Background Women who inject drugs are at elevated risk for many adverse health outcomes, including sexually transmitted infections (STIs). Exchange sex is prevalent in this population, but its independent effect on STIs is unclear.

Methods We included data regarding the past year from cisgender women age <60 who reported injecting drugs and participated in the 2015 or 2016 cycles of the National HIV Behavioral Surveillance (NHBS) survey in Seattle (N=377). Using a log-binomial regression model, we estimated the odds of self-reported bacterial STI (gonorrhea, syphilis, or chlamydia) among women who inject drugs associated with exchanging sex for money or drugs. We adjusted for sociodemographic characteristics, condom use, and substance use behaviors. We hypothesized that engaging in exchange sex would be independently associated with increased odds of STI.

Results The period prevalence of bacterial STI in the past 12 months was 8.1% in the full sample. On univariate analysis, STI prevalence was significantly higher among women who reported exchange sex than among those who did not (10.8% vs 4.0%; p=0.02) as was STI testing (53.4% vs 34.0%; p<0.01). Women who exchanged sex were less likely to report condomless vaginal or anal sex at last intercourse (84.4% vs 89.1%; p=0.19). Women who exchanged sex were more likely to use non-injection crack (59.1% vs 38.8%; p<0.01) and were more likely to report heavy alcohol use (31.3% vs 19.7%; p=0.01). After adjusting for sociodemographic variables, condom use, and substance use; the association between exchange sex and STI remained statistically significant (adjusted odds ratio=2.7; 95% confidence interval: 1.1–7.2).

Conclusion In this sample of Seattle area women who inject drugs, exchanging sex for drugs or money was associated with double the odds of STI which could be a result of more frequent STI testing. Healthcare providers should prioritize making testing and treatment accessible and appropriate for women who exchange sex.

Disclosure No significant relationships.