Abstract
Demographic, behavioral, and structural factors among four mutually exclusive transactional sex categories were assessed in an online sample of 7217 sexually active US men who have sex with men (MSM): (1) No Trade Sex group (87%); (2) Sellers, accepting money or drugs for sex (5%); (3) Buyers, giving money or drugs for sex (6%); and (4) Sellers and Buyers, accepting and giving money or drugs for sex (2%). Separate multivariable logistic regressions compared men who did not report past 60-day transactional sex with men in the three transactional sex groups. Sellers were more likely to report being black or Asian (versus white), low income, a recent STI diagnosis, six or more recent male anal sex partners, and polydrug use. Buyers were more likely to report being older, higher income, urban residence, incarceration history, a recent STI diagnosis, and having non-main sex partners. Sellers and Buyers were more likely to report a higher income, incarceration history, six or more recent male anal sex partners, and polydrug use. Findings suggest that public health policy and HIV prevention harm reduction strategies should address the distinct sexual and behavioral risk patterns among MSM who engage in transactional sex based on payment direction.
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Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., et al. (2012). Antiretroviral prophylaxis for HIV-1 prevention among heterosexual men and women. The New England Journal of Medicine, 367(5), 399–410. https://doi.org/10.1056/NEJMoa1108524.
Baral, S. D., Friedman, M. R., Geibel, S., Rebe, K., Bozhinov, B., Diouf, D., et al. (2015). Male sex workers: Practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet, 385(9964), 260–273. https://doi.org/10.1016/S0140-6736(14)60801-1.
Baskin, S., Ahmed, A., & Forbes, A. (2015). Criminal laws on sex work and HIV transmission: Mapping the laws, considering the consequences. Denver Law Review, 93(2), 355–388
Berg, R. C., Schmidt, A. J., Weatherburn, P., & The EMIS Network. (2015). Transactional sex: Supply and demand among European men who have sex with men (MSM) in the context of local laws. International Journal of Sexual Health, 27(3), 286–302. https://doi.org/10.1080/19317611.2014.982263.
Biello, K. B., Oldenburg, C. E., Mitty, J. A., Closson, E. F., Mayer, K. H., Safren, S. A., & Mimiaga, M. J. (2017). The “safe sex” conundrum: Anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex. AIDS and Behavior, 21(1), 300–306.
Biello, K. B., Oldenburg, C. E., Rosenberger, J., Mayer, K. H., Novak, D., & Mimiaga, M. J. (2016). Is involvement in sex work associated with engagement in HIV-related medical care in Latin American men who have sex with men? Results of a large multinational internet survey. LGBT Health, 3(3), 233–237. https://doi.org/10.1089/lgbt.2015.0006.
Bimbi, D. S. (2007). Male prostitution: Pathology, paradigms, and progress in research. Journal of Homosexuality, 53(1–2), 7–35.
Bobashev, G. V., Zule, W. A., Osilla, K. C., Kline, T. L., & Wechsberg, W. M. (2009). Transactional sex among men and women in the south at high risk for HIV and other STIs. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 86(Suppl 1), 32–47. https://doi.org/10.1007/s11524-009-9368-1.
Bowring, A.L., Pasomsouk, N., Hughes, C., van Gemert, C., Higgs, P., Sychareun, V., Hellard, M., & Power, R. (2016). “We might get some free beers”: Experience and motivation for transactional sex among behaviorally bisexual men in Vientiane, Laos. Archives Sex Behavior, [Epub ahead of print]. doi:https://doi.org/10.1007/s10508-016-0705-7
Braine, N., van Sluytman, L., Acker, C., Friedman, S., & DesJarlais, D. C. (2010). Money, drugs, and bodies: Examining exchange sex from multiple perspectives. Journal of Gay & Lesbian Social Services, 22(4), 463–485. https://doi.org/10.1080/10538720.2010.491755.
Cambou, M. C., Perez-Brumer, A. G., Segura, E. R., Salvatierra, H. J., Lama, J. R., Sanchez, J., & Clark, J. L. (2014). The risk of stable partnerships: Associations between partnership characteristics and condomless anal intercourse among men who have sex with men and transgender women recently diagnosed with HIV and/or STI in Lima, Peru. PLoS One, 9(7), e102894. https://doi.org/10.1371/journal.pone.0102894.
Centers for Disease Control and Prevention. (2015). Paying for PrEP. Retrieved November 28, 2017, from: https:/www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-paying-for-prep.pdf
Chang, L. W., Serwadda, D., Quinn, T. C., Wawer, M. J., Gray, R. H., & Reynolds, S. J. (2013). Combination implementation for HIV prevention: Moving from evidence to population level impact. The Lancet Infectious Diseases, 13(1), 65–76. https://doi.org/10.1016/S1473-3099(12)70273-6.
Chiasson, M. A., Shuchat Shaw, F., Humberstone, M., Hirshfield, S., & Hartel, D. (2009). Increased HIV disclosure three months after an online video intervention for men who have sex with men (MSM). AIDS Care, 21(9), 1081–1089.
El-Bassel, N., Simoni, J. M., Cooper, D. K., Gilbert, L., & Schilling, R. F. (2001). Sex trading and psychological distress among women on methadone. Psychology of Addictive Behavior, 15(3), 177–184.
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., et al. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. The New England Journal of Medicine, 363(27), 2587–2599. https://doi.org/10.1056/NEJMoa1011205.
Grov, C., Breslow, A. S., Newcomb, M. E., Rosenberger, J. G., & Bauermeister, J. A. (2014). Gay and bisexual men’s use of the internet: Research from the 1990s through 2013. Annual Review of Sex Research, 51(4), 390–409.
Grov, C., Koken, J. A., Smith, M., & Parsons, J. T. (2017). How do male sex workers on craigslist differ from those on Rentboy? A comparison of two samples. Culture Health and Sexuality, 19(4), 405–421. https://doi.org/10.1080/13691058.2016.1229035.
Grov, C., Rodriguez-Diaz, C. E., & Jovet-Toledo, G. G. (2016). Male escorts’ and male clients’ sexual behavior during their last commercial sexual encounter: Comparing and contrasting findings from two online studies. Archives of Sexual Behavior, 45, 965–973. https://doi.org/10.1007/s10508-015-0531-3.
Grov, C., Rodriguez-Diaz, C. E., Jovet-Toledo, G. G., & Parsons, J. T. (2015). Comparing male escorts’ sexual behavior with their last male client versus non-commercial male partner. Culture, Health, and Sexuality, 17, 194–207. https://doi.org/10.1080/13691058.2014.961035.
Guadamuz, T., Kunawararak, P., Beyrer, C., Pumpaisanchai, J., Wei, C., & Celentano, D. D. (2010). HIV prevalence, sexual and behavioral correlates among Shan, Hill tribe, and Thai male sex workers in northern Thailand. AIDS Care, 22(5), 597–605.
Harawa, N. T., Williams, J. K., Ramamurthi, H. C., Manago, C., Avina, S., & Jones, M. (2008). Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. Archives of Sexual Behavior, 37(5), 748–762. https://doi.org/10.1007/s10508-008-9361-x.
Harcourt, C., & Donovan, B. (2005). The many faces of sex work. Sexually Transmitted Infections, 81(3), 201–206. https://doi.org/10.1136/sti.2004.012468.
Hirshfield, S., Chiasson, M. A., Joseph, H., Scheinmann, R., Johnson, W. D., Remien, R. H., Shaw, F. S., Emmons, R., Yu, G., & Margolis, A. D. (2012). An online randomized controlled trial evaluating HIV prevention digital media interventions for men who have sex with men. PLoS One, 7(10), e46252. https://doi.org/10.1371/journal.pone.0046252.
Jackman, T. (2018). House passes anti-online sex trafficking bill, allows targeting of websites like Backpage.com . The Washington Post. Retrieved June 4, 2018, from www.washingtonpost.com .
Jenness, S. M., Kobrak, P., Wendel, T., Neaigus, A., Murrill, C. S., & Hagan, H. (2011). Patterns of exchange sex and HIV infection in high-risk heterosexual men and women. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 88(2), 329–341. https://doi.org/10.1007/s11524-010-9534-5.
Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia, PA: Saunders.
Koken, J. A., Parsons, J. T., Severino, J., & Bimbi, D. S. (2005). Exploring commercial sex encounters in an urban community sample of gay and bisexual men a preliminary report. Journal of Psychology & Human Sexuality, 17, 197–213.
Levy, M. E., Wilton, L., Phillips, G., Glick, S. N., Kuo, I., Brewer, R. A., Elliott, A., Watson, C., & Magnus, M. (2014). Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS and Behavior, 18(5), 972–996. https://doi.org/10.1007/s10461-014-0719-x.
Masvawure, T. B., Sandfort, T. G. M., Reddy, V., Collier, K. L., & Lane, T. (2015). “They think that gays have money”: Gender identity and transactional sex among black men who have sex with men in four South African townships. Culture, Health & Sexuality, 17(7), 891–905. https://doi.org/10.1080/13691058.2015.1007168.
McCarthy, B., Benoit, C., & Jansson, M. (2014). Sex work: A comparative study. Archives of Sexual Behavior, 43(7), 1379–1390. https://doi.org/10.1007/s10508-014-0281-7.
Mimiaga, M. J., Reisner, S. L., Tinsley, J. P., Mayer, K. H., & Safren, S. A. (2009). Street workers and internet escorts: Contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 86(1), 54–66. https://doi.org/10.1007/s11524-008-9316-5.
Minichiello, V., Scott, J., & Callander, D. (2015). A new public health context to understand male sex work. BMC Public Health, 15, 282. https://doi.org/10.1186/s12889-015-1498-7.
Minichiello, V., & Scott, J. (Eds). Male sex work and society. (2014). Harrington Park Press, New York.
Oldenburg, C. E., Perez-Brumer, A. G., Reisner, S. L., Mattie, J., Bärnighausen, T., Mayer, K. H., & Mimiaga, M. J. (2014). Global burden of HIV among men who engage in transactional sex: A systematic review and meta-analysis. PLoS One, 9(7), e103549. https://doi.org/10.1371/journal.pone.0103549.
Oldenburg, C. E., Perez-Brumer, A. G., Reisner, S. L., & Mimiaga, M. J. (2015). Transactional sex and the HIV epidemic among men who have sex with men (MSM): Results from a systematic review and meta-analysis. AIDS and Behavior, 19(12), 2177–2183. https://doi.org/10.1007/s10461-015-1010-5.
Oldenburg, C. E., Perez-Brumer, A. G., Biello, K. B., Landers, S. J., Rosenberger, J. G., Novak, D. S., et al. (2015). Engagement in transactional sex among men who have sex with men in Latin America: A multilevel analysis of economic, sociodemographic, and psychosocial factors. American Journal of Public Health, 105(5), e95–e102. https://doi.org/10.2105/AJPH.2014.302402.
Pitts, M. K., Smith, A. M. A., Grierson, J., O’Brien, M., & Misson, S. (2004). Who pays for sex and why? An analysis of social and motivational factors associated with male clients of sex workers. Archives of Sexual Behavior, 33(4), 353–358. https://doi.org/10.1023/B:ASEB.0000028888.48796.4f.
Prestage, G., Mao, L., Jin, F., Grulich, A., Kaldor, J., & Kippax, S. (2007). Sex work and risk behavior among HIV-negative gay men. AIDS Care, 19(7), 931–934.
Prestage, G., Jin, F., Bavinton, B., & Hurley, M. (2014). Sex workers and their clients among Australian gay and bisexual men. AIDS and Behavior, 18(7), 1293–1301. https://doi.org/10.1007/s10461-014-0755-6.
Reilly, K. H., Neaigus, A., Jenness, S. M., Wendel, T., Marshall, D. M., & Hagan, H. (2014). Factors associated with recent HIV testing among men who have sex with men in New York City. AIDS and Behavior, 18(Suppl. 3), 297–304.
Rekart, M. L. (2005). Sex-work harm reduction. Lancet, 366(9503), 2123–2134.
Shahmanesh, M., Patel, V., Mabey, D., & Cowan, F. (2008). Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: A systematic review. Tropical Medicine & International Health, 13(5), 659–679.
Shefer, T., Clowes, L., & Vergnani, T. (2012). Narratives of transactional sex on a university campus. Culture, Health, & Sexuality, 14(4), 435–447. https://doi.org/10.1080/13691058.2012.664660.
Smith, M. D., & Grov, C. (2011). In the company of men: Inside the lives of male prostitutes (sex, love, and psychology). Praeger, Santa Barbara: CA.
Smith, M. D., & Seal, D. W. (2008). Motivational influences on the safer sex behavior of agency-based male sex workers. Archives of Sexual Behavior, 37(5), 845–853. https://doi.org/10.1007/s10508-008-9341-1.
Smith, M. D., Grov, C., & Seal, D. W. (2008). Agency-based male sex work: A descriptive focus on physical, personal, and social Space. The Journal of Men's Studies, 16(2), 193–210.
Underhill, K., Morrow, K. M., Colleran, C., Holcomb, R., Calabrese, S. K., Operario, D., et al. (2015). A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by U.S. male sex workers and other men who have sex with men: Implications for biomedical HIV prevention. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 92(4), 667–686. https://doi.org/10.1007/s11524-015-9961-4.
US Food and Drug Administration (USFDA). (2012). OraQuick In-Home HIV TEST. Retrieved December 17, 2017, from http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm310436.htm .
Vanwesenbeeck, I. (2013). Prostitution push and pull: Male and female perspectives. Journal of Sex Research, 50(1), 11–16. https://doi.org/10.1080/00224499.2012.696285.
Weber, A. E., Craib, K. J., Chan, K., Martindale, S., Miller, M. L., & Schechter, M. T. (2001). Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. International Journal of Epidemiology, 30, 1449–1456.
Weitzer, R. (2005). New directions in research on prostitution. Crime, Law, & Social Change, 43, 211–235.
Acknowledgments
Primary support was provided by the Centers for Disease Control and Prevention (UR6 PS000415), where technical assistance was provided through a federal cooperative agreement in the design and conduct of the study. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The first author was supported as a postdoctoral fellow in the Behavioral Sciences Training in Drug Abuse Research program sponsored by National Development and Research Institutes, Inc. and New York University Rory Meyers College of Nursing with funding from the National Institute on Drug Abuse (T32 DA007233); the first author is also a Research Education Institute for Diverse Scholar recipient (REIDS) (R25MH087217).
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This study was funded by the Centers for Disease Control and Prevention (UR6 PS000415), where technical assistance was provided through a federal cooperative agreement in the design and conduct of the study.
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Bond, K.T., Yoon, I.S., Houang, S.T. et al. Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based U.S. Sample of Men Who Have Sex with Men. Sex Res Soc Policy 16, 255–267 (2019). https://doi.org/10.1007/s13178-018-0366-5
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DOI: https://doi.org/10.1007/s13178-018-0366-5