Prevalence and Correlates of Sex Exchange Among a Nationally Representative Sample of Adolescents and Young Adults

The present study examines prevalence and correlates of exchanging sex for drugs, money, food shelter, or other favors (sex exchange) among a nationally representative sample of youth and young adults. Adolescents and young adults (n = 11,620, 53% female, 47% male) from the National Longitudinal Study of Adolescent Health were used for the current sample. Participants completed in-home interviews at both waves. Results revealed that sex exchange was reported by 4.9% (n = 569) of the population in wave 2 or wave 3, and 4.6% (n = 26) of those who exchanged sex did so at both waves. More males reported exchanging sex than females (n = 332 versus n = 237). Respondents who reported child sexual abuse were more likely to exchange sex (95% CI 2.51–4.28, p < .05) than respondents who reported any other form of child abuse. Both males and females who engaged in sex exchange were at greater risk for sexually transmitted infections; however, the odds of ever exchanging sex were highest among males who ever had gonorrhea (OR = 6.2; 95% CI 3.75–10.3). Although sex exchange has been studied extensively among homeless and runaway youth, the current study reveals sex exchange also occurs in the general population.     

Risk behaviors and perceptions of AIDS among street injection drug users

Standardized survey interviews (n = 325) and guided in-depth interviews (n = 22) were conducted with injection drug users (IDUs) in Long Beach, California, to document drug usage and injection patterns, sexual practices, perceived risk of HIV infection, sources of health information, and knowledge and attitudes about AIDS. Most IDUs reported sharing needles (87.9%), and a large minority reported regular sterilization of needles/syringes (40.3%). Lower rates of needle sharing were reported among cocaine users than among heroin and speedball users. HIV seroprevalence was 5.7 percent (11/194). Sexually active female (60.7%) and male (20.5%) IDUs reported exchanging sex for money or drugs. Overall, 48.3 percent of IDUs reported having made changes in their injection practices and one-third reported modifying their sexual behavior in order to avoid HIV infection. Differences in drug use, sexual practices, and drug treatment history were found with regard to gender, ethnicity, age, and type of drug injected. Implications of findings for the development of AIDS risk-reduction programs are presented.     

Sexual decision making and safer sex behavior among young female injection drug users and female partners of IDUs

Data from interviews with 94 young women who were injection drug users (IDUs) or partners of IDUs were analyzed to examine associations between self-reported sexual decision making and condom use, contraceptive use, and relationship characteristics. Most women (73-85%) reported participating in decisions about condom use, contraception, and when to have sex. Adjusting for potential covariates, respondents who reported participating in decisions about condom use and when to have sex were 7 and 19 times, respectively, more likely than others to report recently using condoms. Respondents who reported participating in decisions about contraception were 20 times more likely than others to report recently using contraceptives. Longer sexual relationships were associated with decreased likelihood of condom or contraceptive use.     

The relationship between adult sexual assault and prostitution: an exploratory analysis

Previous research has established a link between childhood sexual abuse and engaging in prostitution as an adult. The purpose of this study was to extend this literature by exploring whether being raped as an adult is associated with exchanging sex for money. Interviews with 102 rape survivors in a major metropolitan area revealed that 23.5% had engaged in prostitution post-rape. Those who had exchanged sex for money were more likely to be women of color, to have a high school education or less, to be unemployed, and to have children to support, than those who had not engaged in prostitution post-assault. The prostitution subsample also had significantly higher levels of psychological distress, physical health symptomatology, and substance use. Survivors were asked whether and how the rape was associated with engaging in prostitution: most (75%) stated that they felt it was related to the assault. The most commonly cited reason for engaging in prostitution by these survivors was that they were trying to regain some control over their lives and their bodies; exchanging sex for money was seen as one way to control men's access to them. Implications for future research on victimization and prostitution are discussed.     

Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.     

Trading sex: Voluntary or coerced? The experiences of homeless youth

This study examined the circumstances surrounding a homeless youth's “decision “ to trade sex for food, money, shelter, or drugs. Forty homeless youth in 4 Midwestern states participated in individual, in‐depth qualitative interviews. Interviewers recruited youth through both service agencies and street outreach. The findings revealed that approximately one third of the sample had some experience with trading sex, whether it was in the form of having traded sex, having been propositioned to trade sex but having refused, or having friends or acquaintances that had traded sex. Young people's reports indicated that they had traded sex for things they deemed necessary in order to survive (i.e., food, shelter, money, or drugs) and that they did not want to trade sex, but did so because they were desperate and lacked alternatives. Additionally, others were coerced, manipulated, or forced to do so, indicating that the decision to trade sex is not always voluntary. We discuss the implications of these findings in terms of cumulative effects on youths’ later development. Directions for future research among this population are also discussed.     

Trading sex: voluntary or coerced? The experiences of homeless youth

This study examined the circumstances surrounding a homeless youth's "decision" to trade sex for food, money, shelter, or drugs. Forty homeless youth in 4 Midwestern states participated in individual in-depth qualitative interviews. Interviewers recruited youth both through service agencies and through street outreach. The findings revealed that approximately 1/3 of the sample had some experience with trading sex, whether it was in the form of having traded sex, having been propositioned to trade sex but having refused, or having friends or acquaintances that had traded sex. Young people's reports indicated that they had traded sex for things they deemed necessary in order to survive (i.e., food, shelter, money, or drugs), and that they did not want to trade sex, but did so because they were desperate and lacked alternatives. Additionally, others were coerced, manipulated, or forced to do so; thus indicating that the decision to trade sex is not always voluntary. We discuss the implications of these findings in terms of cumulative effects on youths' later development. Directions for future research among this population are also discussed.     

Effects of accuracy feedback versus monetary contingency on arousal in high and low frequency gamblers

This study examined the effects on arousal of feedback regarding prediction accuracy without monetary gain or loss versus accuracy feedback combined with monetary contingency involved in most gambling. Physiological and subjective arousal was assessed in frequent (n = 35; 16 females) and infrequent gamblers (n = 35; 16 females) during participation in a laboratory gambling game. Both samples consisted of undergraduate student volunteers. In one condition, subjects gambled money on their predictions about a sequence of events, hence receiving both feedback and monetary outcome. In the other condition, only feedback about accuracy was provided, with no money wagered. Arousal was greater for both groups during actual gambling than in the feedback only condition. Across both conditions, frequent gamblers exhibited greater arousal than did infrequent gamblers. There were, however, no significant Group X Condition interactions. These results suggest that actual monetary contingency rather than accuracy feedback alone is most motivating in gambling. Methodological limitations possibly related to the lack of Group X Condition interactions were discussed.     

Puerto Rican injection drug users: Prevention implications in Massachusetts and Puerto Rico

This study examines whether place of residence is a factor associated with reporting a positive HIV/AIDS, Hepatitis C (HCV), or Sexually Transmitted Disease (STD) status in a sample of 400 injection drug users (IDUs) residing on the Island of Puerto Rico (N=139) and in western Massachusetts (N=261). Logistic regression models revealed that IDUs residing in western Massachusetts were 66% less likely to be HIV positive compared to IDUs residing in Puerto Rico (p<.000) while IDUs residing in western Massachusetts were about 67% less likely to have a positive STD status than those residing in Puerto Rico (p<.000). Place of residence was not significantly associated with HCV status. Results indicate the need to develop prevention programs tailored to the unique socio-cultural context of Puerto Rican IDUs residing on the Island of Puerto Rico whose circumstances differ from those in the mainland US. To reduce drug use, HIV/AIDS, HCV, and STDs among Puerto Ricans in both locales, the Capacity Enhancement Model is proposed in order to develop more effective prevention programs.     

F.A.D.E. A.W.A.Y.-The Financial Affairs of Dementing Elders and Who Is the Attorney?

The financial affairs of twenty-five community dwelling elders with dementia who had lost financial competence were studied by a semi-structured interview with the main carer. Many elders had no access to their own money. Inappropriate management was revealed in twenty-four cases although professionals had been consulted previously in most instances. Legal advice was sought in six cases and resulted in four procedures which were rendered invalid by confusion. In six cases pensions were collected by local authority employees without appropriate authority. Most financial institutions when contacted had no written policy for controlling the resources of those who have lost financial competence.     

Sexual Risk Behavior Among Women with Injected Drug Use Histories

This study documents the sexual risk, behavior for HIV infection and transmission in inner-city women with a history of injected drug use (IDU). The sample consists of N = 38 HIV+ and N = 37 HIV- women who were demographically comparable. A surprisingly high number of women in both. groups reported both male and female sex partners during their lifetime, and significantly more HIV+ women currently identified as bisexual and lesbian. Overall, HIV+ women had had more lifetime male and female sex partners, although the two groups did not differ in their current sexual behavior regarding numbers of partners and sex occasions. Both groups of women had little information about risk characteristics of their male sex partners, except for a history of IDU that was common among partners of both HIV+ and HIV- women. Sex for money was practiced by a subgroup of women in both groups and sex in exchange for drugs by very few women. A disturbingly high number of HIV+ and HIV- women reported occasions of unprotected sex during the past six months (86% vs. 97%), a finding that suggests that educational efforts for behavior change in IDU women need to be intensified.     

Social Exchange and Sexual Behavior in Young Women's Premarital Relationships in Kenya

Transactional sex, or the exchange of money and gifts for sexual activities within nonmarital relationships, has been widely considered a contributing factor to the disproportionate prevalence of HIV/AIDS among young women in sub-Saharan Africa. This study applied social exchange theory to premarital relationships in order to investigate the linkages between a variety of young women's resources-including employment and material transfers from male partners-and sexual behaviors. Data on the first month of premarital relationships (N=551 relationships) were collected from a random sample of young adult women ages 18-24 in Kisumu, Kenya, using a retrospective life history calendar. Consistent with the hypotheses, results showed that young women's income increases the likelihood of safer sexual activities, including delaying sex and using condoms consistently. Material transfers from the male partner displayed the opposite effect, supporting the view that resources obtained from within the relationship decrease young women's negotiating power.     

The encounter with family violence and risky sexual activity among young adolescent females

In this article, we analyze the relationship between family violence and risky sexual activity for female adolescents (age 14 to 17). We examine two forms of family violence: experience (receiving physical abuse from a parent or parent-figure) and exposure (witnessing interparental physical violence). We hypothesize that either form of violence will predict greater odds of engaging in risky sexual behavior. We define risky sexual activity as any of the following: having multiple partners within the last 12 months or having sex with partners who are themselves engaging in risky behavior (e.g., having multiple partners of either sex, injecting unprescribed drugs, sharing unprescribed needles for injecting drugs). We analyzed data from 710 respondents taken from the National Survey of Family Growth, Cycle V, living with at least one biological parent. Results showed that experiencing violence from a parent greatly increased the likelihood of risky sex, even when controlling for the experience of forced sex, age, mother's age at first birth, race, socioeconomic status, and religiosity. Female adolescents who had experienced forced sex, those who were older (especially 17-year-olds), non-Hispanic Blacks (but not Hispanics), those living in a family with low educational attainment (less than a high school diploma), and those for whom religion was not or only somewhat personally important were more likely to report risky sex compared to others. These effects were not modified by whether the respondents lived in single- or two-parent families. An interaction between the two forms of physical violence suggests that either form is sufficient to increase significantly the odds of risky sex; an analysis in which respondents were differentiated by their experience of either form of violence showed a strong effect of experience on risky sex, net of the control variables.     

Sexual deception as a social-exchange process: development of a behavior-based sexual deception scale

The use of deception in association with sexual encounters may take many forms, ranging from outright lies to more subtle, evasive manipulations. To address such deceptions, a behavior-based sexual deception scale was developed utilizing social exchange theory. Participants were 267 individuals associated with two large universities who were surveyed regarding different aspects of their sexual deceptive behaviors. In addition, items addressing sexually related behaviors and attitudes were assessed for validation purposes. Principal components analysis identified three components of sexual deception, labeled Blatant Lying, Self-Serving, and Avoiding Confrontation. Confirmatory factor analysis verified the resulting structure, and promising validity was noted. In general, those using any of these deceptions reported more sexual partners and one-night stands. Those telling blatant lies to have sex were more likely to report greater needs for sex, while those using self-serving lies or having sex to avoid confrontation experienced greater worry about partner loss. Men were more likely to use blatant lies to have sex, while women were more likely to have sex to avoid confrontation. Results support sexual deception as an exchange process, with sex for pleasure and positive relationship outcomes acting as rewards, and unwanted sex and deception consequences as costs. Implications for health interventions and primary prevention applications are discussed.     

“You Still Need to Give Her a Token of Appreciation”: The Meaning of the Exchange of Money in the Sexual Relationships of Out-of-School Adolescents in Rural Southwest Uganda

This article challenges the pervasive assumption that exchanging gifts and money in adolescent sexual relationships is transactional. Data were derived from a multi-method, qualitative sexual health needs assessment of 31 out-of-school adolescents in rural southwest Uganda. Grounded theory analysis allows contextual meanings of exchange to emerge. Adolescents have developed gendered courting and exchange models that parallel marital relationships in this cultural context. Whereas exchange is considered transactional and immoral in some types of relationships, in adolescent relationships, it is not. Young women are not ashamed of, or stigmatized by, the exchange; they are proud of it. The exchange signifies several things: self-respect and a partner's willingness to wait for the relationships to become sexual and, therefore, that they are valued and respected by their partners. This demonstrates commitment from a partner, whose role is as a provider. To expect no gift or to have sex for pleasure are the hallmarks of the worst kind of woman—a malaya. “Need” is the only acceptable rationale for extramartial sex for any woman in this sexual value system. Interventions promoting longer courting and sustained support for one partner would encourage a delay in debut for young women and encourage greater monogamy in young men.     

Sexual Deception as a Social-Exchange Process: Development of a Behavior-Based Sexual Deception Scale

The use of deception in association with sexual encounters may take many forms, ranging from outright lies to more subtle, evasive manipulations. To address such deceptions, a behavior-based sexual deception scale was developed utilizing social exchange theory. Participants were 267 individuals associated with two large universities who were surveyed regarding different aspects of their sexual deceptive behaviors. In addition, items addressing sexually related behaviors and attitudes were assessed for validation purposes. Principal components analysis identified three components of sexual deception, labeled Blatant Lying, Self-Serving, and Avoiding Confrontation. Confirmatory factor analysis verified the resulting structure, and promising validity was noted. In general, those using any of these deceptions reported more sexual partners and one-night stands. Those telling blatant lies to have sex were more likely to report greater needs for sex, while those using self-serving lies or having sex to avoid confrontation experienced greater worry about partner loss. Men were more likely to use blatant lies to have sex, while women were more likely to have sex to avoid confrontation. Results support sexual deception as an exchange process, with sex for pleasure and positive relationship outcomes acting as rewards, and unwanted sex and deception consequences as costs. Implications for health interventions and primary prevention applications are discussed.     

Sex in America online: an exploration of sex, marital status, and sexual identity in internet sex seeking and its impacts

This was an exploratory study of sex and relationship seeking on the Internet, based on a survey of 15,246 respondents in the United States Seventy-five percent of men and 41% of women had intentionally viewed or downloaded porn. Men and gays/lesbians were more likely to access porn or engage in other sex-seeking behaviors online compared with straights or women. A symmetrical relationship was revealed between men and women as a result of viewing pornography, with women reporting more negative consequences, including lowered body image, partner critical of their body, increased pressure to perform acts seen in pornographic films, and less actual sex, while men reported being more critical of their partners' body and less interested in actual sex. Married and divorced were more likely than singles to go online seeking a serious relationship. Only 2% of users met the threshold of compulsive use established by previous studies.     

Sexual self control as a mediator of high risk sexual behavior in a New York city cohort of HIV+ and HIV‐ gay men

This paper describes the development of the Perceived Sexual Control inventory (PSC) and a study investigating the relationship between an individual's perception of control over sexual behavior and actual sexual risk behavior in a New York City cohort of 108 HIV+ and 48 HIV‐ gay men. Correlational analysis indicated that reported difficulty controlling sexual behavior was associated with having more male sex partners and sex occasions over lifetime and in the 6 months prior to interview, with a greater number of one‐time partners and out‐of‐home partners, with less monogamy, and with being abstinent in the prior 6 months. Those who perceived difficulty with sexual control were significantly more likely to use cocaine or amyl nitrate (poppers) during sex, to do so on more occasions and to use more drugs overall. Additionally, perceptions of sexual control were found to relate to high risk sexual practices. Those lower in perceived sexual control reported more occasions of receiving anal ejaculation than those who reported greater sexual control. Two subscales (Perceived Control Over Sex Drive and Perceived Control Over Risk Behavior), derived via factor analysis from the 20‐item inventory used to assess perceived sexual control, were also examined in relation to the above variables, and differential findings are discussed. The overall pattern of findings supports the construct validity of the PSC.     

Trauma and health risk behaviors in people with severe mental illness

The current study tests the association between a composite measure of unsafe sex and sharing syringes for drug use with six of the more common lifetime traumatic/stressful events in 421 community mental health clients with severe mental illness (SMI) while controlling for psychiatric symptoms and related problems. A small but significant proportion of respondents said they had injected drugs with a shared needle in their lifetime (30, 7.2%), and a much larger proportion of respondents had engaged in unprotected sex (165, 39.2%). Unprotected sex and needle sharing were significantly correlated (Spearman’s rho = .20, p < .01). Frequency of lifetime traumatic events that occurred at least once was reported by one third to three quarters of clients depending on type of trauma. Regression analysis revealed that substance abuse and lifetime homelessness were significantly correlated with health risk behaviors. Practitioners need to be continuously vigilant to comorbid substance use and the housing needs of people with SMI. Limitations of the study include its cross-sectional design.