University of Southampton, Southampton SO17 1BJ, UK.
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Sex Health. 2022 Jan;18(6):487-497. doi: 10.1071/SH21128.
Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6months until July2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex. Conclusions More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men.
男男性行为者（GBM）中，有过商业性行为（即与性伴发生性行为以换取毒品、金钱或物品）的人，会增加性传播感染（STI）的风险，包括 HIV。本研究旨在探讨与 GBM 商业性行为相关的其他心理社会和健康相关因素。
本研究采用应答者驱动抽样（RDS）方法，于 2012 年至 2015 年在加拿大温哥华招募 GBM，每 6 个月进行一次随访，直至 2019 年 7 月。我们使用多变量三水平混合效应模型，分析了与商业性行为相关的因素。
在 698 名 GBM 中，22.1%报告曾有过性交易行为，即通过与性伴发生性行为以换取毒品、金钱或物品。年轻（<30 岁）、收入较低、受教育程度较低和住房不稳定的 GBM 更有可能报告商业性行为。报告商业性行为的 GBM 更有可能报告物质使用（即冰毒、啪啪剂、GHB 和非甾体类注射药物）和高风险性行为（即性伴更多、参加性派对和与性伴 HIV 状态不同或未知时无保护肛交）；但他们感染 HIV 的可能性并不更高，也不太可能报告最近患有细菌性 STI。报告孤独感、焦虑感和认知逃避感较高的 GBM，也更有可能报告商业性行为。
温哥华有超过五分之一的 GBM 报告有商业性行为，而这些人更有可能面临心理社会压力、增加物质使用和更高风险的性行为。为了支持这些男性改善心理健康、身体健康和性健康，有必要制定考虑到 GBM 进行商业性行为所面临的个人、社会和结构挑战的相互关系的项目。
