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Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context

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Abstract

The goal of this research was to examine associations among sociodemographic factors, HIV risk, and community context (e.g., economic insecurity, job training, housing instability, crime victimization, and perceived community norms) in adolescents and young adults who ever exchanged sex for drugs or money. Anonymous survey data were collected using ACASIs at community venues where adolescents and young adults congregate in resource-challenged, STI prevalent, urban, US neighborhoods. Conventional descriptive statistics, Fisher’s exact tests, and generalized estimating equations approaches were used to examine associations. Participants (1818, 95.5 % of those screened eligible) were, on average, aged 21.0 years; 42.2 % were males, and 4.6 % were transgender. Almost one-third (32.1 %) identified as gay or lesbian, 18.1 % identified as bisexual; 66.2 % were Black and 21.0 % were Hispanic; 1.3 % was ‘living on the street’. A sizeable proportion reported HIV-related risk: 16.3 % exchanged sex, 12.6 % had sex with someone they knew to be HIV-infected, 7.8 % had sex with someone who injected drugs, and 1.3 % injected drugs. Multivariate comparisons identified a number of variables (e.g., being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, job training access, housing instability, crime victimization, perceived community norms) that were significantly associated with exchange of sex (p < 0.05). This research contributes to the knowledge-base regarding exchange of sex among adolescents and young adults, particularly as it relates to community context. Longitudinal studies to describe the trajectory of social, health, and physical risks and consequences are needed for development of effective evidence-based prevention strategies.

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Notes

  1. The variable “ever injected drugs,” though significantly associated with exchange of sex in the bivariate analyses, was removed from the multivariate model due to small cell sizes leading to model instability. Likewise, the variable “primary source of money” was excluded due to the potential for collinearity introduced by the response option of a sexual partner providing money to the participant.

  2. Several additional models were fit to the data to assess the sensitivity of the final model to the selected changes in the variables that were included in the model. The results of these models did not appreciably differ from the results presented in Table 3.

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Acknowledgments

We acknowledge the contribution of the investigators and staff at the following Adolescent Medicine Trials Units (AMTUs) that participated in this research: Children’s Hospital of Los Angeles (Marvin Belzer, MD, Miguel Martinez, MSW/MPH, Julia Dudek, MPH, Milton Smith, BA); John H. Stroger Jr. Hospital of Cook County and the CORE Center (Lisa Henry-Reid, MD, Jaime Martinez, MD, Ciuinal Lewis, MS, Atara Young, MS, Jolietta Holliman, Antoinette McFadden, BA); Children’s Hospital National Medical Center (Lawrence D’Angelo, MD, William Barnes, PhD, Stephanie Stines, MPH, Jennifer Sinkfield, MPH) Montefiore Medical Center (Donna Futterman, MD, Bianca Lopez, MPH, Elizabeth Spurrell, MPH, LCSW, Rebecca Shore, MPH); Tulane University Health Sciences Center (Sue Ellen Abdalian, MD, Nadrine Hayden, BS; St. Jude Children’s Research Hospital (Patricia Flynn, MD, Aditya Guar, MD, Andrea Stubbs, MPH); University of Miami School of Medicine (Lawrence Friedman, MD, Kenia Sanchez, MSW); Children’s Hospital of Philadelphia (Steven Douglas, MD, Bret Rudy, MD, Marne Castillo, PhD, Alison Lin, MPH); University of South Florida (Patricia Emmanuel, MD, Diane Straub, MD, Amanda Schall, MA, Rachel Stewart-Campbell, BA; Cristian Chandler, MPH, Chris Walker, MSW); Baylor College of Medicine, Texas Children’s Hospital (Mary Paul, MD, Kimberly Lopez, DrPH; Wayne State University (Elizabeth Secord, MD, Angulique Outlaw, MD, Emily Brown, MPP); Johns Hopkins University, School of Medicine (Allison Agwu, MD, Renata Sanders, MD, Marines Terreforte, MPA); The Fenway Institute (Kenneth Mayer, MD, Liz Salomon, EdM, Benjamin Perkins, MA, M.Div.); and University of Colorado (Daniel Reirdan, MD, Jamie Sims, MSW, Moises Munoz, BA).

We appreciate the scientific review provided by members of the Community Prevention Leadership Group of the ATN. We are also grateful to the ATN Coordinating Center at the University of Alabama (Craig Wilson, MD; Cynthia Partlow, MEd, and Jeanne Merchant, MPH) who provided scientific and administrative oversight; the ATN Data and Operations Center at Westat, (James Korelitz, PhD, Barbara Driver, RN, Rick Mitchell MS, and Marie Alexander, BS) who provided operations and analytic support; and the National Coordinating Center at Johns Hopkins University, Department of Pediatrics (Jessica Roy, MSW, Rachel Stewart-Campbell, MA, MPH) who provided national-level oversight, technical assistance, and staff training. Additionally, we acknowledge Anthony Kung, BA and Rich Fallon, MA from the Division of Adolescent and Young Adult Medicine, University of California, San Francisco, who provided administrative assistance to Cherrie Boyer, PhD. We are indebted to our community partners for their assistance and guidance. Most of all, we thank the young people who gave of their time to participate in this research.

Funding

This research was funded by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health [U01 HD 040533 and U01 HD 040474] through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Bill Kapogiannis, MD), with supplemental funding from the National Institutes on Drug Abuse (Richard Jenkins, PhD) and Mental Health (Pim Brouwers, PhD, Susannah Allison, PhD).

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Authors and Affiliations

  1. Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118, USA

    Cherrie B. Boyer

  2. Westat, Rockville, MD, USA

    Lauren Greenberg, Dina Monte & Jennifer Kirk

  3. Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA

    Kate Chutuape & Bendu Walker

  4. All Children’s Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA

    Jonathan M. Ellen

Authors
  1. Cherrie B. Boyer
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  2. Lauren Greenberg
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  3. Kate Chutuape
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  4. Bendu Walker
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  5. Dina Monte
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  6. Jennifer Kirk
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  7. Jonathan M. Ellen
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Consortia

the Adolescent Medicine Trials Network

  • Marvin Belzer
  • , Miguel Martinez
  • , Julia Dudek
  • , Milton Smith
  • , John H. Stroger Jr.
  • , Lisa Henry-Reid
  • , Jaime Martinez
  • , Ciuinal Lewis
  • , Atara Young
  • , Jolietta Holliman
  • , Antoinette McFadden
  • , Lawrence D’Angelo
  • , William Barnes
  • , Stephanie Stines
  • , Jennifer Sinkfield
  • , Donna Futterman
  • , Bianca Lopez
  • , Elizabeth Spurrell
  • , Rebecca Shore
  • , Sue Ellen Abdalian
  • , Nadrine Hayden
  • , Patricia Flynn
  • , Aditya Guar
  • , Andrea Stubbs
  • , Lawrence Friedman
  • , Kenia Sanchez
  • , Steven Douglas
  • , Bret Rudy
  • , Marne Castillo
  • , Alison Lin
  • , Patricia Emmanuel
  • , Diane Straub
  • , Amanda Schall
  • , Rachel Stewart-Campbell
  • , Cristian Chandler
  • , Chris Walker
  • , Mary Paul
  • , Kimberly Lopez
  • , Elizabeth Secord
  • , Angulique Outlaw
  • , Emily Brown
  • , Allison Agwu
  • , Renata Sanders
  • , Marines Terreforte
  • , Kenneth Mayer
  • , Liz Salomon
  • , Benjamin Perkins
  • , Daniel Reirdan
  • , Jamie Sims
  •  & Moises Munoz

Corresponding author

Correspondence to Cherrie B. Boyer.

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The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

This research involved human subject participants.

Informed Consent

Informed verbal consent was obtained to protect the anonymity of study participants, which was approved by each participating site’s Institutional Review Board.

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Boyer, C.B., Greenberg, L., Chutuape, K. et al. Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context. J Community Health 42, 90–100 (2017). https://doi.org/10.1007/s10900-016-0234-2

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