Correlates of Transactional Sex Among a Rural Population of People Who Inject Drugs

  • Sean T. AllenEmail author
  • Rebecca Hamilton White
  • Allison O’Rourke
  • N. Jia Ahmad
  • Tim Hazelett
  • Michael E. Kilkenny
  • Susan G. Sherman
Original Paper


In the United States, high rates of HIV infection among persons who engage in transactional sex are partially driven by substance use. Little is known about transactional sex among rural populations of people who inject drugs (PWID). Using data from a 2018 survey of 420 rural PWID in West Virginia, we used logistic regression to identify correlates of recent transactional sex (past 6 months). Most study participants were male (61.2%), white (83.6%), and reported having injected heroin (81.0%) in the past 6 months. Nearly one-fifth (18.3%) reported engaging in recent transactional sex. Independent correlates of transactional sex were: being female [adjusted odds ratio (aOR) 3.90; 95% CI 2.12–7.16]; being a sexual minority (aOR 3.07; 95% CI 1.60–5.87); being single (aOR 3.22; 95% CI 1.73–6.01); receptive syringe sharing (aOR 3.13; 95% CI 1.73–5.66); and number of injections per day (aOR 1.08; 95% CI 1.01–1.15). Rural PWID who engage in transactional sex are characterized by multiple vulnerabilities that increase their HIV risk.


HIV Transactional sex Rural health People who inject drugs 



This research was supported by a Grant from the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health to Dr. Sean T. Allen. This research has been facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. STA is also supported by the National Institutes of Health (K01DA046234). The funders had no role in study design, data collection, or in analysis and interpretation of the results, and this paper does not necessarily reflect views or opinions of the funders. We are grateful to the collaboration of the Cabell Huntington Health Department, without whom, this project would not have been possible. We are especially grateful to Thommy Hill, Tyler Deering, Kathleen Napier, Jeff Keatley, Michelle Perdue, Chad Helig, and Charles “CK” Babcock for all their support throughout the study implementation. We are also grateful for the hard work of the West Virginia COUNTS! research team: Megan Keith, Anne Maynard, Aspen McCorkle, Terrance Purnell, Ronaldo Ramirez, Kayla Rodriguez, Lauren Shappell, Kristin Schneider, Brad Silberzahn, Dominic Thomas, Kevin Williams, and Hayat Yusuf. We gratefully acknowledge the West Virginia Department of Health and Human Resources. We also wish to acknowledge Josh Sharfstein, Michelle Spencer, Dori Henry, and Akola Francis for their support throughout each phase of the study. Most importantly, we are grateful to our study participants.

Compliance with Ethical Standards

Conflict of interest

None of authors have any conflicts of interest.


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Copyright information

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

Authors and Affiliations

  1. 1.Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.DC Center for AIDS ResearchDepartment of Psychology at the George Washington UniversityWashingtonUSA
  3. 3.Cabell-Huntington Health DepartmentHuntingtonUSA

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