ShareCompartir Fast Facts The risk of HIV and other sexually transmitted diseases is high among persons who exchange sex for money or nonmonetary items. Few large-scale population-based studies have been done on HIV among this diverse group of people. Many social and structural factors make it difficult to prevent and treat HIV among persons who exchange sex for money or nonmonetary items.
Persons who exchange sex are at increased risk of getting or transmitting HIV and other sexually transmitted diseases STDs because they are more likely to engage in risky sexual behaviors e. Those who exchange sex more regularly as a source of ongoing income are at higher risk for HIV than those who do so infrequently.
Persons who engage in such activities include escorts; people who work in massage parlors, brothels, and the adult film industry; exotic dancers; state-regulated prostitutes in Nevada ; and men, women, and transgender persons who participate in survival sex, i. For any of the above, sex can be consensual or nonconsensual.
It is important for people who exchange sex to get tested for HIV regularly and know their status. Condoms are highly effective in preventing a person from getting or transmitting HIV infection if used the right way every time during sex. Prevention Challenges Lack of Data There is a lack of population-based studies on persons who exchange sex, although some studies have been done in singular settings such as prisons and exotic dance clubs.
However, the illegal—and often criminalized—nature of exchange sex makes it difficult to gather population-level data on HIV risk among this population.
This lack of data creates significant barriers to developing targeted HIV prevention efforts. Socioeconomic Factors Many persons who exchange sex face stigma, poverty, and lack of access to health care and other social services—all of which pose challenges to HIV prevention efforts.
Some transgender persons may turn to exchange sex because of discrimination and lack of economic opportunities. They may exchange sex to generate income for rent, drugs, medicines, hormones, and gender-related surgeries. Sexual Risk Factors Persons who exchange sex may not use condoms consistently. Several factors may contribute to this behavior, including Economics: Persons who exchange sex may receive more money for sex without a condom.
Persons who exchange sex may use condoms less often with regular clients than with one-time clients and even less frequently with intimate partners. Unequal power in a relationship with clients may make it difficult for persons who exchange sex to negotiate condom use. Other risk factors for this population include Multiple high-risk sex partners, e. More money for sex with partners known to be HIV positive. Drug and Alcohol Use There is a strong link between exchange sex and drug and alcohol use.
Persons who exchange sex, if under the influence of drugs or alcohol, may have impaired judgment, engage in riskier forms of sex such as anal sex, and have difficulty negotiating safer sex condom use, for example with their customers. People who trade sex for drugs tend to have more clients, use condoms less often, and are more likely to share needles and other drug works. Are uncomfortable sharing information about sexual and substance use histories as part of HIV testing protocol.
Some persons who know their HIV status may be reluctant to seek or stay in care because of Mistrust of the health care system. Concern that they may lose income if identified as being HIV-positive. Financial circumstances and other barriers e. Activities include Support and technical assistance to help community-based organizations implement interventions directed toward persons who exchange sex e.
Act Against AIDS , a national initiative that focuses on raising awareness, fighting stigma, and reducing the risk of HIV infection among at-risk populations. Comprehensive HIV Prevention Programs for Health Departments , a 5-year HIV prevention initiative for health departments in states, territories, and select cities, including those serving clients at risk for HIV infection because of exchanging sex.