Transactional sex as a pathway for rising sexually transmitted infections amidst the opioid epidemic in the United States

Thursday, 24 November, 2022 - 15:00 to 16:30

Abstract

Background. Recently, the United States has been experiencing increases in both sexually transmitted infections (STIs) and opioid overdose fatalities. Discussion of STIs in association with the opioid epidemic typically center on injection drug use and needle-sharing. However, there are other pathways of infection associated with substance use, in particular, the exchange of oral, anal or vaginal sex for drugs. The purpose of this study was to examine the prevalence and associated factors of transactional sex for drugs among a sample of chronic opioid users.

Methods. Individuals entering treatment for opioid use disorder (N=4,366) were surveyed from 2019-2021 at one of 96 sites across the United States on sociodemographic variables, opioid use patterns, and sexual behaviors, including history of STI diagnosis and/or treatment.

Results. Transactional sex was endorsed by 24.9% of the sample. Sexual (56.6%) and gender (53.8%) minorities had significantly (p<0.001) higher rates of trading sex compared to heterosexuals and cisgender individuals (19.2% and 24.5%, respectively), as did females compared to males (33.4% vs. 18.6%). Transactional sex was associated with significantly higher rates of opioid injection (61.2% vs. 44.5%), sexual abuse history (59.0% vs. 24.4%), and psychiatric comorbidity (66.2% vs. 44.9%). Those engaging in transactional sex had higher rates of being diagnosed with at least one STI (62.3% vs. 33.9%), syphilis (14.3% vs. 4.4%), Hepatitis C (22.2 vs. 15.4%), and HIV (4.0 vs. 0.9%).

Conclusions. Transactional sex was endorsed by a significant proportion of individuals with opioid use disorder and associated with higher rates of STIs, notably syphilis and HIV. While rates were higher among females, opioid injectors and those with psychiatric comorbidity, engagement was greatest among sexual/gender minorities. All of these sub-populations of opioid users, but particularly sexual/gender minorities, should receive increased engagement with prevention and intervention programs designed to mitigate potential infection from trading sex for drugs.

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