Ellis Matthew S, Kasper Zachary A, Takenaka Bryce, Buttram Mance E, Shacham Enbal
Department of Psychiatry, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri.
Department of Psychiatry, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri.
Am J Prev Med. 2023 Jan;64(1):17-25. doi: 10.1016/j.amepre.2022.07.011. Epub 2022 Sep 6.
Coinciding with the rise in opioid use across the U.S., the rates of sexually transmitted infections have reached historically high levels, underscoring the need to understand multiple pathways of disease spread. Although prevention is often focused on injection-related behaviors, this study sought to identify the prevalence and associations of a little understood pathway, transactional sex, among individuals with opioid use disorder, including associations of transactional sex with the prevalence of sexually transmitted infection diagnoses.
Data were sourced from a nationwide opioid surveillance program of treatment-seeking individuals with opioid use disorder utilizing a serial, cross-sectional survey of 4,366 new entrants to 1 of 99 substance use treatment programs for opioid use disorder in 37 states from October 2018 to June 2021.
A quarter of the sample (24.9%) self-reported a lifetime history of transactional sex for drugs, with rates highest for sexual (56.6%) and gender (53.8%) minority, female (33.4%), Latinx (30.4%), and Black (29.6%) subgroupings. Lifetime diagnoses of all specific sexually transmitted infections analyzed were significantly higher (p<0.001) among those reporting transactional sex, particularly syphilis (14.3% vs 4.4%) and HIV (4.0 vs 0.9%). Financial hardship, trauma, and psychiatric disorder were significantly associated with transactional sex engagement.
Transactional sex is relatively common among patients with opioid use disorder, particularly among sexual/gender minorities, which was associated with a greater lifetime prevalence of all sexually transmitted infections assessed. Sexually transmitted infection testing remains at low levels within substance use treatment programs, occurring in just 26.3% of programs; sexual health screenings and sexually transmitted infection prevention/testing need to be prioritized and integrated into opioid use disorder patient care.
在美国，随着阿片类药物使用量的上升，性传播感染率达到了历史最高水平，这凸显了了解疾病传播多种途径的必要性。尽管预防措施通常侧重于与注射相关的行为，但本研究旨在确定阿片类药物使用障碍患者中一种鲜为人知的途径——交易性行为的患病率及其关联因素，包括交易性行为与性传播感染诊断患病率的关联。
数据来源于一项针对寻求阿片类药物使用障碍治疗的个体的全国性监测项目，该项目采用系列横断面调查，对2018年10月至2021年6月期间37个州99个阿片类药物使用障碍物质使用治疗项目中的4366名新入院患者进行了调查。
四分之一的样本（24.9%）自我报告有过以毒品换取性行为的终生经历，其中性少数群体（56.6%）、性别少数群体（53.8%）、女性（33.4%）、拉丁裔（30.4%）和黑人（29.6%）亚组的发生率最高。在报告有交易性行为的人群中，所有分析的特定性传播感染的终生诊断率显著更高（p<0.001），尤其是梅毒（14.3%对4.4%）和艾滋病毒（4.0对0.9%）。经济困难、创伤和精神障碍与参与交易性行为显著相关。
交易性行为在阿片类药物使用障碍患者中相对常见，尤其是在性/性别少数群体中，这与所有评估的性传播感染的更高终生患病率相关。在物质使用治疗项目中，性传播感染检测水平仍然较低，仅在26.3%的项目中进行；性健康筛查和性传播感染预防/检测需要得到优先重视，并纳入阿片类药物使用障碍患者的护理中。
