AIDS and Behavior

, Volume 21, Issue 8, pp 2283–2294 | Cite as

Exchange Sex and HIV Infection Among Men Who Have Sex with Men: 20 US Cities, 2011

  • Lina M. Nerlander
  • Kristen L. Hess
  • Catlainn Sionean
  • Charles E. Rose
  • Anna Thorson
  • Dita Broz
  • Gabriela Paz-Bailey
Behavioral Surveillance


This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive–unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive–unaware. In multivariable analysis, exchange sex was associated with being HIV-positive–unaware (aPR 1.34, 95 % CI 1.05–1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.


MSM Exchange sex Sex work Prostitution HIV Undiagnosed HIV 


  1. 1.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2014. 2015.Google Scholar
  2. 2.
    Wejnert C, Le B, Rose CE, Oster AM, Smith AJ, Zhu J, et al. HIV infection and awareness among men who have sex with men-20 cities, United States, 2008 and 2011. PLoS One. 2013;8(10):e76878.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JM. HIV due to female sex work: regional and global estimates. PLoS One. 2013;8(5):e63476.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Baral SD, Friedman MR, Geibel S, Rebe K, Bozhinov B, Diouf D, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet. 2014;385:260–73.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rietmeijer CA, Wolitski RJ, Fishbein M, Corby NH, Cohn DL. Sex hustling, injection drug use, and non-gay identification by men who have sex with men. Associations with high-risk sexual behaviors and condom use. Sex Transm Dis. 1998;25(7):353–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Weber AE, Craib KJ, Chan K, Martindale S, Miller ML, Schechter MT, et al. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. Int J Epidemiol. 2001;30(6):1449–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Mimiaga MJ, Reisner SL, Tinsley JP, Mayer KH, Safren SA. Street workers and internet escorts: contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. J Urban Health. 2009;86(1):54–66.CrossRefPubMedGoogle Scholar
  8. 8.
    Mor Z, Shohat T, Goor Y, Dan M. Risk behaviors and sexually transmitted diseases in gay and heterosexual men attending an STD clinic in Tel Aviv, Israel: a cross-sectional study. Isr Med Assoc J. 2012;14(3):147–51.PubMedGoogle Scholar
  9. 9.
    Ward H, Ronn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):305–10.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Estcourt CS, Marks C, Rohrsheim R, Johnson AM, Donovan B, Mindel A. HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney. Sex Transm Infect. 2000;76(4):294–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Newman PA, Rhodes F, Weiss RE. Correlates of sex trading among drug-using men who have sex with men. Am J Public Health. 2004;94(11):1998–2003.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.CrossRefPubMedGoogle Scholar
  13. 13.
    Melendez-Torres G, Bourne A. Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers? Curr Opin Infect Dis. 2016;29(1):58–63.CrossRefPubMedGoogle Scholar
  14. 14.
    Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med. 2007;147(2):89–96.CrossRefPubMedGoogle Scholar
  15. 15.
    Buot ML, Docena JP, Ratemo BK, Bittner MJ, Burlew JT, Nuritdinov AR, et al. Beyond race and place: distal sociological determinants of HIV disparities. PLoS One. 2014;9(4):e91711.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Robertson MJ, Clark RA, Charlebois ED, Tulsky J, Long HL, Bangsberg DR, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–17.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Myers T, Allman D, Xu K, Remis RS, Aguinaldo J, Burchell A, et al. The prevalence and correlates of hepatitis C virus (HCV) infection and HCV-HIV co-infection in a community sample of gay and bisexual men. Int J Infect Dis. 2009;13(6):730–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Bacon O, Lum P, Hahn J, Evans J, Davidson P, Moss A, et al. Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco. Sex Transm Dis. 2006;33(4):228–34.CrossRefPubMedGoogle Scholar
  19. 19.
    Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles. J Urban Health. 2009;86(Suppl 1):63–76.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Koken JA, Parsons JT, Severino J, Bimbi DS. Exploring commercial sex encounters in an urban community sample of gay and bisexual men: a preliminary report. J Psychol Human Sex. 2005;17(1–2):197–213.CrossRefGoogle Scholar
  21. 21.
    Elifson KW, Boles J, Sweat M. Risk factors associated with HIV infection among male prostitutes. Am J Public Health. 1993;83(1):79–83.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Boily M-C, Shubber Z. Modelling in concentrated epidemics: informing epidemic trajectories and assessing prevention approaches. Curr Opin HIV AIDS. 2014;9(2):134–49.CrossRefPubMedGoogle Scholar
  24. 24.
    Boily M, Lowndes C, Alary M. The impact of HIV epidemic phases on the effectiveness of core group interventions: insights from mathematical models. Sex Transm Infect. 2002;78(Suppl 1):i78–90.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Vickerman P, Foss AM, Pickles M, Deering K, Verma S, Demers E, et al. To what extent is the HIV epidemic in southern India driven by commercial sex? A Model Anal AIDS. 2010;24(16):2563–72.Google Scholar
  26. 26.
    Boily M-C, Pickles M, Alary M, Baral S, Blanchard J, Moses S, et al. What really is a concentrated HIV epidemic and what does it mean for West and Central Africa? Insights from mathematical modeling. J Acquir Immun Defic Syndr. 2015;68:S74–82.CrossRefGoogle Scholar
  27. 27.
    Kato M, Granich R, Bui DD, Tran HV, Nadol P, Jacka D, et al. The potential impact of expanding antiretroviral therapy and combination prevention in Vietnam: towards elimination of HIV transmission. J Acquir Immun Defic Syndr. 2013;63(5):e142–9.CrossRefGoogle Scholar
  28. 28.
    Gomez GB, Borquez A, Caceres CF, Segura ER, Grant RM, Garnett GP, et al. The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study. PLoS Med. 2012;9(10):e1001323.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the US: The National HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):32–8.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men—a national application of venue-based, time-space sampling. Public Health Rep. 2007;122(Suppl 1):39–47.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Finlayson TJ, Le B, Smith A, Bowles K, Cribbin M, Miles I, et al. HIV risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance System, 21 US cities, United States, 2008. Surveill Summ. 2011;60(14):1–34.Google Scholar
  32. 32.
    CDC. Notice to readers: protocols for confirmation of reactive rapid HIV tests. Morb Mortal Wkly Rep. 2004;53(10):221–2.Google Scholar
  33. 33.
    CDC. Update: HIV counseling and testing using rapid tests–United States, 1995. Morb Mortal Wkly Rep. 1998;47(11):211–5.Google Scholar
  34. 34.
    CDC. Interpretation and use of the western blot assay for serodiagnosis of human immunodeficiency virus type 1 infections. Morb Mortal Wkly Rep. 1989;38(Suppl 7):1–7.Google Scholar
  35. 35.
    Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr. 2010;53(4):537–43.CrossRefPubMedGoogle Scholar
  37. 37.
    Jin F, Prestage GP, Imrie J, Kippax SC, Donovan B, Templeton DJ, et al. Anal sexually transmitted infections and risk of HIV infection in homosexual men. J Acquir Immune Defic Syndr. 2010;53(1):144–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, et al. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immun Defic Syndr. 2009;51(3):349–55.CrossRefGoogle Scholar
  39. 39.
    Workowski KA, Berman SM, Control CfD, Prevention. Sexually transmitted diseases treatment guidelines, 2010: department of Health and Human Services, Centers for Disease Control and Prevention; 2010.Google Scholar
  40. 40.
    Parsons JT, Koken JA, Bimbi DS. The use of the Internet by gay and bisexual male escorts: sex workers as sex educators. AIDS Care. 2004;16(8):1021–35.CrossRefPubMedGoogle Scholar
  41. 41.
    Mosbergen D. The internet’s most desired gay male escorts tell all. Huffpost Gay Voices. 2014.Google Scholar
  42. 42.
    Döring NM. The Internet’s impact on sexuality: a critical review of 15 years of research. Comput Human Behav. 2009;25(5):1089–101.CrossRefGoogle Scholar
  43. 43.
    Sullivan PS, Carballo-Dieguez A, Coates T, Goodreau SM, McGowan I, Sanders EJ, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012;380(9839):388–99.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    US Public Health Service. Prexposure prophylaxis for the prevention of HIV infection in the United States-2014. A clinical practice guideline-2014.Google Scholar
  45. 45.
    Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13:482.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Amaral MLS, Abdo CH, Tavares H. Scanavino MdT. Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil. J Sex Med. 2015;12(2):557–66.CrossRefPubMedGoogle Scholar
  47. 47.
    Gullette D, Booth BM, Wright PB, Montgomery BE, Stewart KE. Sexual sensation seeking, transactional sex, and rural African American cocaine users. J Assoc Nurses AIDS Care. 2014;25(4):289–96.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2016

Authors and Affiliations

  • Lina M. Nerlander
    • 1
    • 2
  • Kristen L. Hess
    • 1
  • Catlainn Sionean
    • 1
  • Charles E. Rose
    • 1
  • Anna Thorson
    • 2
  • Dita Broz
    • 1
  • Gabriela Paz-Bailey
    • 1
  1. 1.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Department of Public Health SciencesKarolinska InstitutetStockholmSweden

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