Survival Sex Work and Increased HIV Risk Among Sexual Minority Street-Involved Youth

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Exchanging sex for money, drugs, or other commodities for survival is associated with an array of HIV risks. We sought to determine if street-involved drug-using sexual minority youth are at greater risk for survival sex work and are more likely to engage in risk behaviors with clients.


We examined factors associated with survival sex work among participants enrolled in the At Risk Youth Study using logistic regression. Self-reported risk behaviors with clients were also examined.


Of 558 participants eligible for this analysis, 75 (13.4%) identified as a sexual minority and 63 (11.3%) reported survival sex work in the past 6 months. Sexual minority males (adjusted odds ratio = 16.1, P < 0.001) and sexual minority females (adjusted odds ratio = 6.87, P < 0.001) were at significantly greater risk for survival sex work. Sexual minority youth were more likely to report inconsistent condom use with clients (odds ratio = 4.30, P= 0.049) and reported a greater number of clients in the past 6 months (median = 14 vs. 3, P = 0.008).


Sexual minority street youth are not only more likely to engage in survival sex work but also demonstrate elevated HIV risk behavior. These findings suggest that harm reduction and HIV prevention programs for sexual minority youth who exchange sex are urgently required.

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