Factors associated with transactional sex among a cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada
Heather L. Armstrong
A * , Jordan M. Sang B , Ales Skala C , Lu Wang B , Julia Zhu B , Nathan J. Lachowsky B D , Kiffer G. Card D , Cecilia Benoit D , Gbolahan Olarewaju B C , Robert S. Hogg B E , David M. Moore B C and Eric A. Roth D
+ Author Affiliations
- Author Affiliations
A University of Southampton, Southampton SO17 1BJ, UK.
B British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
C University of British Columbia, Vancouver, BC, Canada.
D University of Victoria, Victoria, BC, Canada.
E Simon Fraser University, Burnaby, BC, Canada.
Sexual Health 18(6) 487-497 https://doi.org/10.1071/SH21128
Submitted: 28 July 2021 Accepted: 18 October 2021 Published: 30 November 2021
© 2021 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM.
Methods: Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6 months until July 2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling.
Results: Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30 years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex.
Conclusions: More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men.
Keywords: HIV, mental health, MSM, sexual behaviours, sex work, STI, substance use, syndemic factors, transactional sex.
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