The mean age of the participants was More than half Most self-identified as bisexual Just under two thirds The majority of participants reported experiencing childhood sexual abuse Those who engaged in sex trading were also more likely to report childhood maltreatment.
Eligibility criteria included use of illicit drugs not including marijuana at least once in the past 30 days and for at least 2 days of the past 90 days, having engaged in sexual behavior with another male in the past 60 days, and being at least 18 years of age. We assessed the association of sex trading with age, ethnicity, self-identified sexual orientation, formal education, homelessness, and childhood maltreatment among a high-risk sample of predominantly ethnic minority, urban MSM. In addition, we investigated crack cocaine, methamphetamine, alcohol, marijuana, and injection drug use as correlates of sex trading within this population.
Our largely African American sample of MSM also suggests that we may need to overcome the frequent stereotypification of high-risk, drug-using MSM as European American methamphetamine users to facilitate innovations in targeted HIV prevention interventions for men who engage in sex trading.
Questions were pilot tested among respondents from the target population and revised as needed to ensure comprehensibility.
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In addition, programs that are overtly identified as gay e. These findings suggest that preventive interventions that address sex trading among MSM must also target use of crack rather than focusing exclusively on methamphetamine.
The interview was self-administered in a private room with audio computer-assisted self-interviewing. Our study suggests that a segment of drug-using MSM engage in sex trading; this population may represent an important epidemiological link between the broader MSM and heterosexual communities. Our findings on homelessness as a predictor of sex trading among MSM extend research findings among high-risk women who trade sex. Also, we found no univariate association between sex trading and injection drug use, but the multivariate analysis revealed a ificant association between these variables.
One limitation of our findings is the use of retrospective measures e. Individuals who engage in sex trading are at elevated risk for HIV infection. We also found ificant associations between sex trading and nongay self-identification, homelessness, and childhood maltreatment. Subanalyses revealed that the lack of a ificant relationship between binge alcohol use and sex trading in the multivariate analysis may have resulted from an interaction with male use. In this study of MSM recruited from street-based venues and community agencies, sex trading was strongly associated with crack use, and with injection drug use.
First, the HIV prevention intervention for which recruitment was conducted may not have been as appealing to younger compared with older MSM. Thus, our may not reflect younger MSM. Nevertheless, our findings cannot be generalized to all MSM. These limitations notwithstanding, our data provide insight into patterns of risk behaviors among an understudied group of MSM at elevated risk for HIV.
The major findings of this study are the associations between crack and injection drug use, nongay self-identification, childhood maltreatment, and homelessness, respectively, and sex trading among MSM. These risk factors suggest that Atlanta majority of HIV prevention programs, which rely on social-cognitive, individual, or small-group models, may be inadequate for addressing high-risk behaviors among MSM who escort sex. Two questions assessed experience of parental violence in childhood with frequency of being hit by parents and frequency of exposure to interparental physical violence.
We performed stratified analyses of methamphetamine and marijuana use on sex trading by level of crack use. Our findings indicate that crack use is strongly associated with sex trading among MSM. Although methamphetamine has been identified as a drug of choice among MSM at high risk for HIV, 28— 30, 42, 43 no association of methamphetamine use with sex trading was observed in this study. The more than 2-fold higher odds of sex trading among MSM who experienced childhood maltreatment suggests that prevention of sexual abuse and parental violence and early intervention to address the sequelae of abuse among young men may protect against sex trading in adulthood.
Try out PMC Labs and tell us what you think. Interviewers were on hand to provide technical assistance and quality assurance. In addition to homelessness, childhood maltreatment may be associated with sex trading. A community advisory board participated in the study planning process and reviewed the questionnaire. These findings suggest that alcohol abuse may be a problem among MSM who trade sex and use crack; injection Georgia use may be a problem among MSM who trade sex but do not use crack.
Individuals who were unable to understand the instructions or the informed consent were excluded from the study. Sex trading may be primarily an economic response driven by the need to obtain drugs or shelter.
We found no differences in sex trading by age or ethnicity. Substance use questions were adapted from a National Institute on Drug Abuse instrument. In fact, there was a nonificant trend of greater methamphetamine use among MSM who did not engage in sex trading. These findings also suggest that preventive interventions may need to target specific types of substance users—crack or injection drug users, and especially users of both crack and alcohol—among MSM who trade sex.
In addition, sex trading, as well as sexual risk behaviors and alcohol and illicit drug use, may be subject to reporting bias. Questions were presented on a laptop computer screen to the participant and verbalized by the computer over headphones. Subanalyses revealed an association between injection drug use and sex trading only among MSM who did not use crack. Participants were recruited for a randomized trial of an HIV prevention intervention for MSM who engage in illicit drug use.
Childhood sexual abuse and parental violence were found to be equally predictive of sex trading, and the proportion of sex trading was about the same for either alone or both together; thus, we combined the 2 into a single construct, childhood maltreatment, for the multiple logistic regression.
Interventions for MSM who trade sex may need to target drug dependence and economic hardship to prevent HIV infection risk behaviors. Similarly, stratified analyses of sexual self-identification, homelessness, and childhood maltreatment on sex trading revealed no interactions with crack use.
The effects of methamphetamine and marijuana use on sex trading were the same regardless of crack use or nonuse. Peter A. Robert E. We examined correlates of trading sex for money, drugs, and shelter, or food among drug-using men who have sex with men MSM.
Audio computer-assisted self-interviewing questionnaires were completed by MSM. Sex-trading prevalence was Multiple risk factors are associated with sex trading among MSM. Interventions may need to address crack and injection drug use, homelessness, and childhood maltreatment and target non—gay-identified MSM who engage in sex trading.
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Prior reports have found good reliability and validity, however, in retrospective reports of childhood sexual abuse. Several practice questions using audio computer-assisted self-interviewing were administered before the actual interview began to familiarize participants with the procedures. Our findings also extend to the MSM population research among women that has documented an association between sex trading and childhood sexual and physical abuse. No differences were found in methamphetamine, marijuana, or injection drug use between sex-trading and non—sex-trading MSM.
MSM who self-identified as other than gay heterosexual, bisexual, or transgender were more than twice as likely to engage in sex trading compared with those who self-identified as gay. research has suggested that many male clients of male sex workers also do not self-identify as gay; these clients may also represent vectors for HIV infection to their other male and female partners.
Participants were prompted to check off a box on the computer screen to indicate their desired response, a process requiring only limited literacy. However, scant research has addressed factors associated with sex trading among MSM. Research in populations other than MSM suggests that several sociodemographic factors may be associated with sex trading.
Furthermore, eligibility criteria included recent illicit drug use, which limits generalizability to non—drug-using MSM. The relatively older age i.
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Overall, the associations between crack use, injection drug use, and homelessness, respectively, and sex trading among MSM suggests an economic imperative to which sex trading is a response. We chose crack use because it was overwhelmingly the most predictive variable.
Any sexual abuse was coded as yes. The present study is derived from baseline data for men who met the eligibility criteria. We used audio computer-assisted self-interviewing in a private setting to reduce underreporting of sensitive behaviors. Learn More. Each of these variables was dichotomized, and the highest level i. The high prevalence of sex trading by non—gay-identified men also lends support to an economic hypothesis that these men may be responding to a market for male sex workers among men.
On the basis of research with gay and bisexual males that suggests shortcomings of a definition of sexual abuse based solely on age differential between partners, 26, 40 we selected a definition of sexual abuse according to role differential child vs adult and advances by the adult perpetrator.
Individuals who were judged to be too intoxicated to complete the interview were rescheduled for a later date. Homelessness was associated with an almost 2-fold increase in the odds of sex trading. Among women, childhood sexual abuse is positively associated with sex trading.
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Thus, in addition to increasing their own risk for contracting HIV, sex-trading MSM may infect their non—sex-trade male and female partners. Homelessness is associated with sex trading among male 17 and female 17, 19 adults and adolescents. Adjusted odds ratios of drug and alcohol use indicated that crack use was associated with an almost 4-fold increase and injection drug use with a 2-fold increase in the odds of engaging in sex trading. Methamphetamine, marijuana, and binge alcohol use were not associated with sex trading after adjustment for the other variables in the model.
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All initial predictors in the univariate model were included in the multiple logistic regression, except for the following changes. Binge alcohol use was associated with sex trading only among MSM who used crack. Although we found a univariate association between sex trading and binge alcohol use, multivariate analysis indicated no ificant relationships between these variables. All participants provided written informed consent.
In addition to demographic and personal characteristics, drug and alcohol use may be associated with sex trading among MSM. Several studies indicate a positive correlation between crack use and sex trading among high-risk women, 11, 17, 37 as well as among HIV-seropositive heterosexual men, women, and MSM 38 and among adults in general.
Those who reported experiencing childhood maltreatment were more than 2. Among MSM, those who engage in sex trading have been found to be more likely than non—sex-trading MSM to engage in unprotected sex with non—sex-trade male 16— 18 and female 17 partners, leading to increased risk for HIV transmission in non—sex-trade encounters.