title: Patterns of exchange sex and HIV infection in high-risk heterosexual men and women.
abstract: Heterosexual partnerships involving the trade of money or goods for sex are a well-described HIV risk factor in Africa and Southeast Asia, but less research has been conducted on exchange partnerships and their impact on HIV infection in the United States. In our study, men and women were recruited from high-risk risk neighborhoods in New York City through respondent-driven sampling in 2006-2007. We examined the factors associated with having an exchange partner in the past year, the relationship between exchange partnerships and HIV infection, and the risk characteristics of those with exchange partners by the directionality of payment. Overall, 28% of men and 41% of women had a past-year exchange partner. For men, factors independently associated with exchange partnerships were older age, more total sexual partners, male partners, and frequent non-injection drug use. For women, factors were homelessness, more total sexual partners, more unprotected sex partners, and frequent non-injection drug use. Exchange partnerships were associated with HIV infection for both men and women, although the relationships were substantially confounded by other behavioral risks. Those who both bought and sold sex exhibited the highest levels of risk with their exchange and non-exchange partners. Exchange partnerships may be an HIV risk both directly and indirectly, given the overlap of this phenomenon with other risk factors that occur with both exchange and non-exchange partners.
authors.affiliation: HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, 346 Broadway, Suite 707D, New York, NY 10013, USA. sjenness@health.nyc.gov
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Jenness
authors.forename: Paul
authors.initials: P
authors.lastname: Kobrak
authors.forename: Travis
authors.initials: T
authors.lastname: Wendel
authors.forename: Alan
authors.initials: A
authors.lastname: Neaigus
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Murrill
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D020010:Heterosexuality; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology*; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult