Correlates Of Sex Trading Among Women In Intimate Relationships: A Risk Profile

Background: Despite the steadying of new HIV infections globally, marked increases and concentrated epidemics continue among subsets of the population including women engaged in sex trading. To date, studies examining the prevalence and correlates of sex trading and HIV vulnerability have mostly targeted women not in long-term, intimate relationships. This abstract focuses on women in long-term relationships with a male sex partner, who report sex trading for money, shelter, food, or drugs, a population that has not extensively been studied in HIV research. Understanding the relationship between sex trading among women in long-term relationships and individual, interpersonal, and structural level factors provides new data and insight about correlates of sex trading and implications for prevention. Our aims were to (1) examine the prevalence of sex trading among 346 low-income, drug-using HIV-negative women in relationships; and (2) investigate the association between sex trading and individual (incarceration, substance use, and mental health), interpersonal- (sexual behaviors, childhood sexual abuse, social support, and intimate partner violence), and structural factors (education, employment, and housing). 

Methods: We used baseline data collected from an HIV prevention randomized control trial (Project Connect Two), conducted in New York City with low-income, drug-using HIV-negative concordant couples. Data reported here is from the female partners (n=346). Couples were recruited via street outreach, homeless shelters, soup kitchens, word-of-mouth, and syringe exchange programs. We assessed for sex trading, mental health, partner violence, childhood sexual abuse, perceived social support, drug and alcohol use, sexual behaviors, incarceration, income, education, employment, and basic socio-demographics. We performed bivariate chi-square and t-tests and further analysis using modified Poisson regressions.

Results: 28% of the participants reported sex trading during the prior 90 days. Adjusting for age, ethnicity, education, marital status, housing and employment, modified Poisson Regression analyses revealed significant associations between physical/sexual intimate partner violence (1.65, p<0.05), prior mental health hospitalization (1.71, p<0.01), psychological distress (1.51, p<0.01), incarceration (1.58, p<0.05), drug use (crack, marijuana, and crystal meth, cumulative use, p<0.05), and unprotected vaginal and anal sex with non-main partners (p<0.05) and engagement in sex trading. Women who traded sex were also more likely to report childhood sexual abuse, unemployment, homelessness, and lower income, though these effects were not significant at the 0.05 alpha levels. 

Conclusions: Key findings from this analysis indicate that women in intimate relationships who trade sex share many of the same risks and vulnerabilities as women who trade sex that are not in long-term intimate relationships. The findings underscore that HIV prevention for women in long-term relationships who trade sex for money needs to consider multiple risk factors Moreover, a couples-based approach may serve as an important HIV strategy to improve communication and safety in relationships and  reduce sexual risk behaviors among women and their long-term sex partners.