From the Departments of Medicine.
Epidemiology, University of Washington.
Sex Transm Dis. 2022 Oct 1;49(10):719-725. doi: 10.1097/OLQ.0000000000001666. Epub 2022 Jul 4.
People who exchange sex (PWES) for money or drugs are at increased risk for poor health outcomes and may be reluctant to engage in health services.
We conducted a cross-sectional analysis of patients seen for new problem visits at the Public Health-Seattle and King County Sexual Health Clinic between October 2010 and March 2020 who reported exchanging sex for drugs or money in a computer assisted self-interview. We analyzed demographics; sexually transmitted infections (STIs), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) history; and HIV preexposure prophylaxis (PrEP) use, stratified by gender. We compared characteristics of people who ever versus never exchanged sex using χ 2 tests and analyzed the visit reason and outcomes among PWES.
Among 30,327 patients, 1611 (5%) reported ever exchanging sex: 981 (61%) cisgender men, 545 (34%) cisgender women, and 85 (5%) transgender and gender diverse persons. Compared with people who never exchanged sex, PWES were more likely to report homelessness (29% vs 7%, P < 0.001), injection drug use (39% vs 4%, P < 0.001), prior STIs (36% vs 19%, P < 0.001), prior HIV diagnosis (13% vs 5%, P < 0.001), and prior HCV diagnosis (13% vs 2%, P < 0.001). People who exchange sex came to the clinic seeking STI tests (60%), HIV tests (45%), and care for STI symptoms (38%). Overall, 320 (20%) PWES were diagnosed with STIs, 15 (1%) were newly diagnosed with HIV, and 12 (1%) initiated PrEP at the visit.
People who exchange sex have complex barriers to care, and sexual health clinic visits present an opportunity to improve health services for this population.
以性交易换取金钱或毒品的人（PWES）面临更高的健康风险，并且可能不愿意接受医疗服务。
我们对 2010 年 10 月至 2020 年 3 月期间在西雅图和金县公共卫生性健康诊所就诊的新出现问题的患者进行了横断面分析，这些患者在计算机辅助的自我访谈中报告了以性交易换取毒品或金钱。我们分析了人口统计学特征；性传播感染（STIs）、人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）病史；以及按性别分层的 HIV 暴露前预防（PrEP）使用情况。我们使用 χ 2 检验比较了曾经和从未进行过性交易的人的特征，并分析了 PWES 的就诊原因和结果。
在 30327 名患者中，有 1611 人（5%）报告曾有过性交易：981 名（61%）为跨性别男性，545 名（34%）为跨性别女性，85 名（5%）为跨性别和性别多样化的人。与从未进行过性交易的人相比，PWES 更有可能报告无家可归（29%比 7%，P < 0.001）、注射吸毒（39%比 4%，P < 0.001）、既往性传播感染（36%比 19%，P < 0.001）、既往 HIV 诊断（13%比 5%，P < 0.001）和既往 HCV 诊断（13%比 2%，P < 0.001）。来诊所就诊的性交易者寻求性传播感染检测（60%）、HIV 检测（45%）和性传播感染症状治疗（38%）。总体而言，320 名（20%）PWES 被诊断患有性传播感染，15 名（1%）新诊断为 HIV，12 名（1%）在就诊时开始接受 PrEP 治疗。
进行性交易的人面临着复杂的医疗服务障碍，而性健康诊所就诊为改善这一人群的健康服务提供了机会。
