Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Differences in HIV Risk Behaviors Among Women Who Exchange Sex for Drugs, Money, or Both Drugs and Money

  • 110 Accesses

  • 28 Citations


The purpose of this study was to investigate differences in drug use and HIV risk behaviors among women who exchanged sex for drugs only, for money only, or for both drugs and money. Structured interview responses from 2,042 drug-using women in 23 cities who reported having exchanged sex in the prior 30 days were analyzed. Results indicated that women who exchanged sex for drugs only (n = 117), and for drugs and money (n = 965), were more likely to use alcohol and smoke crack than those who exchanged sex for money only(n = 960). They were also more likely to have had unprotected sex and sex with a drug injector. Those who exchanged sex only for drugs reported having sex half as often as the other two groups and had one fourth the number of partners, but used condoms the least when having sex. Women who exchanged sex for money only were the most likely to inject drugs and the least likely to have had unprotected sex. Promoting condom use and increasing availability of condoms to women who exchange sex, and to their partners, is crucial. Continued research into the relationship between crack use and sex-related HIV risk behaviors is also needed.

This is a preview of subscription content, log in to check access.


  1. Astemborski, J. D., Vlahov, D., Warren, D., Solomon, L., and Nelson, K. E. (1994). The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. American Journal of Public Health, 84, 382–387.

  2. Battjes, R. J., Pickens, R. W., Haverkos, H. W., and Sloboda, Z. (1994). HIV risk factors among injecting drug users in five US cities. AIDS, 8, 681–687.

  3. Booth, R. E., Crowley, T. J., and Zhang, Y. (1996). Substance abuse treatment entry, retention and effectiveness: Out-oftreatment opiate injection drug users. Drug and Alcohol Dependence, 2, 11–20.

  4. Booth, R. E., Kwiatkowski, C. F., and Chitwood, D. D. (1999). Sex related HIV risk behaviors: Differential risks among injection drug users, crack smokers and drug users who smoke crack. Drug and Alcohol Dependence, in press.

  5. Booth, R. E., Kwiatkowski, C. F., Iguchi, M. Y., Pinto, D., and John, D. (1998). Facilitating treatment entry among out-oftreatment injection drug users. Public Health Reports, 113, 1–13.

  6. Booth, R. E., Watters, J. K., and Chitwood, D. D. (1993). HIV risk-related behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. American Journal of Public Health, 38, 1144–1148.

  7. Bulterys, M., Chao, A., and Dushimimana, A. (1993). Multiple sexual partners and mother-to-child transmission of HIV-1. AIDS, 7, 1639–1645.

  8. Cates, W., and Stone, K. M. (1992). Family planning, sexually transmitted diseases, and contraceptive choice: A literature update. Family Planning Perspective, 24, 75–84.

  9. Centers for Disease Control and Prevention. (1998). HIV/AIDS surveillance report, No. 10. Atlanta GA: Author.

  10. Cohen, D., Scribner, R., Bedimo, R., and Farley, T. A. (1999). Cost as barrier to condom use: The evidence for condom subsidies in the United States. American Journal of Public Health, 89, 567–568.

  11. Des Jarlais, D. C., Abdul-Quader, A., Minkoff, H., and Tross, S. (1991). Crack use and multiple AIDS risk behaviors [Letter]. Journal of AIDS, 4, 446–447.

  12. Des Jarlais, D. C., Friedman, S. R., Goldsmith, D., and Hopkins, W. (1990). Heterosexual transmission of human immunodefi-ciency virus from intravenus drug users: Regular partnerships and prostitution. In B. Voeller, J. M. Reinisch, and M. Gottlieb (Eds.), AIDS and Sex(pp. 245–256). New York: Oxford Unversity Press.

  13. Donoghoe, M. C. (1992). Sex, HIV and the injecting drug user. British Journal of Addiction, 87, 405–416.

  14. Dowling-Guyer, S., Johnson, M. E., Fisher, D. G., Needle, R., Watters, J., Anderson, M., Anderson, M., Williams, M., Kotranski, L., Booth, R., Rhodes, F., Weatherby, N., Estrada, A. L., Fleming, D., Deren, S. and Tortu, S. (1994). Reliability of drug users self-reported recent drug use. Assessment, 1, 383–392.

  15. Edlin, B. R., Irwin, K. L., Faruque, S., McCoy, C. B., Word, C., Serrano, Y., Inciardi, J. A., Bowser, B. P., Schilling, R. F., and Holmberg, S. D. (1994). Intersecting epidemics: Crack cocaine use and HIV infection among inner-city young adults. New England Journal of Medicine, 331, 1422–1427.

  16. Fullilove, M. (1998). HIV and crack: Impact on the epidemic. Presented at the Thirteenth Annual Rocky Mountain Regional Conference on HIV Disease, Denver, CO.

  17. Goldstein, P. J., Ouellet, L. J., and Fendrich, M. (1992). From bag brides to skeezers: A historical perspective on sex-for-drugs behavior. Journal of Psychoactive Drugs, 24, 349–361.

  18. Kim, M. Y., Marmour, M., Dublin, N., and Wolfe, H. (1993). HIV risk-related sexual behaviors among heterosexuals in New York City: Associations with race, sex, and intravenous drug use. AIDS, 7, 409–414.

  19. Magura, S., Goldsmith, D. S., Casriel, C., Goldstein, P. J. and Lipton, D. S. (1987). The validity of methadone clients' selfreported drug use. International Journal of the Addictions, 22, 727–749.

  20. Maisto, S. A., McKay, J. R., and Connors, G. J. (1990). Self-report issues in substance abuse: State of the art and future directions. Behavioral Assessment, 121, 117–134.

  21. McCoy, C. B., and Khoury, E. (1990). Drug use and the risk of AIDS. American Behavioral Scientist, 33, 419–431.

  22. Padian, N. S., Shiboski, S. C., Glass, S. O., and Vittinghoff, E. (1997). Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: Results from a tenyear study. American Journal of Epidemiology, 146, 350–357.

  23. Ratner, M. S. (Ed.) (1993). Crack pipe as pimp: An ethnographic investigation of sex-for-crack exchanges. New York: Lexington Books.

  24. van Den Hoek, A., van Haastrecht, H. J. A., and Coutinho, R. A. (1990). Heterosexual behavior of intravenous drug users in Amsterdam: implications for the AIDS epidemic. AIDS, 4, 449–453.

  25. Watkins, K. E., Metzger, D., Woody, G., and McLellan, A. T. (1993). Determinants of condom use among intravenous drug users. AIDS, 7, 719–723.

  26. Weatherby, N. L., Needle, R., Cesari, H., Booth, R. E., McCoy, C., Watters, J. K., Williams, M., and Chitwood, D. D. (1994). Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Education and Program Planning, 17, 347–355.

  27. Weatherby, N. L., Shultz, J. M., Chitwood, D. D., McCoy, H. V., McCoy, C. B., Ludwig, D. D., and Edlin, B. R. (1992). Crack cocaine use and sexual activity in Miami, Florida. Journal of Psychoactive Drugs, 24, 373–380.

  28. Weller, S. C. (1993). A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Social Science Medicine, 36, 1635–1644.

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kwiatkowski, C.F., Booth, R.E. Differences in HIV Risk Behaviors Among Women Who Exchange Sex for Drugs, Money, or Both Drugs and Money. AIDS Behav 4, 233–240 (2000). https://doi.org/10.1023/A:1009512601057

Download citation

  • HIV
  • women
  • drugs
  • sex
  • prostitution