Descriptors and Correlates of Sex Trading Amongst Active Methamphetamine Users in Cape Town, South Africa

Introduction: South Africa has witnessed a tremendous rise in methamphetamine consumption since the year 2000. Sex trading is a phenomenon that has been observed in active drug users, globally and within South Africa, and has been associated with risks for HIV infection and violence. This paper is a secondary analysis examining sex trading among active methamphetamine users in Cape Town, South Africa. Methods: Respondent driven sampling was used to recruit 360 active methamphetamine users in a peri-urban township in Cape Town. A structured clinical interview and computerized survey were used to assess history of sex trading, demographics, drug use, sexual risk behaviors, history of violence, and mental health. Logistic regression models were used to examine predictors of sex trading, separately for men and women. Results: In a total sample of 201 men and 159 women, 40% of men and 33% of women endorsed trading sex for tik or money in the past 3 months. Those who traded sex were more likely to meet the criteria for ICD-10 amphetamine dependence among both men (OR=4.59, 95% CI=1.31-16.13) and women (OR=8.00, 95% CI: 1.02-62.59). Men who were concurrent heroin users were also more likely to exchange sex (OR=2.58, 95% CI: 1.06-6.28). Sexual risk behaviors were significantly associated with sex trading. Notably, unprotected sex with a casual partner was correlated with sex trading in men (OR=3.57, 95% CI:1.66-7.69) and women (OR=3.68, 95% CI:1.63-8.29). Among women, those who experienced childhood sexual trauma (OR=3.79, 95% CI: 1.89-7.59) and had the symptoms of post-traumatic stress disorder (OR=2.95, 95% CI: 1.45-5.99) were also more likely to trade sex. Discussion: This study offers insight into the interventions needed for this high-risk population in a LMIC (low and/or middle income countries) context. The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. The risky sexual practices illustrate how targeted interventions geared toward safe sex practices may help this population. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior. In a context of high rates of trauma and violence, women need interventions that are attuned to their particular vulnerabilities and offer empowerment through counseling.