Logo of straninfSexually Transmitted InfectionsVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Sex Transm Infect. Dec 2004; 80(6): 531–535.
PMCID: PMC1744918

Factors associated with sex trade involvement among male participants in a prospective study of injection drug users


Objectives: While much research to date has examined female sex trade work, little has been done to evaluate factors associated with male sex trade involvement or to assess their health service needs. This is particularly true for male sex trade workers who are also injection drug users (IDUs). Therefore, the present analyses were undertaken to evaluate factors associated with sex trade work in a prospective cohort study of male IDUs.

Methods: We identified factors associated with sex trade involvement among male participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available at semiannual intervals, variables potentially associated with sex trade involvement were evaluated with adjusted odds ratios (AOR) and 95% confidence intervals (CI) computed using generalised estimating equations (GEE).

Results: Between 1996 and 2003, 995 male IDUs were enrolled into the VIDUS cohort among whom 108 (11%) reported being involved in the sex trade at enrolment and 102 (10%) individuals initiated sex trade involvement during the follow up period. In multivariate analyses, factors independently associated with sex trade involvement included HIV positive serostatus (AOR: 1.77 (95% CI: 1.44 to 2.17)), daily cocaine injection (AOR: 1.37 (95% CI: 1.11 to 1.70)), daily crack smoking (AOR: 1.36 (95% CI: 1.07 to 1.72)), borrowing syringes (AOR: 1.73 (95% CI: 1.32 to 2.25)), and inconsistent use of condoms with casual sexual partners (AOR 0.66, CI 0.53 to 0.82). We also found that male sex trade workers were more likely to report having sought but been unable to access substance abuse treatment (AOR: 1.28 (95% CI: 0.98 to 1.67); p = 0.076).

Conclusions: Males involved in the sex trade in this setting have higher levels of HIV infection and engage in risky injection behaviours at an elevated rate. Since these behaviours have major implications for HIV acquisition and public health, prevention efforts and targeted provision of addiction treatment to this population should be expanded.

Full Text

The Full Text of this article is available as a PDF (65K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Spittal PM, Bruneau J, Craib KJP, Miller C, Lamothe F, Weber AE, Li K, Tyndall MW, O'Shaughnessy MV, Schechter MT. Surviving the sex trade: a comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs. AIDS Care. 2003 Apr;15(2):187–195. [PubMed]
  • Elifson KW, Boles J, Sweat M. Risk factors associated with HIV infection among male prostitutes. Am J Public Health. 1993 Jan;83(1):79–83. [PMC free article] [PubMed]
  • Elifson KW, Boles J, Sweat M, Darrow WW, Elsea W, Green RM. Seroprevalence of human immunodeficiency virus among male prostitutes. N Engl J Med. 1989 Sep 21;321(12):832–833. [PubMed]
  • O'Connell Jacqueline M, Lampinen Thomas M, Weber Amy E, Chan Keith, Miller Mary Lou, Schechter Martin T, Hogg Robert S. Sexual risk profile of young men in Vancouver, British Columbia, who have sex with men and inject drugs. AIDS Behav. 2004 Mar;8(1):17–23. [PubMed]
  • Ross MW, Wodak A, Gold J, Miller ME. Differences across sexual orientation on HIV risk behaviours in injecting drug users. AIDS Care. 1992;4(2):139–148. [PubMed]
  • Diaz T, Vlahov D, Greenberg B, Cuevas Y, Garfein R. Sexual orientation and HIV infection prevalence among young Latino injection drug users in Harlem. J Womens Health Gend Based Med. 2001 May;10(4):371–380. [PubMed]
  • Crofts N, Marcus L, Meade J, Sattler G, Wallace J, Sharp R. Determinants of HIV risk among men who have homosexual sex and inject drugs. AIDS Care. 1995;7(5):647–655. [PubMed]
  • Bull Sheana Salyers, Piper Patrick, Rietmeijer Cornelis. Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors. J Homosex. 2002;42(3):31–51. [PubMed]
  • Hogg RS, Weber AE, Chan K, Martindale S, Cook D, Miller ML, Craib KJ. Increasing incidence of HIV infections among young gay and bisexual men in Vancouver. AIDS. 2001 Jul 6;15(10):1321–1322. [PubMed]
  • Weber Amy E, Craib Kevin J, Chan Keith, Martindale Steve, Miller Mary Lou, Cook Darrel A, Schechter Martin T, Hogg Robert S. Determinants of HIV serconversion in an era of increasing HIV infection among young gay and bisexual men. AIDS. 2003 Mar 28;17(5):774–777. [PubMed]
  • Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001 May 5;357(9266):1397–1401. [PubMed]
  • Strathdee Steffanie A, Sherman Susan G. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003 Dec;80(4 Suppl 3):iii7–ii14. [PMC free article] [PubMed]
  • Deren S, Estrada A, Stark M, Williams M, Goldstein M. A multisite study of sexual orientation and injection drug use as predictors of HIV serostatus in out-of-treatment male drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Aug 1;15(4):289–295. [PubMed]
  • Tyndall Mark W, Currie Sue, Spittal Patricia, Li Kathy, Wood Evan, O'Shaughnessy Michael V, Schechter Martin T. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003 Apr 11;17(6):887–893. [PubMed]
  • Miller Cari L, Johnston Caitlin, Spittal Patricia M, Li Kathy, Laliberté Nancy, Montaner Julio S G, Schechter Martin T. Opportunities for prevention: hepatitis C prevalence and incidence in a cohort of young injection drug users. Hepatology. 2002 Sep;36(3):737–742. [PubMed]
  • Wood Evan, Kerr Thomas, Spittal Patricia M, Li Kathy, Small Will, Tyndall Mark W, Hogg Robert S, O'Shaughnessy Michael V, Schechter Martin T. The potential public health and community impacts of safer injecting facilities: evidence from a cohort of injection drug users. J Acquir Immune Defic Syndr. 2003 Jan 1;32(1):2–8. [PubMed]
  • Spittal Patricia M, Craib Kevin J P, Wood Evan, Laliberté Nancy, Li Kathy, Tyndall Mark W, O'Shaughnessy Michael V, Schechter Martin T. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002 Apr 2;166(7):894–899. [PMC free article] [PubMed]
  • Hu FB, Goldberg J, Hedeker D, Flay BR, Pentz MA. Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes. Am J Epidemiol. 1998 Apr 1;147(7):694–703. [PubMed]
  • Craib Kevin J P, Spittal Patricia M, Wood Evan, Laliberte Nancy, Hogg Robert S, Li Kathy, Heath Katherine, Tyndall Mark W, O'Shaughnessy Michael V, Schechter Martin T. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ. 2003 Jan 7;168(1):19–24. [PMC free article] [PubMed]
  • Doherty MC, Garfein RS, Monterroso E, Brown D, Vlahov D. Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000 Apr 14;14(6):717–726. [PubMed]
  • Strathdee SA, Patrick DM, Currie SL, Cornelisse PG, Rekart ML, Montaner JS, Schechter MT, O'Shaughnessy MV. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997 Jul;11(8):F59–F65. [PubMed]
  • Weber AE, Craib KJ, Chan K, Martindale S, Miller ML, Schechter MT, Hogg RS. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. Int J Epidemiol. 2001 Dec;30(6):1449–1456. [PubMed]
  • Tyndall MW, Craib KJ, Currie S, Li K, O'Shaughnessy MV, Schechter MT. Impact of HIV infection on mortality in a cohort of injection drug users. J Acquir Immune Defic Syndr. 2001 Dec 1;28(4):351–357. [PubMed]
  • Des Jarlais DC, Paone D, Milliken J, Turner CF, Miller H, Gribble J, Shi Q, Hagan H, Friedman SR. Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: a quasi-randomised trial. Lancet. 1999 May 15;353(9165):1657–1661. [PubMed]
  • Culhane DP, Gollub E, Kuhn R, Shpaner M. The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia. J Epidemiol Community Health. 2001 Jul;55(7):515–520. [PMC free article] [PubMed]
  • Belza MJ, Llácer A, Mora R, Morales M, Castilla J, de la Fuente L. Sociodemographic characteristics and HIV risk behaviour patterns of male sex workers in Madrid, Spain. AIDS Care. 2001 Oct;13(5):677–682. [PubMed]
  • Williams Mark L, Timpson Sandra, Klovdal Alden, Bowen Anne M, Ross Michael W, Keel K Blair. HIV risk among a sample of drug using male sex workers. AIDS. 2003 Jun 13;17(9):1402–1404. [PubMed]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...