Factors associated with exchanging sex for money in men who have sex with men in Brazil

Alecrim, Denyr Jeferson Dutra; Ceccato, Maria das Graças Braga; Dourado, Inês; Kerr, Ligia; Brito, Ana Maria de; Guimarães, Mark Drew Crosland

doi:10.1590/1413-81232020253.18052018

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FREE THEMES • Ciênc. saúde coletiva 25 (3) • Mar 2020 • https://doi.org/10.1590/1413-81232020253.18052018 copy

Factors associated with exchanging sex for money in men who have sex with men in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to analyze the association between sociodemographic, programmatic and contextual factors and the receipt of money in exchange for sex among men who have sex with men (MSM). This is a multicenter, cross-sectional study conducted in ten Brazilian cities between 2008 and 2009. Adult MSM recruited through the Respondent Driven Sampling (RDS) were interviewed. Weighted Odds Ratio (ORw) was obtained through logistic regression, retaining the variables associated with the event (p < 0.05) in the final model. Of the total sample, 33.3% reported receiving money in exchange for sex in the last 12 months before the interview. The variables that were independently associated with the event were age less than or equal to 25 years, lower education, lower social classes, previous history of syphilis, using sites or services to find sexual partners in the previous month, very high risk behavior, using illicit drugs in the previous six months, self-identifying as heterosexual or bisexual, having suffered physical violence due to sexual orientation and having suicidal thoughts always or most of the time. It was observed that MSM who received money in exchange for sex had greater socioeconomic, programmatic and contextual vulnerability, potentially increasing the risk of HIV infection than the other MSM in the sample.

Key words
Men who have sex with men; Commercial sex; HIV

Characteristics	n² 2 Unweighted proportion. (%)	% w³ 3 Weighted proportion.
a. Sociodemographic
Age (≤ 25 years):	1971 (52.8)	41.6
Schooling (≤ 8 years):	1127 (30.2)	41.4
Social class (C-D-E):	2563 (71.2)	75.2
Skin color / ethnicity (Non-white):	3275 (87.4)	83.2
Marital status (Single/alone):	3128 (83.5)	84.4
Currently employed (No):	1208 (32.2)	29.5
b. Programmatic
Positive serology for HIV (Yes):	323 (9.8)	12.6
Positive serology for syphilis (Yes):	340 (10.3)	14.6
Knowledge of HIV transmission (Insufficient):	1617 (43.2)	42.3
Prior HIV test (Never):	1777 (47.4)	48.4
Prior syphilis test (Never):	2579 (71.4)	74.3
Prior syphilis history (Yes):	232 (6.2)	7.7
STD history in the last 12 months (Yes):	854 (22.8)	27.6
Received free condoms in the last 12 months (No):	873 (23.3)	27.6
Received advice on STD in the last 12 months (No):	1363 (36.4)	68.1
Received lubricant gel in the last 12 months (No):	3099 (82.7)	54.5
iii. Contextual:
iii.a. Behavioral
Gender of first sexual partner (Woman):	1782 (47.6)	52.9
Age at first sexual intercourse (≤14 years):	1858 (49.9)	46.9
Number of partners in the last 6 months (> 5):	1078 (29.0)	24.5
Condom use in all sexual intercourses in the last 12 months (No):	2241 (59.8)	63.6
Using places/services to find partners in the last month (Yes):	1568 (41.9)	41.9
Sex with a network of potential guests (Yes):	2207 (61.0)	51.8
Received money for sex (Yes):	1146 (30.6)	33.3
Sexual intercourse under the effects of any drug in the last 6 months	2447 (65,5)	66,3
(Yes)	2447 (65.5)	66.3
Self-perceived risk of HIV infection (Mod-High):	1010 (26.9)	29.9
Risk Behavior Score - 12 months (> 8 Very high):	738 (19.7)	19.9
Alcohol use frequency (Twice a week or more)	2238 (59.8)	63.5
Use of illicit drugs in the last 6 months (Yes):	1497 (40.1)	42.8
iii.b. Related to sexual orientation:
Self-sexual identity (Bi-Hetero):	1450 (38.7)	38.7
Discrimination due to sexual orientation (Yes)	1293 (36.4)	27.9
Suffered verbal violence (Yes):	1697 (45.3)	43.2
Suffered physical violence (Yes):	557 (14.9)	13.4
Suffered sexual violence (Yes):	592 (15.8)	15.0
iii.c. Related to mental health:
Feeling tense/worried (Always/most of the time):	2475 (66.1)	74.1
Sleeping problems (Always/most of the time):	1445 (38.6)	42.5
Feeling fear and panic (Always/most of the time):	731 (19.5)	22.2
Feeling sad/depressed (Always/most of the time):	1821 (48.6)	54.2
Suicidal thoughts (Always/most of the time):	357 (9.5)	11.0

Characteristics	YES n (%)	NO n (%)	OR_W² 2 Weighted Odds Ratio. (CI 95%)	X² (p-value)
i. Sociodemographic:
Age:
≤ 25 years	676 (34.9)	1295 (65.1)	1.12 (0.98 - 1.28)	0.088
> 25 years	464 (32.3)	1299 (67.7)	1.00
Schooling:
≤ 8 years	563 (52.6)	564 (47.4)	4.50 (3.90 - 5.20)	< 0.001
> 9 years	577 (19.8)	2029 (80.2)	1.00
Social class:
C-D-E	889 (35.1)	1674 (64.9)	4.27 (3.41 - 5.37)	< 0.001
A-B	156 (11.2)	882 (88.8)	1.00
Skin color / ethnicity:
Non-white	1012 (33.1)	2263 (66.9)	0.92 (0.78 - 1.11)	0.414
White	134 (34.7)	338 (65.3)	1.00
Marital status:
Single/alone	986 (34.0)	2146 (66.0)	1.18 (0.98 - 1.43)	0.076
Married/Common-law marriage	164 (30.2)	456 (69.8)	1.00
Currently employed:
No	446 (36.8)	762 (63.2)	1.24 (1.07 - 1.44)	0.003
Yes	700 (31.9)	1841 (68.1)	1.00
ii. Programmatic:
Positive serology for HIV:
No	244 (12.8)	2029 (87.2)	0.94 (0.76 - 1.16)	0.547
Yes	79 (12.1)	930 (87.9)	1.00
Positive serology for syphilis:
No	236 (13.6)	2055 (86.4)	1.29 (1.06 - 1.56)	0.011
Yes	104 (16.8)	903 (83.2)	1.00
Knowledge of HIV transmission:
Insufficient	601 (38.8)	1016 (61.2)	1.51 (1.33 - 1.74)	< 0.001
Sufficient	542 (29.5)	1583 (70.5)	1.00
Prior HIV test:
No	712 (40.1)	1065 (59.9)	1.81 (1.58 - 2.07)	< 0.001
Yes	434 (27.0)	1538 (73.0)	1.00
Prior syphilis test:
No	901 (35.1)	1678 (64.9)	1.37 (1.17 - 1.61)	< 0.001
Yes	209 (28.3)	824 (71.7)	1.00
Prior syphilis history:
Yes	62 (39.0)	170 (61.0)	1.30 (1.02 - 1.66)	< 0.034
No	1081 (33.0)	2430 (67.0)
STD history in the last 12 months:
Yes	281 (40.3)	573 (59.7)	1.52 (1.31 - 1.76)	< 0.001
No	862 (30.8)	2027 (69.2)	1.00
Received free condoms in the last 12 months:
No	267 (32.0)	606 (68.0)	0.92 (0.78 - 1.07)	0.257
Yes	876 (34.0)	1993 (66.0)	1.00
Received advice on STD in the last 12 months:
No	363 (27.9)	1000 (72.1)	0.68 (0.59 - 0.79)	< 0.001
Yes	781 (36.0)	1600 (64.0)	1.00
Received lubricant gel in the last 12 months:
No	1014 (36.1)	2085 (63.9)	2.40 (1.94 - 2.99)	< 0.001
Yes	129 (19.0)	515 (81.0)	1.00
iii. Contextual
iii.a. Behavioral:
Gender of first sexual partner:
Woman	731 (42.7)	1051 (57.3)	2.52 (2.18 - 2.90)	< 0.001
Man/Transvestite	415 (22.8)	1548 (77.2)	1.00
Age at first sexual intercourse:
≤ 14 years	669 (41.7)	1189 (58.3)	2.01 (1.75 - 2.30)	< 0.001
> 14 years	473 (26.2)	1394 (73.8)	1.00
Number of partners in the last 6 months:
> 5	569 (56.5)	509 (43.5)	3.76 (2.23 - 4.39)	< 0.001
≤ 5	557 (25.6)	2082 (74.4)	1.00
Condom use in all sexual intercourses in the last 12 months
No	656 (32.8)	1595 (67.2)	0.93 (0.82 - 1.08)	0.371
Yes	500 (34.2)	1008 (65.8)	1.00
Using places or services to find partners in the last month:
Yes	593 (41.5)	975 (58.5)	1.86 (1.62 - 2.13)	< 0.001
No	551 (27.6)	1625 (72.4)	1.00
Sex with a network of potential guests:
Yes	706 (36.4)	1501 (63.6)	1.32 (1.16 - 1.52)	< 0.001
No	401 (30.1)	1007 (69.9)	1.00
Sexual intercourse under the effects of any drug in the last 6 months:
Yes	879 (38.2)	1568 (61.8)	1.97 (1.69 - 2.29)	< 0.001
No	263 (24.0)	1025 (76.0)	1.00
Self-perceived risk of HIV infection:
Moderate - High	390 (41.3)	620 (58.7)	1.79 (1.48 - 2.03)	0.027
Don't know - ND	211 (32.2)	454 (67.8)	1.17 (0.99 - 1.40)
None - Poor	545 (28.8)	1529 (71.2)	1.00
Risk Behavior Score - in the last 12 months:
> 8 (Very high)	358 (54.9)	353 (45.1)	3.16 (2.69 - 3.72)	< 0.001
≤ 8 (Low - Medium - High)	751 (27.8)	2249 (72.2)	1.00
Alcohol use frequency:
Twice a week or more	775 (36.9)	1463 (63.1)	1.55 (1.34 - 1.79)	< 0.001
Never/Casual	369 (27.4)	1135 (72.6)	1.00
Use of illicit drugs in the last 6 months:
Yes	689 (50.4)	808 (49.6)	3.88 (3.37 - 4.47)	< 0.001
No	454 (20.8)	1784 (79.2)	1.00
iii.b. Related to sexual orientation:
Self-sexual identity:
Bisexual/Heterosexual	690 (48.6)	760 (51.4)	3.05 (2.66 - 3.51)	< 0.001
MSM/Homosexual	454 (23.7)	1841 (76.3)	1.00
Discrimination due to sexual orientation:
Yes	327 (25.6)	966 (74.4)	0.63 (0.52 - 0.71)	< 0.001
No	819 (36.3)	1637 (63.7)	1.00
Suffered verbal violence:
Yes	459 (28.6)	1238 (71.4)	0.68 (0.59 - 0.78)	< 0.001
No	684 (37.1)	1362 (62.9)
Suffered physical violence:
Yes	193 (41.5)	364 (58.5)	1.49 (1.23 - 1.80)	< 0.001
No	950 (32.2)	2235 (67.8)
Suffered sexual violence:
Yes	179 (39.2)	413 (60.8)	1.34 (1.22 - 1.62)	0.001
No	967 (32.3)	2190 (67.7)	1.00
iii.c. Related to mental health:
Feeling tense or worried:
Always/most of the time	759 (33.4)	1716 (66.6)	0.99 (0.85 - 1.16)	0.923
Never/Rarely	385 (33.6)	883 (66.4)	1.00
Sleeping problems:
Always/most of the time	488 (35.7)	957 (64.3)	1.19 (1.04 - 1.37)	0.010
Never/Rarely	656 (31.8)	1642 (68.2)	1.00
Feeling fear and panic:
Always/most of the time	308 (44.0)	423 (56.0)	1.80 (1.54 - 2.11)	< 0.001
Never/Rarely	836 (30.4)	2176 (69.6)	1.00
Feeling sad or depressed:
Always/most of the time	617 (37.5)	1204 (62.5)	1.50 (1.31 - 1.72)	< 0.001
Never/Rarely	527 (28.6)	1395 (71.4)	1.00
Suicidal thoughts:
Always/most of the time	173 (59.8)	184 (40.2)	3.44 (2.79 - 4.24)	< 0.001
Never/Rarely	971 (30.2)	2414 (69.8)	1.00

	Intermediate models					Final model
Characteristics	Sociodemographic	Programmatic	Behavioral	Related to sexual identity	Related to mental health
Age
≤ 25 years	1.60 (1.36 - 1.88)^ () p < 0.01;					2.04 (1.68 - 2.48)^ () p < 0.01;
Schooling
≤ 8 years	3.45 (2.97 - 4.07)^ () p < 0.01;					3.58 (2.92 - 4.37)^ () p < 0.01;
Social class
C-D-E	2.78 (2.19 - 3.54)^ () p < 0.01;					2.35 (1.77 - 3.11)^ () p < 0.01;
Currently employed
No	1.46 (1.24 - 1.72)^ () p < 0.01;
Knowledge of HIV transmission
Insufficient		1.32 (1.15 - 1.53)^ () p < 0.01;
Prior HIV test
No		1.60 (1.38 - 1.86)^ () p < 0.01;
Prior syphilis history
Yes		1.40 (1.05 - 1.87)^* *()** p < 0.05;				1.60 (1.13 - 2.25)^ () p < 0.01;
STD history in the last 12 months
Yes		1.52 (1.29 - 1.80)^* *()** p < 0.05;
Received advice on STD in the last 12 months
No		0.84 (0.71 - 0.98)^* *()** p < 0.05;
Received lubricant gel in the last 12 months
No		2.06 (1.64 - 2.58)^ () p < 0.01;
Gender of first sexual partner
Woman			2.89 (2.46 - 3.40)^ () p < 0.01;			2.32 (1.87 - 2.89)^ () p < 0.01;
Age at first sexual intercourse sexual
≤ 14 years				1.69 (1.45 - 1.98)^ () p < 0.01;		1.78 (1.48 - 2.16)^ () p < 0.01;
Using places/services to find partners in the last month
Yes			1.46 (1.24 - 1.70)^ () p < 0.01;			1.27 (1.05 - 1.56)^* *()** p < 0.05;
Sex with a network of potential guests
Yes			1.18 (1.02 - 1.38)^* *()** p < 0.05;			1.25 (1.04 - 1.51)^* *()** p < 0.05;
Risk Behavior Score - 12 months
> 8 (Very high)			1.84 (1.52 - 2.24)^ () p < 0.01;			2.76 (2.16 - 3.52)^ () p < 0.01;
Use of illicit drugs in the last 6 months
Yes			2.72 (2.33 - 3.18)^ () p < 0.01;			1.89 (1.56 - 2.29)^ () p < 0.01;
Self-sexual identity
Bisexual/Heterosexual				2.94 (2.54 - 3.40)^ () p < 0.01;		2.49 (2.03 - 3.05)^ () p < 0.01;
Discrimination due to sexual orientation
Yes				0.79 (0.56 - 0.81)^ () p < 0.01;
Suffered verbal violence
Yes				0.79 (0.67 - 0.93)^ () p < 0.01;
Suffered physical violence
Yes				2.08 (1.67 - 2.58)^ () p < 0.01;
Suffered sexual violence
Yes				1.53 (1.25 - 1.88)^ () p < 0.01;
Sleeping problems
Always/most of the time					0.87 (0.74 - 1.02)^* *()** p < 0.05;
Feeling fear and panic
Always/most of the time					1.46 (1.24 - 1.75)^ () p < 0.01;
Feeling sad/depressed
Always/most of the time					1.20 (1.02 - 1.40)^* *()** p < 0.05;
Suicidal thoughts
Always/most of the time					3.01 (2.42 - 3.75)^ () p < 0.01;	2.71 (2.05 - 3.59)^ () p < 0.01;

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[1] Collaborations

DJD Alecrim and MGB Ceccato contributed to the project design, data interpretation, writing and relevant critical review of the article content, as well as accompanying all stages of the work in ensuring the accuracy and integrity of any part of the work. I Dourado, L Kerr and AM Brito contributed to the project design, writing and relevant critical review of the content of the article, as well as accompanying all stages of the work to ensure the accuracy and integrity of any part of the work. MDC Guimarães contributed to the project design, data analysis and interpretation, writing and relevant critical review of the article content, as well as accompanying all stages of the work in ensuring the accuracy and integrity of any part of the work.