Among women who exchange sex (WES), social cohesion is associated with multi-level HIV-risk reduction factors, and client condom coercion (CCC) is associated with increased HIV-risk. Sexual minority WES (SM-WES) face exacerbated HIV-risk, yet relevant research is scant. We examined the role of sexual orientation in the relationship between social cohesion and CCC among cisgender WES (n = 384) in Baltimore, Maryland using stratified logistic regression, controlling for potential confounders. Forty-five percent of WES experienced CCC. SM-WES reported significantly higher social cohesion than heterosexual WES. The relationship between social cohesion and CCC differed by sexual orientation. Among SM-WES, higher social cohesion was independently associated with decreased odds of experiencing CCC, controlling for food insecurity, crack use, police harassment, and method of finding clients. Among heterosexual WES, no significant association was found. Ongoing research and practice with WES should (1) collect sexual orientation data to allow for deeper understanding and tailored interventions, (2) leverage and nurture social cohesion and (3) tailor interventions to populations with attention to sexual orientation.
Bibliographical noteFunding Information:
This project was supported by the National Institute on Drug Abuse (Grant No. R01DA038499-01) and Johns Hopkins University Center for AIDS Research (Grant No. 1P30AI094189). The funders had no role in the study design, data collection, or in the analysis and interpretation of the results, and this paper does not necessarily reflect the views or opinions of the funders.
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
- Client condom coercion
- Sexual orientation
- Social cohesion
- Women who exchange sex (WES)
ASJC Scopus subject areas
- Social Psychology
- Public Health, Environmental and Occupational Health
- Infectious Diseases