The Prevalence and Correlates of Receiving Sex in Exchange for Drugs, Money, or Shelter Among Black Men in Baltimore City

Introduction: Black men are disproportionately affected by HIV in the United States and their participation in HIV high-risk sexual behaviors may lead to their contracting or transmitting HIV or other infectious diseases. One particularly risky sexual behavior that has not yet been thoroughly examined in the research literature is men’s involvement in receiving sex in exchange for drugs, money or shelter, hereafter referred to as “purchasing sex.”  This study sought to address this gap in the literature by examining the prevalence and correlates of purchasing sex among Black men.

Methods: This study was a secondary data analysis of 98 Black men who participated in a baseline assessment for a randomized trial of Integrated Family and Cognitive-Behavioral Therapy-HIV Prevention Intervention (IFCBT-HIVPI; R01DA014498). Participants were included in the parent study because they reported drug use in the previous six months and were HIV negative, or were the intimate partners of recent drug users who participated in the parent study. Participants completed an in-person interview including the Traumatic Events Scale and Structured Clinical Interview for DSM-IV-TR to assess for lifetime psychiatric and substance use disorders. They were also asked other questions including whether a health professional ever told them they had a sexually transmitted infection (STI) or whether they had ever taken medication for emotional or behavioral problems. Correlation analyses and multiple logistic regression were used to assess associations between traumatic events, HIV sexual risk factors, psychiatric and substance use disorders, psychiatric treatment, and purchasing sex.

Results: Participants were between 18-61 years old (M=44.04; SD=9.28). The majority were single/had never been married (61.2%), had used drugs during the past six months (68.0%), and had at least a high school or equivalent education (67.3%). Fifty percent reported having purchased sex during their lifetime. Several variables were associated with purchasing sex in bivariate analyses. In the multiple logistic regression, purchasing sex was associated with ever having a STI or taking medication for emotional behavior problems. Participants who had a STI had nearly 4 times greater odds of purchasing sex than those who did not have a STI (AOR =3.94, 95% CI=1. 5, 10.4, p<.01) after controlling for age and other covariates. Additionally, men who had ever taken medication for emotional or behavior problems had nearly three times greater odds of purchasing sex compared to men who had never taken medication for emotional or behavioral problems (AOR =2.89, 95% CI=1. 0, 8.3, p<.05).

Conclusions:

This study examines an HIV high-risk sexual behavior in a sample of Black men, the majority of whom had used drugs in the past six months. Findings suggest that HIV prevention interventions should aim to reach Black men who have purchased sex given their increased risk for having a STI. Furthermore, the higher prevalence of psychiatric treatment among men who purchased sex suggests that future research should seek to better understand the nature of mental health problems in this population of men, including whether mental health treatment reduces the likelihood of purchasing sex.