Relationship between purchasing sex, substance use, and social networks among drug users in Baltimore, MD

Abstract Although sex exchange is a risk factor for HIV, few studies have examined the characteristics of those who purchase sex. We analyzed the factors that were associated with the purchasing of sex with money or drugs among inner-city individuals who were involved in a network HIV prevention intervention, which targeted active injection drug users and their drug and sexual risk partners. A baseline survey and social network inventory was administered to 1024 participants. Out of 848 sexually active participants, 20% reported purchasing sex in the prior 3 months. 28% of the men and 10% of the women reported purchasing sex. 10% of the men who reported exchange partners had same sex exchange partners. In bivariate analyses, factors that were significantly associated with purchasing sex included older age, male gender, homelessness, high level of depressive symptoms, greater frequency of alcohol and crack use, greater number of injectors and crack smokers within the social network, and higher network density. However, in multivariate logistic regression models only gender, crack use, and number of crack users in the social network, and network density remained associated with purchasing sex. These data suggest that the social environment surround crack use and the interconnections among network members are linked to purchasing sex.