Exchange Sex Among High School Students—Washington, DC, 2017

Abstract Purpose Exchange sex, the exchange of money or nonmonetary items for sex, is associated with sexually transmitted diseases and HIV. We sought to identify prevalence and characteristics associated with exchange sex among District of Columbia (DC) high school students. Methods We used the 2017 DC Youth Risk Behavior Survey, a cross-sectional survey of students in grades 9–12 (n = 8,578). We performed multivariable logistic regression to examine associations between exchange sex and demographic, home environment, and substance use measures. Results In 2017, a total of 7.4% (95% confidence interval [CI]: 6.6–8.2) of students reported ever having engaged in exchange sex. Odds of exchange sex were higher among males (adjusted odds ratio [AOR]: 2.5; 95% CI: 1.6–4.0) and students who had sexual contact with partners of both sexes (AOR: 2.4; 95% CI: 1.2–4.9), compared with students having sexual contact with partners of opposite sex only. Exchange sex was also associated with having been kicked out, run away, or abandoned during the past 30 days (AOR: 10.7; 95% CI: 7.0–16.3]); going hungry during the past 30 days (AOR: 2.2; 95% CI: 1.1–4.5); and ever using synthetic marijuana (AOR: 2.6; 95% CI: 1.3–5.0) or cocaine, heroin, methamphetamines, or ecstasy (AOR: 2.9; 95% CI: 1.6–5.3]), compared with those who had not. Conclusions Approximately one in 14 DC high school students engaged in exchange sex. Programs providing services to youth with unstable housing, food insecurity, or who use drugs should incorporate sexual health services to address exchange sex practices.