Prevalence and Correlates of Transactional Sex Among an Urban Emergency Department Sample: Exploring Substance Use and HIV Risk

Men and women involved in transactional sex (TS) report increased rates of HIV risk behaviors and substance use problems as compared with the general population. When people engaged in TS seek health care, they may be more likely to utilize the emergency department (ED) rather than primary care services. Our goal was to examine the prevalence and correlates of TS involvement among an ED sample of men and women. Adults ages 18-60 were recruited from an urban ED, as part of a larger randomized control trial. Participants (n = 4,575; 3,045 women, 1,530 men) self-administered a screening survey that assessed past 3-month substance use (including alcohol, marijuana, illicit drugs, and prescription drugs) and HIV risk behaviors, including TS (i.e., being paid in exchange of a sexual behavior), inconsistent condom use, multiple partners, and anal sex. Of the sample, 13.3% (n = 610) reported TS within the past 3 months (64.4% were female). Bivariate analysis showed TS was significantly positively associated with alcohol use severity, marijuana use, and both illicit and prescription drug use, and multiple HIV risk behaviors. These variables (except marijuana) remained significantly positively associated with TS in a binary logistic regression analysis. The prevalence of recent TS involvement among both male and female ED patients is substantial. These individuals were more likely to report higher levels of alcohol/drug use and HIV risk behaviors. The ED may be a prime location to engage both men and women who are involved in TS in behavioral interventions for substance use and sexual risk reduction.