Abstract
Purpose: Transactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high-risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice-involved Appalachian women who use drugs. Methods: Participants (N = 400) were randomly selected, screened, and interviewed face-to-face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex. Findings: On average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration. Conclusions: Results suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice-involved and may signal other HIV-related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk-reduction interventions, including jail-based interventions, to educate vulnerable, hard-to-reach populations on the risks associated with HIV.
| Original language | English |
|---|---|
| Pages (from-to) | 789-794 |
| Number of pages | 6 |
| Journal | Journal of Rural Health |
| Volume | 39 |
| Issue number | 4 |
| DOIs | |
| State | Published - Sep 1 2023 |
Bibliographical note
Funding Information:Opinions expressed are those of the authors and do not represent the position of the National Institute on Drug Abuse or the correctional facilities. As part of a larger, National Institute on Drug Abuse (NIDA)-funded study (R01-DA033866), 400 women who use drugs were recruited from 3 rural Appalachian Kentucky jails, located in counties with a Rural-Urban Continuum Code of 5 or greater.25 For full recruitment and procedural details, refer to Staton et al (2018).26 Between November 2012 and September 2015, randomly selected women (N = 900) were invited to a screening session where they were provided informed consent and were asked to complete a screener that included the NIDA-modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST; NIDA, 2009) and questions about risky sexual behavior. Of those invited to the screening session, 688 (76%) participated. Eligible and willing participants (N = 440) were scheduled for an interview. Eligibility was based on (1) an NM-ASSIST score of 4+ for any drug; and (2) engagement in at least 1 sex-risk behavior in the 3 months before incarceration.26 In some instances (n = 40), participants were released prior to baseline. Interviews were conducted face-to-face by trained female interviewers from the local community, in a private room at the jail with no correctional staff present, using laptops outfitted with Computer Assisted Personal Interview software. Demographic, health, and health risk behavior information (eg, drug use and risky sex practices) was collected. Participants were paid $25 for their time, and all research activities were approved by the University of Kentucky IRB. As part of a larger, National Institute on Drug Abuse (NIDA)-funded study (R01-DA033866), 400 women who use drugs were recruited from 3 rural Appalachian Kentucky jails, located in counties with a Rural-Urban Continuum Code of 5 or greater.25 For full recruitment and procedural details, refer to Staton et al (2018).26 Between November 2012 and September 2015, randomly selected women (N = 900) were invited to a screening session where they were provided informed consent and were asked to complete a screener that included the NIDA-modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST; NIDA, 2009) and questions about risky sexual behavior. Of those invited to the screening session, 688 (76%) participated. Eligible and willing participants (N = 440) were scheduled for an interview. Eligibility was based on (1) an NM-ASSIST score of 4+ for any drug; and (2) engagement in at least 1 sex-risk behavior in the 3 months before incarceration.26 In some instances (n = 40), participants were released prior to baseline. Interviews were conducted face-to-face by trained female interviewers from the local community, in a private room at the jail with no correctional staff present, using laptops outfitted with Computer Assisted Personal Interview software. Demographic, health, and health risk behavior information (eg, drug use and risky sex practices) was collected. Participants were paid $25 for their time, and all research activities were approved by the University of Kentucky IRB. Demographic information included age, race (1 = White, 0 = non-White), years of education, relationship status (1 = married/living as married; 0 = single), employment in the 6 months prior to incarceration (PTI; 1 = employed at least part-time; 0 = unemployed), and housing (1 = stable housing; 0 = nonstable housing, eg, friend's house or temporary shelter). Participants were also asked if they experienced money problems in the 6 months PTI (1 = yes; 0 = no). Participants were asked about their risky sex practices during the baseline interview, including if they had had sex with a partner in exchange for things like money, drugs, food, shelter, or transportation in their lifetime (1 = yes; 0 = no) or in the year PTI (1 = yes; 0 = no). Participants were also asked what charges resulted in their current incarceration and the length of their current incarceration (number of days). For the purposes of this study, charges were categorized into violent (eg, assault), property (eg, shoplifting), court-related (eg, parole/probation violation), substance-related (eg, public intoxication), or “other” (eg, disorderly conduct) offenses. Participants reported mental health symptoms using subscales from the Global Appraisal of Individual Needs (GAIN; Dennis, 2003). Those reporting criteria consistent with anxiety, depression, or post-traumatic stress disorder were combined into a single category (1 = any mental health problem; 0 = no mental health problem). Victimization history was also collected using a GAIN subscale (1 = any prior victimization; 0 = no victimization). Lastly, participants were asked to rate their overall health during the past 12 months using a Likert-type scale ranging from 0 (excellent) to 4 (poor). Participants were also asked to report injection drug use in the year PTI (1 = yes; 0 = no), number of sexual partners in the year PTI, and how often they had unprotected sex with a casual partner (1 = ever; 0 = never). In addition, the GAIN Substance Problem Scale (Dennis, 2003) was used to measure participants’ substance use problem severity. Two sets of analyses were conducted using IBM SPSS Statistics for Windows, Version 28 (IBM Corp., Armonk, NY). First, chi-square, t-tests, and Mann-Whitney (U) tests were used to identify differences between those who reported engaging in transactional sex during the year PTI and those who did not. Second, a multivariable logistic regression model examined independent correlates of engaging in transactional sex in the year PTI. Additional analyses were conducted to verify that there was no collinearity among the variables in the final model. Two participants were excluded from the final sample (N = 398) due to missing data on at least 1 variable of interest.
Publisher Copyright:
© 2023 National Rural Health Association.
Keywords
- Appalachia
- drug use
- mental health
- transactional sex
- women
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
