Theme: Epidemiology & Public Health Research Year: 2025
Background:
Global estimates show that about one-third of women who inject drugs (WWID) engage in transactional sex (TS); exchanging sex for drugs, money, or other items. Differences between WWID and men who inject drugs (MWID) engaging in TS are not well-understood, particularly within resource-limited settings.
Methods:
We recruited 3153 people who inject drugs from needle and syringe programs in Kenya using respondent driven sampling. Participants completed biobehavioral surveys and received HIV and Hepatitis C (HCV) testing. Chi-squared and Fisher’s exact tests were conducted to examine relationships between gender, TS, and disease status.
Results:
Participants were predominantly male (90.3%), and 4.7% of the sample reported ever having TS. Women were significantly more likely than men to be HIV-positive (31.1% vs. 7.4%, p<0.001), HCV-positive (26.5% vs. 18.6%, p<0.001), and HIV/HCV-coinfected (10.8% vs. 3.2%, p<0.001); there were no within-gender differences between those with and without TS history. Women were significantly more likely than men to report TS (30.7% vs. 2.0%, p<0.001). Of those reporting TS, women and men were similarly likely to have exchanged sex for money (94.7% vs. 89.5%, p=0.233), but women were significantly more likely to have exchanged sex for drugs (60.6% vs. 35.1%, p=0.002), clothes (19.1% vs. 7.0%, p=0.031), food (48.9% vs. 21.1%, p<0.001), and a place to stay (20.2% vs. 1.8%, p=0.001). Additionally, women reporting TS were significantly more likely than men to report ever being sexually assaulted (29.8% vs. 12.3%, p=0.032). Participants reporting TS were significantly more likely to have ever been sexually assaulted compared to their counterparts with no TS history (women: 29.8% vs. 8.0%, p<0.001; men: 12.3% vs. 1.9%, p<0.001), suggesting this difference is associated with TS, rather than gender alone.
Conclusion:
These findings highlight differences in sex-related risks among WWID and MWID and underscore the need for further research exploring how gender inequality influences BBI risk, particularly among WWID.
Disclosure of Interest Statement:
MJA reports grants from the National Institute on Drug Abuse (DP2DA053730, R00DA043011, R61DA060627), National Institute on Minority Health and Health Disparities (R01MD016744), National Institutes of Allergy and Infectious Diseases Centers for AIDS Research (P30AI124414), and investigator-initiated research funding paid to his institution from Gilead Sciences and AbbVie.
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