This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention’s 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.

本研究调查了美国注射吸毒者 (PWID) 的地域特征与异性交换性行为之间的整体和性别特定关联。 2012 年全国艾滋病毒行为监测。行政数据用于描述 PWID 居住的邮政编码、MSA、县和州的经济、社会和政治特征。多层次建模估计了地方特征和交换性别的关联。我们发现 52% 的女性和 23% 的男性报告了过去一年的异性交换性行为（N = 7599）。生活在支持工作照料者政策更强有力的州的女性 PWID 发生性交换的几率较低（aOR = 0.80；95% CI 0.69, 0.94）。生活在经济贫困程度更高的邮政编码中的 PWID 发生性交换的几率更高（aOR = 1.10；95% CI 1.03, 1.17）。我们发现很大比例的男性 PWID 与女性发生性关系；该群体的决定因素和风险值得探索。如果未来的研究确定此处确定的关系是因果关系，则减少注射吸毒者之间性交的干预措施应包括支持工作照料者和降低贫困率的政策。