Sexuality Research and Social Policy

, Volume 16, Issue 3, pp 255–267 | Cite as

Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based U.S. Sample of Men Who Have Sex with Men

  • Keosha T. Bond
  • Irene S. Yoon
  • Steven T. Houang
  • Martin J. DowningJr
  • Christian Grov
  • Sabina HirshfieldEmail author


Demographic, behavioral, and structural factors among four mutually exclusive transactional sex categories were assessed in an online sample of 7217 sexually active US men who have sex with men (MSM): (1) No Trade Sex group (87%); (2) Sellers, accepting money or drugs for sex (5%); (3) Buyers, giving money or drugs for sex (6%); and (4) Sellers and Buyers, accepting and giving money or drugs for sex (2%). Separate multivariable logistic regressions compared men who did not report past 60-day transactional sex with men in the three transactional sex groups. Sellers were more likely to report being black or Asian (versus white), low income, a recent STI diagnosis, six or more recent male anal sex partners, and polydrug use. Buyers were more likely to report being older, higher income, urban residence, incarceration history, a recent STI diagnosis, and having non-main sex partners. Sellers and Buyers were more likely to report a higher income, incarceration history, six or more recent male anal sex partners, and polydrug use. Findings suggest that public health policy and HIV prevention harm reduction strategies should address the distinct sexual and behavioral risk patterns among MSM who engage in transactional sex based on payment direction.


Sex work Gay/bisexual men Drug abuse HIV/AIDS 



Primary support was provided by the Centers for Disease Control and Prevention (UR6 PS000415), where technical assistance was provided through a federal cooperative agreement in the design and conduct of the study. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The first author was supported as a postdoctoral fellow in the Behavioral Sciences Training in Drug Abuse Research program sponsored by National Development and Research Institutes, Inc. and New York University Rory Meyers College of Nursing with funding from the National Institute on Drug Abuse (T32 DA007233); the first author is also a Research Education Institute for Diverse Scholar recipient (REIDS) (R25MH087217).


This study was funded by the Centers for Disease Control and Prevention (UR6 PS000415), where technical assistance was provided through a federal cooperative agreement in the design and conduct of the study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Public HealthNew York Medical CollegeValhallaUSA
  2. 2.L2 Gartner, Research and Strategy TeamNew YorkUSA
  3. 3.Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of PsychologyCUNY Lehman CollegeNew YorkUSA
  5. 5.Department of Community Health and Social SciencesCUNY Graduate School of Public Health and Health PolicyNew YorkUSA
  6. 6.CUNY Institute for Implementation Science in Population HealthNew YorkUSA
  7. 7.Department of Medicine, SUNY Downstate Medical CenterBrooklynUSA

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