six 2-hour sessions that taught HIV prevention risk reduction and the making, marketing and selling of jewellery. Bivariate comparisons examined behaviour change pre- and 3-months post-intervention. The intervention's effect on the change in the number of sex trade partners from baseline to follow-up was explored with multiple linear regression. Participants were 62.0% African American, 5.0% were currently employed, and the median age was 39 years old (Inter Quartile Range [IQR]: 34–45). Women attended an average of six (IQR: 4.5–6.0) sessions. The women sold over $7,000 worth of jewellery in eleven sales. In comparing self-reported risk behaviours pre and 3-month post intervention participation, we found significant reductions in: receiving drugs or money for sex (100% versus 71.0%, p<0.0005); the median number of sex trade partners per month (9 versus 3, p=0.02); daily drug use (76.0% vs. 55.0%, p=0.003); the amount of money spent on drugs daily (US$52.57 versus US$46.71, p = 0.01); and daily crack use (27.3% versus 13.1.0%, p = 0.014). In the presence of other variables in a multivariate linear model, income from the jewelry sale was associated with a reduction in the number of sex trade partners at follow-up. The pilot indicated effectiveness of a novel, HIV prevention, economic enhancement intervention upon HIV sexual risk behaviours and drug utilization patterns.

Psychological Correlates of Trading Sex for Money Among African American Crack Cocaine Smokers

This article compares demographic characteristics, sexual practices, and psychosocial status among 193 African American female crack cocaine users who currently, previously, or never traded sex for money. Current traders were less likely to have a main sexual partner, more likely to have a casual sexual partner, and more likely to smoke larger quantities of crack. There was a significant trend towards current traders reporting lower self-esteem, greater depression and anxiety, poorer decision-making confidence, more hostility, less social conformity, greater risk taking behaviors, and more problems growing up, compared to previous and never traders. These differences suggest that interventions should address self-esteem, risk-taking practices, depression and anxiety as well as other psychosocial factors.

The role of contact efficacy in evaluating sexual health promotion—evidence-based outreach work within a public sex environment

This paper explores the role of contact efficacy in evidence-based health promotion by evaluating a public sex environment (PSE) based sexual health outreach program. The service operated in situ from a dedicated mobile unit to promote sexual health among PSE users. A cross-sectional survey (response rate 56%) measured socio-demographics, sexual health behaviours and outreach-service use among men sampled within the PSE (n = 216). Most participants were aware of the service and two-thirds had contacted them. Men who had not completed hepatitis A vaccination (odds ratio (OR) = 2.02), who had ever received money for sex (OR = 2.07) or who reported a diagnosed mental health disorder(s) (OR = 2.38) were significantly more likely to have contacted the service. Although 89% of service users perceived the intervention positively, only 26% felt it had contributed to sexual behaviour changes. The 'mobile-unit' outreach model contacted a large proportion of PSE users, specifically men who had greater health needs. We advocate the adoption of this outreach model over traditional PSE-based outreach approaches. Contact efficacy evaluation is useful to assess ongoing health interventions. However, caution must be exerted when interpreting certain contact efficacy results. Since causality may not always be inferred, triangulation with other evaluative methodologies is recommended.

HIV-Related Risk Factors Associated with Commercial Sex Among Female Migrants in China

Data from 633 sexually experienced female migrants were analyzed to examine the sociodemographic and psychosocial factors and human immunodeficiency virus (HIV)-related behaviors associated with involvement in commercial sex. Six percent (40/633) of the participants reported having had sex for money. Compared with women who had not engaged in commercial sex, women who had sold sex were younger, less educated, and more likely to be unmarried. They were more likely to have engaged in HIV-related risk behaviors, such as becoming intoxicated with alcohol and using drugs. Among women who engaged in commercial sex, only 28% of them consistently used condoms during the last three episodes of sexual intercourse. Women who had ever engaged in commercial sex demonstrated greater depressive symptoms than those without such a history (p < .01). Female migrants, especially those engaging in commercial sex, were vulnerable to HIV/sexually transmitted diseases (STDs). Sexual risk reduction and condom promotion are urgently needed among this population. Further studies are needed to examine the causal relationship between depression and HIV risk behaviors.

Sexual exposure to blood and behavioural risks among STI clinic patients in Cape Town, South Africa

Exposure to blood during sexual intercourse is potentially important and yet understudied in HIV transmission. The study included 415 men and 127 women receiving diagnostic and treatment services at a sexually transmitted infections (STI) clinic in Cape Town, South Africa, who completed anonymous sexual health behaviour surveys. More than 30% of both men and women reported engaging in sexual intercourse involving genital bleeding in the previous 3 months. Individuals who had engaged in sexual intercourse involving blood had significantly greater numbers of sex partners in the previous 3 months (OR = 1.6, 95%, CI = 1.1-2.3), engaged in higher rates of unprotected vaginal intercourse (OR = 1.2, 95%, CI = 1.1-1.2), were significantly more likely to have exchanged sex for money or materials (OR = 3.1, 95%, CI = 1.7-5.5) and were significantly more likely to have experienced condom breaks during intercourse (OR = 1.7, 95%, CI = 1.2-2.4). These findings suggest that exposure to blood during vaginal intercourse is prevalent among STI clinic patients in Cape Town and may be an important contributing factor to the rapid spread of HIV in South Africa.