title: Prevalence and factors associated with sex trading in the year prior to entering treatment for drug misuse in England.
abstract: BACKGROUND
  This study estimates the past year prevalence of and factors associated with sex trading (offering sex for money, drugs or something else) among 1796 men and women presenting to 342 drug misuse treatment agencies in England, and identifies service development and delivery implications.
  
  
  METHODS
  Secondary analysis of baseline data from a prospective cohort was conducted. Short Form-12 measured mental and physical wellbeing, psychiatric diagnoses were self-reported and the circumstances, motivation and readiness tool assessed readiness for/pressure to enter treatment. Logistic regression models determined associations with sex trading separately by sex. Inverse probability population weights were calculated, utilising demographics from the National Drug Treatment Monitoring System and agency specific data collection windows.
  
  
  RESULTS
  The estimated prevalence rate of sex trading in the past 12 months was 5.1% (15.0% for women and 2.1% for men). For women, adjusted models identified crack use (aOR 1.83, 95% CI 1.22-2.74, p=0.004), previous treatment (aOR 3.00, 95% CI 1.31-6.86, p=0.010) and greater readiness for treatment (aOR 1.12, 95% CI 1.01-1.24, p=0.027) as independently associated with sex trading. For men, lower mental wellbeing (aOR 0.97, 95% CI 0.94-0.99, p=0.030) was independently associated and marginal effects were identified for syringe sharing (aOR 2.89, 95% CI 0.94-8.86, p=0.064) and unprotected sex (aOR 2.23, 95% CI 0.95-5.26, p=0.065).
  
  
  CONCLUSIONS
  Sex trading among drug misusers is associated with additional health risks and specific treatment needs. Given the scale of the problem it is important that treatment providers have the competencies to adequately address the issue and provide accessible and appropriate services.
authors.affiliation: King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom. Electronic address: gail.gilchrist@kcl.ac.uk.
authors.forename: Gail
authors.initials: G
authors.lastname: Gilchrist
authors.affiliation: King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom. Electronic address: Nicola.Singleton@kcl.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Singleton
authors.affiliation: National Drug Evidence Centre, Institute of Population Health, University of Manchester, Ellen Wilkinson Building, 4th Floor, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: M.Donmall@manchester.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Donmall
authors.affiliation: National Drug Evidence Centre, Institute of Population Health, University of Manchester, Ellen Wilkinson Building, 4th Floor, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: Andrew.Jones@manchester.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009042:Motivation; D016485:Needle Sharing / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011336:Probability; D011446:Prospective Studies; D012737:Sex Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D047568:Unsafe Sex / Q000706:statistics & numerical data
keywords: Drug misuse; Drug treatment services; Gender differences; Risk factors; Secondary analysis; Sex trading