Sex Trading and HIV risk among Rural and Urban Drug Users in the South

Background. Exchanging sex for drugs or money places drug users at increased risk for HIV and other sexually transmitted infections (STIs). Although rural and urban drug users are both at risk of HIV, few studies have compared risk behaviors across groups in the South where HIV and STIs are increasing. This study examines sex trading among drug users in the South.

Methods. A sample of 198 rural and 942 urban users of crack, powder cocaine, methamphetamine, heroin and injected drugs was recruited between 2005 and 2007 from two rural and two urban counties in central North Carolina using respondent driven sampling (RDS).

Results. Rural participants were significantly more likely to be female (50% vs 33%) and non-Hispanic white (31% vs 15%). Use of methamphetamine, powder cocaine and crack was similar in both groups, but heroin use was significantly higher in the urban sample. HIV prevalence was 8% in both groups. In bivariate analyses, urban drug users were significantly more likely to report purchasing sex (30% vs 20%, p < 0.01) but rates of selling sex were not significantly different (29% vs. 24%). In multiple logistic regression models that adjusted for demographic characteristics and use of different drugs there were no differences between rural and urban drug users in purchasing or selling sex.

Conclusions These analyses confirm findings from a qualitative study in the same counties that found high rates of sexual risk in the rural and urban counties. Innovative interventions are needed to reduce sexual risks among rural drug users.