Prevalence and Factors Associated with Sex Trading Among Drug-Involved Women Under Community Supervision in New York City

Background and Purpose: Community supervision programs, including probation, parole, and alternative to incarceration programs such as drug treatment, now represent the largest segment of the criminal justice system in the U.S. Rates of female incarceration are rising and ethnic minority women are over-represented. Additionally, HIV infection among criminal justice-involved women is disproportionately high, particularly among ethnic minority women, who, in addition to being over-represented in criminal justice settings, are 3-7 times more likely to be diagnosed with HIV than white women. HIV transmission and acquisition among incarcerated populations is driven by substance use and sexual risk behaviors such as sex trading for money, drugs, or other resources. Social and economic vulnerability also increases HIV risk among this population. Limited research has examined sex trading among drug-involved women in community supervision. This is critical because women in community supervision programs face additional barriers to accessing services and resources; understanding the factors associated with sex trading may offer insight into the unique prevention and intervention needs of this growing population. This paper seeks to examine the prevalence of and micro-, mezzo-, and macro-level factors associated with sex trading among a sample of drug-involved women under community supervision.

Methods: 337 drug-involved women were enrolled into an HIV risk reduction study in NYC. Data reported here are from the baseline survey. Participants were asked a range of questions pertaining to socio-demographic characteristics, recent (past 90-days) sex trading, alcohol and drug use, mental health, and exposure to IPV. Descriptive statistics were used to examine the prevalence of sex trading, after which bivariate and multivariate logistic regression analyses were used to examine the associations between sex trading and micro, mezzo, and macro-level risks such as housing, drug and alcohol use, and mental health.

Results: Nearly half (40.7%) of the sample reported trading sex for money, food, drugs, or other resources in the prior 90 days. Multivariate analyses indicated that age (OR=1.03, p<.05), being married (OR=0.42, p<.05), ethnic minority status (OR=2.46, p<.05), prior mental health hospitalization (OR=1.74, p<.05), binge drinking (OR=1.80, p<.05), and reporting jail or prison time in the past six months (OR=1.69, p<.05) were significantly associated with sex trading. Homelessness in the past 90 days was marginally significant (OR=2.398, p<0.05). Among women with a main partner, women who reported recent drug use only her partner and not herself, were more likely to report sex trading than women who reported that neither they nor their partner recently used drugs (OR=7.67, p<.05, respectively).

Conclusions and Implications: Findings suggest a high prevalence of sex trading among women in community supervision, and point to a need for multi-pronged intervention efforts that simultaneously address sexual and drug-risk behaviors while improving access to mental health and other services, and other resources. Findings also suggest that community supervision programs may be uniquely positioned to engage women in HIV testing, prevention and treatment, and linkage to other services, if they are able to safely disclose engagement in risk behaviors such as sex trading and substance use without recourse (e.g. re-arrest).