Associations Between Exchange Sex and Substance Use among a sample of Homeless Youth in Los Angeles

Homeless youth are at high risk for HIV and other STDs. One sexual risk disproportionately reported by homeless youth is exchanging sex for money, food, drugs, or a place to stay.  Previous estimates of exchange sex among homeless youth have ranged widely from 3% to 43%, indicating that continued research on this practice is needed. This study investigated the associations between exchange sex and specific substance(s) used among 154 homeless youth recruited from a drop-in center in Los Angeles in 2009.  Twenty percent reported ever having traded sex, and more commonly exchanged sex for drugs (14%) than for money (12%) over the previous 30 days. Exchange sex was practiced equally by each gender and was significantly correlated with recent use of crack, amphetamines, cocaine, and heroin.  It was also significantly more common among youth who had ever injected drugs or who had ever been in foster care. Preliminary OLS regression results indicate that practicing exchange sex increased with age (p=.002) and with greater amphetamine use over the previous 30 days (p=.036). While information about the gender of the exchange partner was not collected, instances of exchange sex increased along with having more same sex partners (p=.004) only among males, which is consistent with previous research indicating that predominantly males engage in transactional sex with homeless youth. Harm reduction interventions targeting homeless youth should teach ways they can protect themselves from victimization and minimize sexual risk while engaging in exchange sex.