Correlates of selling sex among male injection drug users in New York City

Background: Compared to female IDUs, the correlates of receiving money, drugs, or other things in exchange for sex ("selling sex") among male IDUs are not well understood. Methods: In 2012, IDUs were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent driven sampling. Analyses were limited to male participants. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to determine the correlates of selling sex to (1) men and (2) women in the past 12 months. Results: Of 394 males, 35 (8.9%) sold sex to men and 66 (16.8%) sold sex to women. Correlates of selling sex to men included bisexual/gay identity (aOR: 31.0; 95% CI: 8.1, 119.1), Bronx residence (vs. Manhattan) (aOR: 38.1; 95% CI: 6.2, 235.5), and in the past 12 months, being homeless (aOR: 9.9; 95% CI: 2.0, 49.6), ≥3 sex partners (aOR: 26.2; 95% CI: 4.7, 147.6), non-injection cocaine use (aOR: 5.4; 95% CI: 1.6, 18.2), and injecting methamphetamine (aOR: 36.9; 95% CI: 5.7, 240.0). Correlates of selling sex to women included, in the past 12 months, ≥3 sex partners (aOR: 14.6; 95% CI: 6.6, 31.9), binge drinking at least once a week (aOR: 3.1; 95% CI: 1.6, 6.1), non-injection crack use (aOR: 3.3; 95% CI: 1.6, 6.7), most frequently injected "speedball" (vs. heroin) (aOR: 2.1; 95% CI: 1.1, 4.2), and receptively shared syringes (aOR: 2.4; 95%CI: 1.2, 4.8). Conclusions: Among male IDUs, those who sold sex had more sex partners, which may facilitate the sexual spread of HIV among IDUs and to non-IDU male and female sex partners. HIV prevention interventions aimed at male IDUs who sell sex should consider both their sexual and parenteral risks and the greater risk of engaging in exchange sex associated with the use of injection and non-injection stimulant drugs.