Abstract
The goal of this research was to examine associations among sociodemographic factors, HIV risk, and community context (e.g., economic insecurity, job training, housing instability, crime victimization, and perceived community norms) in adolescents and young adults who ever exchanged sex for drugs or money. Anonymous survey data were collected using ACASIs at community venues where adolescents and young adults congregate in resource-challenged, STI prevalent, urban, US neighborhoods. Conventional descriptive statistics, Fisher’s exact tests, and generalized estimating equations approaches were used to examine associations. Participants (1818, 95.5 % of those screened eligible) were, on average, aged 21.0 years; 42.2 % were males, and 4.6 % were transgender. Almost one-third (32.1 %) identified as gay or lesbian, 18.1 % identified as bisexual; 66.2 % were Black and 21.0 % were Hispanic; 1.3 % was ‘living on the street’. A sizeable proportion reported HIV-related risk: 16.3 % exchanged sex, 12.6 % had sex with someone they knew to be HIV-infected, 7.8 % had sex with someone who injected drugs, and 1.3 % injected drugs. Multivariate comparisons identified a number of variables (e.g., being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, job training access, housing instability, crime victimization, perceived community norms) that were significantly associated with exchange of sex (p < 0.05). This research contributes to the knowledge-base regarding exchange of sex among adolescents and young adults, particularly as it relates to community context. Longitudinal studies to describe the trajectory of social, health, and physical risks and consequences are needed for development of effective evidence-based prevention strategies.
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Notes
The variable “ever injected drugs,” though significantly associated with exchange of sex in the bivariate analyses, was removed from the multivariate model due to small cell sizes leading to model instability. Likewise, the variable “primary source of money” was excluded due to the potential for collinearity introduced by the response option of a sexual partner providing money to the participant.
Several additional models were fit to the data to assess the sensitivity of the final model to the selected changes in the variables that were included in the model. The results of these models did not appreciably differ from the results presented in Table 3.
References
Centers for Disease Control and Prevention. (2015). STDs in adolescents and young adults: An overview of statistics and data collection methods based on the 2014 STD Surveillance Report. Retrieved from http://www.cdc.gov/std/stats14/adol.htm#foot1.
Centers for Disease Control and Prevention. (2015). Sexually transmitted infections among young Americans: Infographic. Retrieved from http://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm. Accessed May 24 2016.
Centers for Disease Control and Prevention. (2016). HIV among youth. Retrieved from http://www.cdc.gov/hiv/group/age/youth/index.html.
Centers for Disease Control and Prevention. (2016). Youth Risk Behavior Surveillance System (YRBSS) overview. Retrieved from http://www.cdc.gov/healthyyouth/data/yrbs/overview.htm.
University of North Carolina at Chapel Hill Carolina Population Center. (n. d.). The National Longitudinal Study of Adolescent to Adult Health (ADD Health). Retrieved from http://www.cpc.unc.edu/projects/addhealth.
Abma, J. C., Martinez, G. M., & Copen, C. E. (2010). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, national survey of family growth 2006–2008. Vital and Health Statistics, 23(30), 1–47.
Barnes, W., D’Angelo, L., Yamazaki, M., et al. (2010). Identification of HIV-infected 12- to 24-year-old men and women in 15 US cities through venue-based testing. Archives of Pediatrics and Adolescent Medicine, 164(3), 273–276.
Boyer, C. B., Hightow-Weidman, L., Bethel, J., et al. (2013). An assessment of the feasibility and acceptability of a friendship-based social network recruitment strategy to screen at-risk African American and Hispanic/Latina young women for HIV infection. JAMA Pediatrics, 167(3), 289–296.
Boyer, C. B., Robles-Schrader, G. M., Li, S. X., et al. (2014). A comparison of network-based strategies for screening at-risk Hispanic/Latino adolescents and young adults for undiagnosed asymptomatic HIV infection. Journal of Adolescent Health, 55(6), 765–773.
Ellen, J. M., Greenberg, L., Willard, N., Stines, S., Korelitz, J., & Boyer, C. B. (2015). Cross-sectional survey comparing HIV risk behaviours of adolescent and young adult men who have sex with men only and men who have sex with men and women in the U.S. and Puerto Rico. Sexually Transmitted Infections, 91(6), 458–461.
Edwards, J. M., Iritani, B. J., & Hallfors, D. D. (2006). Prevalence and correlates of exchanging sex for drugs or money among adolescents in the United States. Sexually Transmitted Infections, 82(5), 354–358.
Cubbin, C., Santelli, J., Brindis, C. D., & Braveman, P. (2005). Neighborhood context and sexual behaviors among adolescents: Findings from the national longitudinal study of adolescent health. Perspectives on Sexual and Reproductive Health, 37(3), 125–134.
Walls, N. E., & Bell, S. (2011). Correlates of engaging in survival sex among homeless youth and young adults. Journal of Sex Research, 48(5), 423–436.
Hein, L. C. (2011). Survival strategies of male homeless adolescents. Journal the American Psychiatric Nurses Association, 17(4), 274–282.
Kaestle, C. E. (2012). Selling and buying sex: A longitudinal study of risk and protective factors in adolescence. Prevention Science, 13(3), 314–322.
Woods-Jaeger, B. A., Sparks, A., Turner, K., Griffith, T., Jackson, M., & Lightfoot, A. F. (2013). Exploring the social and community context of African American adolescents’ HIV vulnerability. Qualitative Health Research, 23(11), 1541–1550.
Raiford, J. L., Herbst, J. H., Carry, M., Browne, F. A., Doherty, I., & Wechsberg, W. M. (2014). Low prospects and high risk: Structural determinants of health associated with sexual risk among young African American women residing in resource-poor communities in the south. American Journal of Community Psychology, 54(3–4), 243–250.
Reilly, K. H., Neaigus, A., Wendel, T., Marshall Iv, D. M., & Hagan, H. (2014). Correlates of selling sex among male injection drug users in New York City. Drug and Alcohol Dependence, 144, 78–86.
Patton, R. A., Cunningham, R. M., Blow, F. C., Zimmerman, M. A., Booth, B. M., & Walton, M. A. (2014). Transactional sex involvement: Exploring risk and promotive factors among substance-using youth in an urban emergency department. Journal of Studies on Alcohol and Drugs, 75(4), 573–579.
Marshall, B. D., Shannon, K., Kerr, T., Zhang, R., & Wood, E. (2010). Survival sex work and increased HIV risk among sexual minority street-involved youth. Journal of Acquired Immune Deficiency Syndromes, 53(5), 661–664.
Lavoie, F., Thibodeau, C., Gagne, M. H., & Hebert, M. (2010). Buying and selling sex in Quebec adolescents: A study of risk and protective factors. Archives of Sexual Behavior, 39(5), 1147–1160.
Silverman, J. G. (2011). Adolescent female sex workers: Invisibility, violence and HIV. Archives of Disease in Childhood, 96(5), 478–481.
Heerde, J. A., Scholes-Balog, K. E., & Hemphill, S. A. (2015). Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: A systematic literature review. Archives of Sexual Behavior, 44(1), 181–212.
Stein, J. A., Milburn, N. G., Zane, J. I., & Rotheram-Borus, M. J. (2009). Paternal and maternal influences on problem behaviors among homeless and runaway youth. American Journal of Orthopsychiatry, 79(1), 39–50.
Gwadz, M. V., Gostnell, K., Smolenski, C., et al. (2009). The initiation of homeless youth into the street economy. Journal of Adolescence, 32(2), 357–377.
McNeal, B. A., & Walker, J. T. (2015). Parental effects on the exchange of sex for drugs or money in adolescents. American Journal of Criminal Justice. doi:10.1007/s12103-015-9313-7.
Reid, J. A., & Piquero, A. R. (2014). Age-graded risks for commercial sexual exploitation of male and female youth. Journal of Interpersonal Violence, 29(9), 1747–1777.
Ziff, M. A., Harper, G. W., Chutuape, K. S., et al. (2006). Laying the foundation for Connect to Protect: A multi-site community mobilization intervention to reduce HIV/AIDS incidence and prevalence among urban youth. Journal of Urban Health, 83(3), 506–522.
Willard, N., Chutuape, K., Stines, S., & Ellen, J. M. (2012). Bridging the gap between individual-level risk for HIV and structural determinants: Using root cause analysis in strategic planning. Journal of Prevention & Intervention in the Community, 40(2), 103–117.
Miller, R. L., Reed, S. J., Francisco, V. T., & Ellen, J. M. (2012). Conflict transformation, stigma, and HIV-preventive structural change. American Journal of Community Psychology, 49(3–4), 378–392.
Chutuape, K. S., Ziff, M., Auerswald, C., Castillo, M., McFadden, A., & Ellen, J. (2009). Examining differences in types and location of recruitment venues for young males and females from urban neighborhoods: Findings from a multi-site HIV prevention study. Journal of Urban Health, 86(1), 31–42.
Geanuracos, C. G., Cunningham, S. D., Weiss, G., Forte, D., Reid, L. M., & Ellen, J. M. (2007). Use of geographic information systems for planning HIV prevention interventions for high-risk youths. American Journal of Public Health, 97(11), 1974–1981.
Reed, S. J., Miller, R. L., & Francisco, V. T. (2014). The influence of community context on how coalitions achieve HIV-preventive structural change. Health Education & Behavior, 41(1), 100–107.
Straub, D. M., Arrington-Sanders, R., Harris, D. R., et al. (2011). Correlates of HIV testing history among urban youth recruited through venue-based testing in 15 US cities. Sexually Transmitted Diseases, 38(8), 691–696.
SAS Institute Inc. (2016). SAS products and solutions. Retrieved January–May, 2016, from http://www.sas.com/software.
Centers for Disease Control and Prevention. HIV among transgender people. http://www.cdc.gov/hiv/group/gender/transgender/. Accessed June 17 2016.
Harper, G. W. (2007). Sex isn’t that simple: Culture and context in HIV prevention interventions for gay and bisexual male adolescents. American Psychologist, 62(8), 803–819.
Wolitski, R. J., Kidder, D. P., & Fenton, K. A. (2007). HIV, homelessness, and public health: Critical issues and a call for increased action. AIDS and Behavior, 11(6 Suppl), 167–171.
Centers for Disease Control and Prevention. (2014). HIV testing among adolescents. Retrieved from http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hivtesting_adolescents.pdf.
White House Office of National AIDS Policy. (n. d.). National HIV/AIDS strategy for the United States: Updated to 2020. Retrieved from https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/.
Acknowledgments
We acknowledge the contribution of the investigators and staff at the following Adolescent Medicine Trials Units (AMTUs) that participated in this research: Children’s Hospital of Los Angeles (Marvin Belzer, MD, Miguel Martinez, MSW/MPH, Julia Dudek, MPH, Milton Smith, BA); John H. Stroger Jr. Hospital of Cook County and the CORE Center (Lisa Henry-Reid, MD, Jaime Martinez, MD, Ciuinal Lewis, MS, Atara Young, MS, Jolietta Holliman, Antoinette McFadden, BA); Children’s Hospital National Medical Center (Lawrence D’Angelo, MD, William Barnes, PhD, Stephanie Stines, MPH, Jennifer Sinkfield, MPH) Montefiore Medical Center (Donna Futterman, MD, Bianca Lopez, MPH, Elizabeth Spurrell, MPH, LCSW, Rebecca Shore, MPH); Tulane University Health Sciences Center (Sue Ellen Abdalian, MD, Nadrine Hayden, BS; St. Jude Children’s Research Hospital (Patricia Flynn, MD, Aditya Guar, MD, Andrea Stubbs, MPH); University of Miami School of Medicine (Lawrence Friedman, MD, Kenia Sanchez, MSW); Children’s Hospital of Philadelphia (Steven Douglas, MD, Bret Rudy, MD, Marne Castillo, PhD, Alison Lin, MPH); University of South Florida (Patricia Emmanuel, MD, Diane Straub, MD, Amanda Schall, MA, Rachel Stewart-Campbell, BA; Cristian Chandler, MPH, Chris Walker, MSW); Baylor College of Medicine, Texas Children’s Hospital (Mary Paul, MD, Kimberly Lopez, DrPH; Wayne State University (Elizabeth Secord, MD, Angulique Outlaw, MD, Emily Brown, MPP); Johns Hopkins University, School of Medicine (Allison Agwu, MD, Renata Sanders, MD, Marines Terreforte, MPA); The Fenway Institute (Kenneth Mayer, MD, Liz Salomon, EdM, Benjamin Perkins, MA, M.Div.); and University of Colorado (Daniel Reirdan, MD, Jamie Sims, MSW, Moises Munoz, BA).
We appreciate the scientific review provided by members of the Community Prevention Leadership Group of the ATN. We are also grateful to the ATN Coordinating Center at the University of Alabama (Craig Wilson, MD; Cynthia Partlow, MEd, and Jeanne Merchant, MPH) who provided scientific and administrative oversight; the ATN Data and Operations Center at Westat, (James Korelitz, PhD, Barbara Driver, RN, Rick Mitchell MS, and Marie Alexander, BS) who provided operations and analytic support; and the National Coordinating Center at Johns Hopkins University, Department of Pediatrics (Jessica Roy, MSW, Rachel Stewart-Campbell, MA, MPH) who provided national-level oversight, technical assistance, and staff training. Additionally, we acknowledge Anthony Kung, BA and Rich Fallon, MA from the Division of Adolescent and Young Adult Medicine, University of California, San Francisco, who provided administrative assistance to Cherrie Boyer, PhD. We are indebted to our community partners for their assistance and guidance. Most of all, we thank the young people who gave of their time to participate in this research.
Funding
This research was funded by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health [U01 HD 040533 and U01 HD 040474] through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Bill Kapogiannis, MD), with supplemental funding from the National Institutes on Drug Abuse (Richard Jenkins, PhD) and Mental Health (Pim Brouwers, PhD, Susannah Allison, PhD).
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Boyer, C.B., Greenberg, L., Chutuape, K. et al. Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context. J Community Health 42, 90–100 (2017). https://doi.org/10.1007/s10900-016-0234-2
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DOI: https://doi.org/10.1007/s10900-016-0234-2