Sex Trade for Money Is Associated with Sexually Transmitted Infections Among Injection Drug Using Women in Baltimore

Background: While injection drug users are disproportionately affected by human immunodeficiency virus (HIV), there has been little study into sexual risk behaviors associated with increased sexually transmitted infection (STI) risk in this high risk population.

Objectives: Test the relationships between trading sex for money or trading sex for drugs and lifetime prevalence of STIs amongst female injection drug using women in Baltimore.

Methods: One hundred and seventy four drug-injecting women (48% African American, 52% White) were recruited in Baltimore, Maryland to participate in the NEURO-HIV Epidemiologic Study. Participants completed the HIV Risk Behavior Interview that included questions regarding lifetime history of STIs (gonorrhea, syphilis, genital herpes, genital warts, Chlamydia, and trichomoniasis) and involvement in sex trade. Logistic regression models were used to estimate the statistical significance of sex trade for either money or drugs on prevalence of STIs while controlling for other potential confounding variables such as race/ethnicity, age, education and homelessness.

Results: Unadjusted odds ratios indicated that higher lifetime STI prevalence was associated with race/ethnicity, as well as both trading sex for drugs and trading sex for money.  The multivariate (adjusted) models supported the significance of sex trade for money. That is female injection drug users who traded sex for money (AOR =4.94, 95% CI = 2.12-11.49, p<.001) had 5 times greater odds of having STI’s in their lifetime compared to female injection drug users who had not traded sex for money, after controlling for covariates.

Conclusions: The findings indicated that sex trade for money, but not trading sex for drugs, was associated with the greater likelihood of female injection drug users having a self-reported STI during their lifetime.  

Implications for Programs, Policy, and/or Research: Findings suggest that STI prevention interventions targeting female injection drug users who trade sex for money may be particularly needed to reduce STI/HIV risk in this population of women.