Walters Suzan M, Kral Alex H, Lamb Shona, Goldshear Jesse L, Wenger Lynn, Bluthenthal Ricky N
Rory Meyers College of Nursing, New York University, New York, NY, USA.
RTI International, San Francisco, CA, USA.
J Urban Health. 2021 Feb;98(1):70-82. doi: 10.1007/s11524-020-00494-y.
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
注射毒品的男性（MWID）且从事交易性性行为（即以性换取金钱或毒品）者易感染艾滋病毒并遭受暴力侵害。然而，与女性相比，从事交易性性行为的注射毒品男性受到的研究较少。我们研究了洛杉矶和旧金山从事交易性性行为的注射毒品男性的相关因素，以及交易性性行为是否与暴力受害情况有关。2011 - 2013年，采用针对性抽样方法招募了注射毒品男性，并完成了涵盖人口统计学、吸毒情况、艾滋病毒感染风险、暴力情况、交易性性行为及其他项目的调查。多变量逻辑回归用于（1）确定与交易性性行为独立相关的因素，以及（2）确定在过去6个月内，交易性性行为是否与注射毒品男性的暴力受害情况独立相关。交易性性行为模型中纳入了收入来源与性身份之间的交互项。样本中的572名注射毒品男性中，47名（8%）报告在过去6个月内有过交易性性行为。未报告有交易性性行为的注射毒品男性自我报告的艾滋病毒感染率为7%，报告有交易性性行为的为17%，报告有交易性性行为且为同性恋或双性恋身份的为24%。在多变量分析中，交易性性行为与同性恋或双性恋身份呈正相关（没有非法收入的同性恋或双性恋调整优势比[AOR] = 5.16；95%置信区间[CI] = 1.86 - 14.27；有非法收入的同性恋或双性恋AOR = 13.55，CI = 4.57 - 40.13），在过去12个月内有过强迫性行为（AOR = 11.66，CI = 1.94 - 70.12），以及在过去12个月内遭受暴力侵害（AOR = 2.31，CI = 1.13 - 4.75）。交易性性行为与（过去30天内）海洛因注射呈负相关（AOR = 0.37；95% CI = 0.18 - 0.78）。在控制混杂因素的情况下，交易性性行为与过去12个月内的暴力受害情况独立相关（AOR = 2.04；95% CI = 1.00 - 4.14）。从事交易性性行为的注射毒品男性感染艾滋病毒及遭受多种形式暴力侵害的风险较高。迫切需要针对这一高危亚人群的干预措施，且应包括在整个艾滋病毒护理连续过程中提供物质使用障碍治疗、受害情况服务及减少伤害服务。
