Non-injection drug use and its association with structural HIV risk factors among women who exchange sex in 4 U.S. cities—2016 Público

Abstract

Background

Exchange sex has been globally recognized to increase risk of HIV transmission, placing women who exchange sex (WES) for money or drugs at a disproportionately higher risk for HIV than women who do not. There are many behavioral, structural, environmental, and social risk factors contributing to this increased risk. The goal of this study is to quantify the association between non-injection drug use (NIDU) and structural risk factors among WES in the United States.

Methods

Using data from the 2016 High-Risk Women (HRW) project embedded within the National HIV Behavioral Surveillance (NHBS) heterosexually active person at increased risk cycle (HET), NIDU exposures of interest were methamphetamine, crack cocaine, downers, painkillers, and non-injected heroin, and structural outcomes of interest were incarceration, arrest for exchange sex, and experiences with homelessness. Bivariate and Multivariable analysis was completed using log-linked Poisson regression to calculate prevalence ratios (PRs) with 95% CIs and robust standard errors.

Results

Among our sample of 827 WES, most of our population was over the age of 40, African American, at or below the federal poverty line with a high school education or lower. Only non-injection heroin and crack cocaine remained significant in multivariable analysis. Non-injection heroin was associated with incarceration (PR 1.6, 95% CI: 1.1, 2.3) and arrest for exchange sex (PR 1.9, 95% CI: 1.2, 3.0), and crack cocaine was associated with incarceration (PR 1.7, 95% CI: 1.1, 2.4), arrest for exchange sex (PR 1.8, 95% CI: 1.1, 3.0), and homelessness (PR 1.3, 95% CI: 1.1, 1.7).

Conclusions

Based on our analysis, use of crack cocaine and non-injection heroin and structural risk factors are critical considerations for HIV prevention interventions tailored to WES. Further understanding how these risks present themselves in the lives of WES, as well as how they are associated with each other, will help in the development of tailored interventions that address the unique circumstances WES face and better inform community health workers providing health services to WES in the US.

Table of Contents

Introduction………………………………………………………………………………..1

Methods……………………………………………………………………………………3

Results……………………………………………………………………………………..6

Discussion…………………………………………………………………………………8

Conclusion……………………………………………………………………………….12

References………………………………………………………………………….…….14

Tables

Table 1………………………………………………………………………19

Table 2………………………………………………………………………21

Table 3………………………………………………………………………22

Table 4………………………………………………………………………23

Table 5………………………………………………………………………24

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	non-injection drug use exchange sex HIV
Committee Chair / Thesis Advisor	Sullivan, Patrick, Emory University
Committee Members	Agnew-Brune, Christine, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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