Predictors of transactional sex among young MSM of color

• In Event: 3-194 - Multilevel Risk Factors and Sexual Behavior in Diverse Adolescents

Integrative Statement

BACKGROUND: In the U.S., young men who have sex with men (YMSM) of color are disproportionately impacted by sexually transmitted infections (STIs). To develop effective disease control measures, researchers must better understand the distal and proximal predictors of increased STI prevalence among this vulnerable population. In this study, we examine the role of multiple behavioral, social, and psychological factors as predictors of transactional sex, a distal predictor of STI prevalence (Edwards, 2006), among Latino, Black, and mixed race YMSM.
METHODS: Data were collected from 448 YMSM in Los Angeles between June 2016 and September 2017. Individuals were eligible to participate if they were 16- to 24-years; male; self-identified as gay, bisexual, or uncertain; had had a same-sex encounter within the previous 12 months; and self-identified as Black/African American, Latino/Hispanic, or multi-ethnic.
We used modified poisson regression (Zou, 2004) to examine the relationship between multiple variables and transactional sex. Transactional sex was defined as exchanging sex sex in the past six months for money, drugs, a place to stay, a ride, travel, clothes, or jewelry. :
The following variables were assessed in the full model in the full model: demographics (age, employment status), substance use (binge drinking, cigarette use, marijuana use, illicit drug use), financial security (hunger in the past 12 months, basic needs not being met in the last 3 months), and social support from family, friends, and significant others. Manual backward elimination procedures (Maldonado & Greenland, 1993) were used to reduce the full model.
RESULTS: Participants were a median age of 22 (IQR: 20,23). The majority of participants were Latino (59%), 22% were African-American, and 20% were mixed race/ethnicity. 16% of men reported engaging in transactional sex within the past six months. 67% of participants were employed at the time of interview, while 54% reported not having enough money to meet basic needs in the past three months and 23% reported not having enough to eat in the last 12 months. 12% of participants were HIV-positive. Use of substances was common, with 65% reporting drinking 6 or more drinks in a single episode within the past six months, 82% reported marijuana use in the past six months, 60% reported cigarette use in the past six months, and 53% reported illicit drug use in the past 6 months.
After backwards elimination, age, not having enough money to meet basic needs, and illicit drug use were retained in the model. In the final adjusted model, illicit drug use was significantly associated with transactional sex (adjusted PR:2.03, 95% CI: 1.18,3.51), controlling for the other variables in the model. Prevalence of transactional sex decreased with increasing age (aPR:0.84, 95% CI: 0.75,0.95) and was higher among YMSM who reported not having basic needs met (aPR:1.97, 95% CI: 1.16,3.36).
CONCLUSIONS: Younger YMSM who use illicit drugs and/or who don’t have enough money to meet basic needs are significantly more likely to engage in transactional sex. Given the relationship between transactional sex and STI acquisition, these results provide important guidance for future intervention programming.

Authors

• Cara Exten Rice, Pennsylvania State University
  Presenting Author

• Katrina Kubicek, Children's Hospital of Los Angeles
  Non-Presenting Author

• Michelle D. Kipke, Children's Hospital of Los Angeles
  Non-Presenting Author