Alcohol, drug, and sexual risk behavior correlates of recent transactional sex among female black South African drug users

Abstract

Introduction: Transactional sex among black South African women has become a mode of economic survival putting them at higher risk for HIV and other infectious disease.

Methods: In order to inform HIV interventions, drug, and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black South African women in Pretoria were examined using log binomial regression.

Results: Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use [adjusted prevalence ratio (APR) = 1.3, 95% CI = 1.1, 1.5] and knew of anyone who died of AIDS (APR = 1.5, 95% CI = 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR = 0.6, 95% CI = 0.4, 0.8), condom use in their first sexual encounter (APR = 0.7, 95% CI = 0.6, 1.0), or reported a recent steady sexual partnership (APR = 0.8, 95% CI = 0.7, 0.9).

Conclusions: Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.

• South Africa
• substance use
• sexual risk behavior

Acknowledgments

Funding for this study was provided by NIDA's Southern Africa Initiative as a supplement to a parent study conducted in the United States (R01DA014498) and from the Drug Dependence Epidemiology Training Grant (T32DA007292). The authors wish to thank Dr. Leah Floyd for her work on this study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.