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Patterns of Exchange Sex and HIV Infection in High-Risk Heterosexual Men and Women

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Abstract

Heterosexual partnerships involving the trade of money or goods for sex are a well-described HIV risk factor in Africa and Southeast Asia, but less research has been conducted on exchange partnerships and their impact on HIV infection in the United States. In our study, men and women were recruited from high-risk risk neighborhoods in New York City through respondent-driven sampling in 2006–2007. We examined the factors associated with having an exchange partner in the past year, the relationship between exchange partnerships and HIV infection, and the risk characteristics of those with exchange partners by the directionality of payment. Overall, 28% of men and 41% of women had a past-year exchange partner. For men, factors independently associated with exchange partnerships were older age, more total sexual partners, male partners, and frequent non-injection drug use. For women, factors were homelessness, more total sexual partners, more unprotected sex partners, and frequent non-injection drug use. Exchange partnerships were associated with HIV infection for both men and women, although the relationships were substantially confounded by other behavioral risks. Those who both bought and sold sex exhibited the highest levels of risk with their exchange and non-exchange partners. Exchange partnerships may be an HIV risk both directly and indirectly, given the overlap of this phenomenon with other risk factors that occur with both exchange and non-exchange partners.

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Acknowledgments

The authors would like to acknowledge Elizabeth DiNenno, Amy Drake, Amy Lansky, and Isa Miles of the Centers for Disease Control and Prevention for their contributions to the NHBS study design; Blayne Cutler, James Hadler, and Colin Shepard for reviewing earlier drafts of this paper; and all the efforts of the NYC NHBS field staff. This work was funded by a cooperative agreement between the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention (grant no. U62/CCU223595-03-1).

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Authors and Affiliations

  1. New York City Department of Health and Mental Hygiene, HIV Epidemiology Program, 346 Broadway, Suite 707D, New York, NY, 10013, USA

    Samuel M. Jenness, Paul Kobrak, Alan Neaigus & Christopher S. Murrill

  2. National Development and Research Institutes, Inc., New York, NY, USA

    Travis Wendel

  3. New York University College of Nursing, New York, NY, USA

    Holly Hagan

Authors
  1. Samuel M. Jenness
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  2. Paul Kobrak
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  3. Travis Wendel
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  4. Alan Neaigus
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  5. Christopher S. Murrill
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  6. Holly Hagan
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Correspondence to Samuel M. Jenness.

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Jenness, S.M., Kobrak, P., Wendel, T. et al. Patterns of Exchange Sex and HIV Infection in High-Risk Heterosexual Men and Women. J Urban Health 88, 329–341 (2011). https://doi.org/10.1007/s11524-010-9534-5

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