Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR

• DOI: 10.1186/s12905-020-01088-1
• Publication Date: 2020-10-02T12:03:02Z
• Authors: Timothy W. Menza; Lauren Lipira; Amisha Bhattarai; Victoria Cali-De ...; E. Roberto Orellana
• Keywords: Substance abuse; Adult; Male; Social Work; Adolescent; Substance-Related Disorders; Sexual Behavior; Sexually Transmitted Diseases; HIV Infections; Substance use; Adult child abuse victims; Vulnerable Populations; Oregon; Young Adult; 03 medical and health sciences; 0302 clinical medicine; 5. Gender equality; Adverse Childhood Experiences; Prevalence; HIV infections -- Diagnosis; Transactional sex; Humans; Adverse childhood experiences; Child; 10. No inequality; Prostitution -- Health aspects; HIV (Viruses); 1. No poverty; Pre-exposure prophylaxis; Gynecology and obstetrics; Middle Aged; Sex Work; HIV testing; 3. Good health; Cross-Sectional Studies; Immune System Diseases; Social Class; Virus Diseases; RG1-991; Female; Public aspects of medicine; RA1-1270; 0305 other medical science; Research Article

Abstract Background Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited.

Methods In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex.

Results Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P < 0.001). Transactional sex was strongly associated with combination methamphetamine and opiate use as well as condomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low.

Conclusions In a sample of women of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.