Background: Globally, sex workers are key sexually transmitted disease population. STD-related research typically focuses solely on this population, hindering our understanding of the prevalence of sex trade among relevant clinical populations, the nature of such experiences, and comparison of their STD risk behavior, infection, and related clinical care-seeking.
Methods: Female family planning clinic patients ages 16-29 (n=3,526) participated in a cross-sectional survey in 2011-2012.
Results: Overall, 2.8% reported a lifetime sex trade history. The majority had traded for money (65.7%), or received drugs (60.6%), shelter (30.3%) and gifts (26.3%) in exchange. Trade partners ranged from strangers (27.3%) to boyfriends (12%). Over one third (38%) first traded as minors, and 12% traded under conditions of force or threats. Sex trade history was associated with recent sexual risk, specifically unprotected vaginal sex (AOR 1.81, 95% CI 1.07, 3.05), unprotected anal sex (AOR 2.02, 95% CI 1.28, 3.20), fear of condom negotiation (AOR 5.47, 95% CI 2.26, 12.27), partner violence (AOR 12.38, 95% CI 6.03, 25.43) and injection drug use (AOR 6.89, 95% CI 2.86, 16.6). Both recent STD and related care-seeking were more common among those with a sex trade history (AOR 3.33, 95% CI 1.66, 6.71, and AOR 2.71, 95% CI 1.78, 4.13, respectively).
Conclusions: Compared with general population estimates, sex trade was relatively common in this sample. Experiences spanned traditional concepts of sex work (e.g., trade with strangers for money), transactional sex (e.g., trade with boyfriends/acquaintances for gifts), and trafficking for exploitation (i.e., trade as minors or under force/coercion). Demonstrated associations of sex trade with recent STD risk, infection and related care-seeking affirm heightened risk to this population. Findings suggest the potential utility of clinical settings in reaching women involved in, and with a history of, sex trade, in addition to the more traditional targeted outreach efforts for this population.