Behavioral Surveillance of Heterosexual Exchange-Sex Partnerships in San Francisco: Context, Predictors and Implications

San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102-6033, USA.
AIDS and Behavior (Impact Factor: 3.49). 03/2010; 15(1):236-42. DOI: 10.1007/s10461-010-9677-0
Source: PubMed


Using San Francisco local data from the 2006 National HIV Behavioral Surveillance (NHBS), we initiated a study of male and female heterosexuals' involvement in exchange sex (money or goods for sex). We examined risk factors for engaging in exchange sex and the prevalence of risk behaviors amongst exchange and non-exchange partnerships. Overall, 13.2% of women and 7.6% of men engaged in exchange sex in the past 6 months; 130 of 1,230 (10.6%) opposite-sex partnerships involved exchange. Women of low socioeconomic status and those who inject drugs were more likely to engage in exchange sex. Men involved in exchange sex were no different from those who did not by age, socio-economic status, marital status, drug use, or history of incarceration or sexually transmitted diseases. Within exchange partnerships, high or drunk sex was more common than unprotected sex. Exchange partnerships had fewer instances of risky sex. In comparison to exchange partnerships, non-exchange partnerships had four times as many episodes of unprotected vaginal sex and twice as many episodes of high or drunk vaginal sex. Prevention efforts addressing exchange sex need to address substance use. Future research and surveillance are needed to better understand the sources of HIV risk and measure and track trends in risk within sexual dyads and networks.

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    ABSTRACT: Drug markets in disadvantaged African American neighborhoods have altered social and sexual norms as well as sexual networks, which impact an individual’s risk of contracting a sexually transmitted infection. Presently, we describe the prevalence of sexual partnerships with males involved with illegal drugs among a sample of non-drug-dependent females. In 2010, 120 Black females aged 18 to 30 years completed a semistructured HIV-risk interview. Descriptive statistics revealed approximately 80% of females perceived neighborhood drug activity as a major problem, 58% had sex with a male drug dealer, 48% reported sex with a male incarcerated for selling drugs, and 56% believed drug dealers have the most sexual partners. Our results suggest sexual partnerships with males involved in the distribution of drugs are prevalent. These partnerships may play a substantial role in the spread of sexually transmitted infections among low-risk females, as drug dealers likely serve as a bridge between higher HIV-risk drug and prison populations and lower HIV-risk females. However, the significance of partnerships with males involved in drug dealing has received little attention in HIV and drug abuse literature. Presently, there is a need for more research focused on understanding the extent to which the drug epidemic affects the HIV risk of non-drug-dependent Black female residents of neighborhoods inundated with drugs. Special consideration should be given to the role of the neighborhood drug dealer in the spread of sexually transmitted infections.
    Journal of drug issues 04/2013; 43(2):154-163. DOI:10.1177/0022042612467009 · 0.38 Impact Factor

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