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Exchange Sex Among Persons Who Inject Drugs in the New York Metropolitan Area: The Importance of Local Context, Gender and Sexual Identity

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Abstract

Exchanging sex for money or drugs is known to increase risk for HIV among persons who inject drugs (PWID). To better understand determinants of exchange sex among PWID we examined factors associated with exchange sex in the New York metropolitan area—defined as New York City (NYC), NY; Newark, NJ; and Long Island, NY—using data from the 2012 National HIV Behavioral Surveillance system cycle on injection drug use. Of the 1160 PWID in this analysis, 24% reported exchange sex, with differences in gender and sexual identity by location. In multivariable analysis gay/bisexual men, heterosexual women, and lesbian, gay, or bisexual (LGB) women were more likely to exchange sex compared to heterosexual men. Exchange sex was also associated with race/ethnicity, homelessness, incarceration, location, and non-injection crack and cocaine use. We find that heterosexual women and LGB women who injected drugs residing in Newark were more likely to report exchange sex compared to NYC. This study highlights how local conditions impact exchange sex.

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Acknowledgements

The authors would like to acknowledge and thank the following people: Michael Schwartz, Kathleen Fallon, Micheal Kimmel of Stony Brook University; Sam Friedman of National Development and Research Institutes; Lina Nerlander, Wade Ivy of the CDC who reviewed earlier drafts of the article. We would like to thank reviewers from New York City Department of Health and Mental Hygiene, New York State Department of Health, and New Jersey Department of Health. Also, we would like to acknowledge and thank: Lina Nerlander, Wade Ivy, Dita Broz, and Gabriela Paz-Bailey of the CDC, who contributed to the NHBS study design locally and nationally and provided guidance for the implementation of the study in NYC, NJ, and Long Island. The study would not have been possible without the efforts of the local NHBS field staff and the study participants who consented to be in the study.

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Authors and Affiliations

  1. Department of Sociology, State University of New York at Stony Brook, 152-11 Union Turnpike Apt 3A, Flushing, Stony Brook, NY, 11367, USA

    Suzan M. Walters

  2. New York State Department of Health, Office of Public Health, Albany, NY, USA

    Bridget J. Anderson

  3. Division of HIV, STD and TB Services, New Jersey Department of Health, Trenton, NJ, USA

    Barbara Bolden & Afework Wogayehu

  4. New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA

    Alexis V. Rivera, Kathleen H. Reilly & Sarah Braunstein

  5. Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA

    Alan Neaigus

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Correspondence to Suzan M. Walters.

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Suzan Walters declares that there are no conflicts of interest. Alexis Rivera declares that there are no conflicts of interest. Bridget Anderson declares that there are no conflicts of interest. Barbara Bolden declares that there are no conflicts of interest. Afework Wogayehu declares that there are no conflicts of interest. Alan Neaigus declares that there are no conflicts of interest. Sarah Braunstein declares that there are no conflicts of interest. This work was made possible through the support of the Centers for disease Control and Prevention PS11-001 National HIV Behavioral Surveillance (NHBS) system. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants.

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Walters, S.M., Rivera, A.V., Reilly, K.H. et al. Exchange Sex Among Persons Who Inject Drugs in the New York Metropolitan Area: The Importance of Local Context, Gender and Sexual Identity. AIDS Behav 22, 2773–2787 (2018). https://doi.org/10.1007/s10461-018-2039-z

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