Factors Associated with Engaging in Sexual Exchange among a Sample of HIV-positive Men in the US, 2000-2004

Background:

Exchange of sex for drugs or money (sexual exchange) is a contextual factor associated with HIV acquisition and transmission. The purpose of this study is to examine factors associated with sexual exchange.

Methods:

A convenience sample of HIV-positive men (n=4,053; white=2026, black=1471, other=556) seeking services completed face-to-face interviews between 2000-2004 in 19 states as part of the Supplement to HIV/AIDS Surveillance (SHAS) Project. Chi-square tests and multiple logistic regression were used to assess the association between engaging in sexual exchange in the year prior to interview and HIV and other health related information, illicit drug use, and sexual risk-taking behaviors in the past year along with sociodemographic characteristics.

Results

Nearly 12% (n=485) of men interviewed reported engaging in sexual exchange in the past year. Of these, 46% identified as heterosexual, 36% as homosexual, and 16% as bisexual. These men were significantly (p < 0.05) less likely to be black than white, have incomes > $10K, and currently take HIV/AIDS medications. Men reporting sexual exchange in the past year were significantly more likely to report an incarceration history, a bisexual than homosexual identity, drug use (injection or non-injection), more sexual partners, partners of unknown HIV status than HIV- positive status, and engaging in unprotected anal or vaginal sex in the past year.

Conclusion:

HIV-positive men engaging in sexual exchange may require interventions that focus on their sexual /drug risk behaviors and their lack of economic resources.