AIDS and Behavior

, Volume 23, Issue 11, pp 2946–2955 | Cite as

The Relationship Between Economic Deprivation, Housing Instability and Transactional Sex Among Women in North Carolina (HPTN 064)

  • Marie C. D. StonerEmail author
  • Danielle F. Haley
  • Carol E. Golin
  • Adaora A. Adimora
  • Audrey Pettifor
Original Paper


Transactional sex is associated with socioeconomic disadvantage and HIV risk but few studies in the United States (US) have examined both individual and area-level predictors of transactional sex or distinguished transactional sex from sex work. We combined data from HIV Prevention Trials Network 064 study and the US Census to estimate prevalence ratios (PR) for the relationship between census-level and individual measures of economic deprivation and housing instability on transactional sex in 417 women in North Carolina. Increased transactional sex was associated with food insecurity (PR 1.86; 95%; CI 1.57, 2.19), housing instability (PR 1.33; 95% CI 1.11, 1.59), substance abuse (PR 1.90; 95% CI 1.64, 2.19) and partner incarceration (PR 1.32; 95% CI 1.09, 1.61). Census-level indicators were not associated with transactional sex, adjusted for individual-level covariates. Interventions should support housing stability and financial opportunities among southern African American women to reduce HIV risk, particularly among women with incarcerated partners.


Transactional sex Economic deprivation Housing instability Multilevel 



Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1AI068619. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Carolina Population CenterUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Health SciencesNortheastern UniversityBostonUSA
  3. 3.Department of MedicineUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Health BehaviorUniversity of North CarolinaChapel HillUSA
  5. 5.Department of EpidemiologyUniversity of North CarolinaChapel HillUSA
  6. 6.Institute for Global Health and Infectious DiseasesUniversity of North CarolinaChapel HillUSA

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