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Individual, Network, and Neighborhood Correlates of Exchange Sex Among Female Non-Injection Drug Users in Baltimore, MD (2005–2007)

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Abstract

The “HIV risk environment” has been characterized as a dynamic interplay between structural and network factors. However, most HIV prevention research has not examined the independent and combined impact of network and structural factors. We aimed to identify individual, network, and neighborhood correlates of exchange sex (≥1 exchange sex partner, past 90 days) among female non-injection drug users (NIDUs). We used baseline data from 417 NIDUs enrolled in a randomized HIV prevention trial in Baltimore (2005–2007). Surveys ascertained demographic variables, drug/sex risk behaviors, neighborhood perceptions, and social/sexual network characteristics. Correlates of exchange sex were identified with descriptive statistics and log-binomial regression. Our findings suggest that sex and drug relationships among female NIDUs are interlinked and may be difficult to modify without altering social norms. Strengthening ties that provide social support but not drug support and reducing ties that provide both drug and social support may facilitate reductions in individual-level HIV-risk behaviors.

Resumen

El “ambiente de riesgo para VIH” se ha caracterizado como una interacción dinámica entre los factores estructurales y de redes sociales. Sin embargo, la mayoría de las investigaciones en la prevención del VIH no han examinado el impacto independiente y combinado de los factores estructurales y de las redes sociales. El objetivo fue identificar la correlación entre los factores individuales, de las redes sociales, y del vecindario con el intercambio de relaciones sexuales (≥1 pareja de intercambio sexual en los últimos 90 días) entre las mujeres que usan drogas no inyectables (UDNIs). Se utilizaron los datos de 417 mujeres UDNIs incluidas en un estudio aleatorio de prevención del VIH en Baltimore (2005–2007). Los cuestionarios incluyeron variables demográficas, de conductas de riesgo (sexual y drogas), percepciones del vecindario, y características de las redes sociales y sexuales. Estadísticas descriptivas y de regresión log-binomial se utilizaron para identificar las correlaciones con las relaciones sexuales de intercambio. Los resultados sugieren que las relaciones sexuales y de drogas entre las mujeres UDNIs están vinculadas y pueden ser difíciles de modificar sin alterar las normas sociales. El fortalecimiento de los vínculos con los que se brinda apoyo social pero no apoyo para drogas y la reducción de los vínculos con los que brindan ambos tipos de apoyo pueden facilitar la reducción de comportamientos de riesgo para VIH.

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Acknowledgments

This work was funded by the National Institute on Mental Health (Grant number R01 MH66810). Further support for this work was provided by the National Institute on Mental Health (Grant number R25 MH080644) and the National Institute on Drug Abuse (Grant numbers T32 DA023356, T32DA007292, and R01 DA028766).

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Correspondence to Abby E. Rudolph.

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Rudolph, A.E., Linton, S., Dyer, T.P. et al. Individual, Network, and Neighborhood Correlates of Exchange Sex Among Female Non-Injection Drug Users in Baltimore, MD (2005–2007). AIDS Behav 17, 598–611 (2013). https://doi.org/10.1007/s10461-012-0305-z

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