What It Really Costs: Sexual Risks of Financially Dependent Inner-city Women

Background: Women who are financially dependent on their sexual partners may be more likely to have multiple partners and experience intimate partner violence and less likely to have safe sex. Objective: The purpose of this study was to explore a causal association between financial dependency and sexual health behaviors. Methods: This study uses data from a survey of 567 inner-city women surveyed at baseline and six months later. Women who reported being financially dependent on at least one sexual partner at baseline (n = 250) were matched with women who reported not being financially dependent (n = 317). The initial matching method used 1-to-1 propensity score matching without replacement, where the propensity score was formulated with 17 factors including demographics, substance abuse, alcohol use, current sexual partner characteristics, sexual risk descriptive norms, sexual risk injunctive norms, income, employment status, and housing status. Results: After the preliminary matching, the 250 dependent and 250 matched non-dependent women did not differ in over 45 background characteristics. Six months later, dependent women reported more sexual partners, more vaginal sex with exchange and casual partners, and less condom use with exchange and exchange partners, compared with the matched non-dependent women. Subsequent investigation will consider other matching methods, including full matching, subclassification, and coarsened exact matching. Conclusion: Women who are financially dependent on sexual partners have HIV and STI risks. Interventions that address women's economic circumstances may be more successful in improving their sexual health outcomes.