Research That Matters (January 17 - 20, 2008)

Background and Purpose: Research has found significant associations between sex trading and human immunodeficiency virus (HIV) infection and HIV-risk behaviors among different at-risk populations. Sex work has been found to be an activity that puts both the workers and their customers at risk for sexually transmitted infections (STI). Opiate-dependent individuals who engage in trading sex for money or drugs are at elevated risks for HIV transmission due to the risks associated with both sex trading and injection drug use. Research has also shown that a history of childhood sexual abuse (CSA) predicts behaviors associated with high risks for HIV/STIs including multiple partners, unprotected sex and sex trading. However, research on CSA and sex trading among heterosexually-identified males has been minimal. This study examines the relationship between CSA and sex trading among a random sample of heterosexually-identified men in methadone maintenance treatment programs (MMTP). Method: A total of 1,300 men enrolled in methadone treatment programs in the greater New York City area were randomly selected. Of the 1,300 individuals, 790 agreed to participate and completed a screening interview. A total of 356 met eligibility criteria and proceeded to complete a 90-minute structured interview that measured HIV risk behaviors (such as history of STIs and sex trading), substance abuse, history of childhood abuse and sociodemographic characteristics. Multivariate logistic regression analysis was used to examine the associations between the dependent variable (lifetime sex trading) and the independent variable (CSA) and other HIV-related factors of interest such as drug and sexual behaviors. Results: Most participants self-identified as African American (38%) or Latino (45%). The mean age was 44 years old (SD=8.5), and the average level of education was 11.6 years (SD=2.3). About one half of the sample was unemployed and almost three-quarters had been incarcerated. The prevalence estimate of sex trading was 54%. The prevalence estimate of CSA was 38%. Among those who reported CSA, 71% also reported ever trading sex. In multivariate logistic regression analyses, factors independently associated with lifetime sex trading included CSA (AOR = 3.4; 95% CI = 1.6 - 7.0), history of imprisonment (AOR = 3.0; 95% CI = 1.2 – 7.4), having ever shared needles (AOR = 2.1; 95% CI = 1.01 – 4.5) and having ever visited a shooting gallery (AOR = 2.7; 95% CI = 1.1 – 6.3). Conclusions and Implications: A significant number of men in MMTPs reported a history of trading sex for money or drugs. A large proportion of these men also reported sexual abuse in their childhood. This study highlights the compelling need for HIV prevention that targets populations with a history of both CSA and sex trading. The study suggests that CSA is a highly prevalent public health problem among men in substance abuse treatment, and that these experiences are associated with HIV-risk drug and sexual behaviors. Therefore, HIV prevention interventions need to incorporate techniques aimed at preventing and/or coping with the effects of CSA, in addition to intervention programs aimed at the prevention of CSA and sex trading.