Testing a Model of the Proposed Associations Between Childhood Abuse, Revictimization, Psychiatric and Substance Use Disorders, and Sex Trade Among Black Women in Baltimore City

Introduction: Black women in the U.S. are disproportionately affected by HIV and most women contract HIV through high-risk heterosexual contact. Research is needed to test multiple co-occurring risk factors for risky sexual behavior (e.g., interpersonal violence and psychiatric and substance use disorders) in order to inform HIV prevention interventions among Black women in the U.S. This study tested multiple co-occurring risk factors for sex trade and proposed associations between childhood abuse and HIV sexual risk (Malow, Devieux, & Lucenko, 2006) among Black women in Baltimore City.

Methods: Participants were 124 Black women who participated in a baseline assessment for a randomized trial (R01DA014498) in Baltimore City, reported recent drug use, and were HIV negative (index participant), or were the intimate partners of index participants (partner participant). The baseline assessment included the Traumatic Events Scale, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision, and questions about participants’ lifetime involvement in selling sex for drugs or money; hereafter referred to as sex trade. Logistic regression was used to test the following variables in relation to lifetime sex trade: age, childhood physical or sexual abuse, adult unwanted sexual experiences, adult physical or otherwise abusive relationship, posttraumatic stress disorder, major depressive disorder, alcohol use disorder (AUD), drug use disorder (DUD), and participant status (i.e., index or partner).

Results: During their lifetime, 40% of the participants had traded sex and 80% met criteria for a DUD. Seventy percent had used drugs in the past six months. Having an adult unwanted sexual experience, being in an adult physically or otherwise abusive relationship, AUD, and DUD were all positively associated with sex trade in bivariate analyses. However, only adult unwanted sexual experiences and DUD were associated with sex trade when controlling for the other variables studied. Women who reported adult unwanted sexual experiences had more than five times greater odds (AOR =5.58, 95% CI=1. 76, 17.71, p<.01) of having traded sex compared to women who did not have adult unwanted sexual experiences. Women who had a DUD had more than nine times greater odds of having traded sex (AOR=9.20, 95% CI=1.11, 75.94, p<.05) compared to women without a DUD.

Conclusions: Findings provide only partial support for the model tested in this population of Black women. Future research should aim to better understand the relationships between adult unwanted sexual experiences, DUD, and sex trade in this high-risk population of women in order to reduce risk for contracting HIV.