Exchanging Sex for Food: Exploring Factors Affecting Young Transgender Adults' Involvement in Sexual Exploitation Due to Food Insecurity

Background and Purpose. Food insecurity, defined as inadequate access to a sufficient quantity of food due to lack of money and other resources, affects LGBT adults at higher rates than non-LGBT adults. Food insecurity has been associated with adverse health outcomes, including mental distress and increased HIV transmission risk. Research has identified exchanging food for sex, a form of sexual exploitation, as means to obtain food. Young transgender adults might be at a higher risk for exchanging food for sex as alternative options, such as seeking food assistance or having a stable job, might be difficult due to discrimination and transphobia. However, there is almost no empirical evidence on risk and protective factors affecting exchanging sex for food among young transgender adults. We conducted this study to explore factors that elevate the risk of exchanging sex for food in young transgender adults in the U.S.

Methods. We analyzed data from a sample of young transgender adults (18–35 years old, N = 20,250) who participated in the 2015 U.S. Transgender Survey (USTS). USTS is the largest survey examining the lives and experiences of transgender people in the United States, with respondents from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and overseas U.S. military bases. Participants were asked if they had engaged in sex or sexual activity for food. Further, participants were asked if they had engaged in sex for food within the past year or more than a year ago. We examined the association of sex for food with demographic, economic, and social characteristics. Two separate multivariable models based on when participants exchanged sex for food were analyzed using firth logistic regression for rare events.

Results. Five percent (n = 1,014) of USTS participants reported engaging in sex for food. Among those who engaged in sex for food, 75% percent did it more than a year ago (n = 756) and 25% exchanged sex for food within the past year (n = 258). Participating in the Supplemental Nutrition Assistance Program, having a disability, being a young transgender person of color, being rejected by any family member, having unsupportive family members, living as a woman on a day-to-day basis, and experiencing homelessness within the past year were significantly associated with a higher likelihood of exchanging sex for food, regardless of time. Living with parents or family that they grew up with was significantly associated with a lower likelihood of sex for food, regardless of time, compared to renters.

Conclusions and Implications. Our study identified risk factors that elevate the likelihood of engaging in sex for food among young transgender adults. These factors underscore various types of rejection and discrimination faced by young transgender adults. In turn, these factors may erode the social support and safety net of young transgender adults, preventing them from accessing and affording adequate food. Although short-term food assistance may reduce risk, our findings suggest solutions addressing social and economic discrimination might effectively tackle food insecurity and sexual exploitation in young transgender adults