Length of Homelessness As a Predictor of Sex Exchange

Background and Purpose: Approximately 580,000 individuals are homeless on any given night. The majority of social work interventions are designed without the stage of homelessness in mind, resulting in little knowledge concerning whether those newly homeless may have unique experiences that warrant tailored interventions to improve overall health and well being. Individuals who are homeless often have co-occurring substance use and mental health problems, along with a severe lack of treatment-related resources. Furthermore, substance use and mental health problems in homeless individuals may lead to high-risk behaviors such as exchanging sex for drugs or money. However, little research has examined additional characteristics of sex exchange among homeless populations, including whether sex exchange is associated with length of homelessness. The purpose of this study was to examine whether the likelihood of exchanging sex for drugs or money is significantly associated with time spent homeless when controlling for known variables associated with sex exchange.

Methods: Data are from the Homeless and Transient Population Study, which sampled homeless individuals from the metropolitan Washington D.C. area, conducted in 1991 (n=776). Participants were asked, “in the past 12 months, have you ever been paid or been given drugs for having sex with someone?” Participants also reported their age, gender, education, employment status, as well as past month drug use, past month symptoms of depression, age first time homeless, and stage of homelessness (Newly Homeless - homeless for less than 6 months, first time homeless; Intermittently Homeless- homeless for less than 6 months, but previously homeless; Long-term Homeless- homeless for the first time, length greater than 6 months; and Long-term Intermittently Homeless- homeless for longer than 6 months and previously homeless). A logistic regression examined whether stage of homelessness or age first time homeless was associated with sex exchange.

Results: Among respondents, 13.5% had exchanged sex for drugs or money in the past year. Sex exchange was significantly associated with gender, past month drug use, past month symptoms of depression, stage of homeless, and age of first homelessness. The logistic regression model predicting sex exchange showed that both past-month drug use (OR= 4.08) and past-month depression (OR= 2.24) were significant predictors of sex exchange. Finally, stage of homelessness was significantly associated with sex exchange, with newly homeless individuals having significantly higher odds of engaging in sex exchange than long-term homeless (OR=2.96), short-term intermittently homeless (OR=2.45), and long-term intermittently homeless individuals (OR=2.86).

Conclusions and Implications: Results indicate a need for increased attention towards interventions targeted at early stages of homelessness in order to prevent engagement in high-risk behaviors. Although prior research has found that individuals who have longer episodes of homelessness face increased difficulty in physical health issues and seeking services, the increased risks that newly homeless individual’s face has been largely ignored. These results also further highlight the need for expedited interventions, such as Housing First, which can reduce the risks of drug abuse and mental illness while individuals are still at an early stage of homelessness.