Correlates of Transactional Sex Among a Rural Population of People Who Inject Drugs

Sean T. Allen, Rebecca Hamilton White, Allison O’Rourke, N. Jia Ahmad, Tim Hazelett, Michael E. Kilkenny, Susan G. Sherman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


In the United States, high rates of HIV infection among persons who engage in transactional sex are partially driven by substance use. Little is known about transactional sex among rural populations of people who inject drugs (PWID). Using data from a 2018 survey of 420 rural PWID in West Virginia, we used logistic regression to identify correlates of recent transactional sex (past 6 months). Most study participants were male (61.2%), white (83.6%), and reported having injected heroin (81.0%) in the past 6 months. Nearly one-fifth (18.3%) reported engaging in recent transactional sex. Independent correlates of transactional sex were: being female [adjusted odds ratio (aOR) 3.90; 95% CI 2.12–7.16]; being a sexual minority (aOR 3.07; 95% CI 1.60–5.87); being single (aOR 3.22; 95% CI 1.73–6.01); receptive syringe sharing (aOR 3.13; 95% CI 1.73–5.66); and number of injections per day (aOR 1.08; 95% CI 1.01–1.15). Rural PWID who engage in transactional sex are characterized by multiple vulnerabilities that increase their HIV risk.

Original languageEnglish (US)
Pages (from-to)775-781
Number of pages7
JournalAIDS and behavior
Issue number3
StatePublished - Mar 1 2020


  • HIV
  • People who inject drugs
  • Rural health
  • Transactional sex

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Social Psychology


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