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Sex Trade and Health Care Utilization Among People Living with HIV/AIDS

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Abstract

People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.

Resumen

Las personas que viven con VIH/SIDA (SLWH) tienes más probabilidades de tener un historial de comercio sexual, poca investigación ha examinado si el comercio sexual está asociado con una menor utilización de atención médica entre las personas PLHW. Este estudio evalúa la asociación con PLWH (N = 583) reclutados y encuestados en seis ciudades en los Estados Unidos. Los participantes fueron 90.6% Negros o Latinos, 30.4% sin hogar y 9.0% (1 en 11) vendió sexo (últimos 90 días). La mayoría informo que recibió atención médica (63.9%, últimos 6 meses) y manejo de caso VIH (68.9%, el pasado año), pero 35.7% perdió una cita médica (últimos 3 meses). En los modelos de regresión ajustada, el sexo comercial fue asociado con una cita médica perdida (OR = 2.31), después de 90 días, pero sin atención o servicios de apoyo VIH. El comercio sexual puede comprometer el uso constante de atención medica en las PLWH.

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Acknowledgements

The authors would like to thank the community-based agencies, staff, and participants of the larger HIV Test and Treat initiative, as well as the Kaiser Permanente Community-Based HIV Test and Treat Study Team (Alexandra X. Caraballo, John Edmiston, Pamela M. Schwartz, Melissa Ramos), without whom this study would not be possible. Specifically, we would like to thank the following agencies and staff of the HIV Test and Treat Initiative that worked closely with us: Action.Skills.Knowledge.4Care (ASK4Care), Duke Global Health Institute—Beth Stringfield, Sara LeGrand; Fortune Society—Nilda Ricard, Brendan O’Connell, Adrian Assina; Institute for Public Health Initiative (IPHI)—Abbi Charles, Bradley Boekeloo; John Wesley Community Health (JWCH) Institute—Christopher Hucks-Ortiz, Sergio Avina, Orlando Rivera; North Jersey Community Research Initiative (NJCRI)—Corey Rosmarin-DeStefano, Liliane Windsor; Public Health Institute (PHI)—Mariko Iwamoto, Tooru Nemoto, Jasmine McKay; and Women Organized to Respond to Life-Threatening Diseases (WORLD)—Cynthia Carey-Grant, Stephanie Cornwell, Samantha Feld. We are also indebted to the countless hours of administrative and analytic support provided by Sankari Ayyaluru, Emma Jackson, Sanne P. Møller and Osika Tripathi, respectively. The writing/analysis of this manuscript was also supported by NIDA K01036439 (Urada) & NIDA K01039767 (Smith).

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Authors and Affiliations

  1. School of Social Work, San Diego State University, Hepner Hall #119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA

    Lianne A. Urada

  2. Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA

    Lianne A. Urada, Laramie R. Smith, Jennifer Yore, Daniel P. Triplett & Anita Raj

  3. JWCH Institute, Inc., Los Angeles, CA, USA

    Christopher Hucks-Ortiz

  4. Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA

    Anita Raj

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Sites obtained site-specific institutional review board approval, and the Institutional Review Board of the University of California San Diego provided approval for the overall cross-site evaluation study protocol (Ref: 130077/2013).

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Urada, L.A., Smith, L.R., Yore, J. et al. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav 22, 2553–2563 (2018). https://doi.org/10.1007/s10461-018-2131-4

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