{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:33:54Z","timestamp":1786984434804,"version":"build-2736575974"},"reference-count":41,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"am","delay-in-days":333,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/100000060","name":"NIAID","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"NIMH","doi-asserted-by":"publisher","award":["R25MH083620"],"award-info":[{"award-number":["R25MH083620"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Annals of Epidemiology"],"published-print":{"date-parts":[[2024,4]]},"DOI":"10.1016\/j.annepidem.2024.02.004","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T12:14:59Z","timestamp":1707826499000},"page":"35-39","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Transactional sex among adults accessing sexual health services in Alabama, 2008\u20132022: Prevalence, associated risk factors, and associations with HIV, HCV, and STI diagnosis"],"prefix":"10.1016","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8302-542X","authenticated-orcid":false,"given":"Kaitlyn","family":"Atkins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Bruce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma Sophia","family":"Kay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Musgrove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polly","family":"Kellar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"MacCarthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.annepidem.2024.02.004_bib1","unstructured":"About Ending the HIV Epidemic in the U.S. Initiative: Centers for Disease Control and Prevention; [Available from: \u3008https:\/\/www.cdc.gov\/endhiv\/about.html\u3009."},{"issue":"Suppl 3","key":"10.1016\/j.annepidem.2024.02.004_bib2","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1007\/s10461-019-02659-6","article-title":"Characteristics of and trends in HIV diagnoses in the deep south region of the United States, 2012-2017","volume":"23","author":"Watson","year":"2019","journal-title":"AIDS Behav"},{"key":"10.1016\/j.annepidem.2024.02.004_bib3","unstructured":"Alabama Diagnosis-based HIV Care Continuum, 2020 Finalized Data. Alabama Department of Public Health."},{"key":"10.1016\/j.annepidem.2024.02.004_bib4","unstructured":"2019 STATE OF ALABAMA HIV SURVEILLANCE ANNUAL REPORT. Alabama Department of Public Health."},{"key":"10.1016\/j.annepidem.2024.02.004_bib5","unstructured":"Sexually Transmitted Diseases Annual Report 2020. Alabama Department of Public Health."},{"issue":"11","key":"10.1016\/j.annepidem.2024.02.004_bib6","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1097\/01.smj.0000286756.54607.9f","article-title":"Minorities, the poor, and survivors of abuse: HIV-infected patients in the US deep South","volume":"100","author":"Pence","year":"2007","journal-title":"South Med J"},{"issue":"4","key":"10.1016\/j.annepidem.2024.02.004_bib7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0091711","article-title":"Beyond race and place: distal sociological determinants of HIV disparities","volume":"9","author":"Buot","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib8","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1080\/17441692.2019.1631366","article-title":"Towards ending the US HIV epidemic by 2030: understanding social determinants of health and HIV in Mississippi","volume":"15","author":"Sprague","year":"2020","journal-title":"Glob Public Health"},{"issue":"6","key":"10.1016\/j.annepidem.2024.02.004_bib9","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1080\/13691058.2015.1110255","article-title":"Structural community factors and sub-optimal engagement in HIV care among low-income women in the Deep South of the USA","volume":"18","author":"Walcott","year":"2016","journal-title":"Cult Health Sex"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib10","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1177\/08901171211041097","article-title":"Revitalizing HIV prevention programs: recommendations from those most impacted by HIV in the deep South","volume":"36","author":"Williams","year":"2022","journal-title":"Am J Health Promot"},{"issue":"10148","key":"10.1016\/j.annepidem.2024.02.004_bib11","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0140-6736(18)31439-9","article-title":"The global response and unmet actions for HIV and sex workers","volume":"392","author":"Shannon","year":"2018","journal-title":"Lancet"},{"issue":"12","key":"10.1016\/j.annepidem.2024.02.004_bib12","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1097\/OLQ.0000000000001085","article-title":"Incidence and predictors of chlamydia, gonorrhea and trichomonas among a prospective cohort of cisgender female sex workers in Baltimore, Maryland","volume":"46","author":"Park","year":"2019","journal-title":"Sex Transm Dis"},{"key":"10.1016\/j.annepidem.2024.02.004_bib13","unstructured":"H.I.V. Risk Among Persons Who Exchange Sex for Money or Nonmonetary Items: Centers for Disease Control and Prevention; [Available from: https:\/\/www.cdc.gov\/hiv\/group\/sexworkers.html."},{"issue":"4","key":"10.1016\/j.annepidem.2024.02.004_bib14","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/QAI.0000000000002362","article-title":"HIV prevalence among women who exchange sex for money or Drugs-4 U.S. cities","volume":"84","author":"Nerlander","year":"2020","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib15","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12954-022-00697-3","article-title":"Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland","volume":"19","author":"Rosen","year":"2022","journal-title":"Harm Reduct J"},{"issue":"4","key":"10.1016\/j.annepidem.2024.02.004_bib16","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/QAI.0b013e3182968d39","article-title":"Client demands for unsafe sex: the socioeconomic risk environment for HIV among street and off-street sex workers","volume":"63","author":"Deering","year":"2013","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"8","key":"10.1016\/j.annepidem.2024.02.004_bib17","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1089\/apc.2019.0054","article-title":"Advancing the HIV pre-exposure prophylaxis continuum: a collaboration between a public health department and a federally qualified health center in the southern United States","volume":"33","author":"Clement","year":"2019","journal-title":"AIDS Patient Care STDS"},{"issue":"7","key":"10.1016\/j.annepidem.2024.02.004_bib18","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1080\/00224499.2022.2072799","article-title":"Intersectional experienced stigma and psychosocial syndemic conditions in a sample of black men who have sex with men engaged in sex work (BMSM-SW) from Six US Cities","volume":"59","author":"Chandler","year":"2022","journal-title":"J Sex Res"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib19","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10508-021-02124-3","article-title":"COVID-19, stigma, and the ongoing marginalization of sex workers and their support organizations","volume":"51","author":"Benoit","year":"2022","journal-title":"Arch Sex Behav"},{"key":"10.1016\/j.annepidem.2024.02.004_bib20","unstructured":"Ending the HIV Epidemic: A Plan for America. Centers for Disease Control and Prevention."},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib21","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/s12905-020-01088-1","article-title":"Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR","volume":"20","author":"Menza","year":"2020","journal-title":"BMC Women\u2019s Health"},{"key":"10.1016\/j.annepidem.2024.02.004_bib22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1471-2288-8-9","article-title":"A comparison of two methods for estimating prevalence ratios","volume":"8","author":"Petersen","year":"2008","journal-title":"BMC Med Res Method"},{"key":"10.1016\/j.annepidem.2024.02.004_bib23","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ahj.2021.03.008","article-title":"To adjust or not to adjust: the role of different covariates in cardiovascular observational studies","volume":"237","author":"Etminan","year":"2021","journal-title":"Am Heart J"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib24","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1186\/s12889-020-08902-3","article-title":"Combined effects of gender affirmation and economic hardship on vulnerability to HIV: a qualitative analysis among U.S. adult transgender women","volume":"20","author":"Jennings Mayo-Wilson","year":"2020","journal-title":"BMC Public Health"},{"issue":"4","key":"10.1016\/j.annepidem.2024.02.004_bib25","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1080\/26895269.2022.2044425","article-title":"Setting a research agenda in trans health: an expert assessment of priorities and issues by trans and nonbinary researchers","volume":"23","author":"Veale","year":"2022","journal-title":"Int J Transgend Health"},{"issue":"2","key":"10.1016\/j.annepidem.2024.02.004_bib26","doi-asserted-by":"crossref","first-page":"154","DOI":"10.2471\/BLT.16.183913","article-title":"Ensuring an inclusive global health agenda for transgender people","volume":"95","author":"Thomas","year":"2017","journal-title":"Bull World Health Organ"},{"issue":"10042","key":"10.1016\/j.annepidem.2024.02.004_bib27","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S0140-6736(16)00683-8","article-title":"Transgender people: health at the margins of society","volume":"388","author":"Winter","year":"2016","journal-title":"Lancet"},{"key":"10.1016\/j.annepidem.2024.02.004_bib28","unstructured":"Quick Facts Birmingham, Alabama: United States Census Bureau; [Available from: https:\/\/www.census.gov\/quickfacts\/birminghamcityalabama."},{"issue":"S1","key":"10.1016\/j.annepidem.2024.02.004_bib29","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0000000000002965","article-title":"Addressing racism's role in the US HIV Epidemic: qualitative findings from three ending the HIV epidemic prevention projects","volume":"90","author":"Harrison","year":"2022","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"10.1016\/j.annepidem.2024.02.004_bib30","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1097\/JNC.0000000000000189","article-title":"How perceived structural racism and discrimination and medical mistrust in the health system influences participation in HIV health services for black women living in the United States South: a qualitative, descriptive study","volume":"31","author":"Randolph","year":"2020","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib31","first-page":"57","article-title":"Incarceration, African Americans and HIV: advancing a research agenda","volume":"100","author":"Harawa","year":"2008","journal-title":"J Natl Med Assoc"},{"issue":"6-7","key":"10.1016\/j.annepidem.2024.02.004_bib32","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1177\/0011128721991823","article-title":"Trust and confidence in police officers and the institution of policing: The views of African Americans in the American South","volume":"67","author":"Pryce","year":"2021","journal-title":"Crime Delinquency"},{"issue":"12","key":"10.1016\/j.annepidem.2024.02.004_bib33","doi-asserted-by":"crossref","first-page":"e1192","DOI":"10.1016\/S2214-109X(17)30375-3","article-title":"Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review","volume":"5","author":"Degenhardt","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/0022042618795141","article-title":"Risky sexual behaviors, substance use, and perceptions of risky behaviors among criminal justice involved women who trade sex","volume":"49","author":"Jones","year":"2019","journal-title":"J Drug Issues"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib35","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1186\/s12879-019-4326-3","article-title":"Links between transactional sex and HIV\/STI-risk and substance use among a large sample of European men who have sex with men","volume":"19","author":"Berg","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"10072","key":"10.1016\/j.annepidem.2024.02.004_bib36","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"Singer","year":"2017","journal-title":"Lancet"},{"issue":"7","key":"10.1016\/j.annepidem.2024.02.004_bib37","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1080\/17441692.2020.1724317","article-title":"Whither syndemics?: Trends in syndemics research, a review 2015-2019","volume":"15","author":"Singer","year":"2020","journal-title":"Glob Public Health"},{"issue":"4","key":"10.1016\/j.annepidem.2024.02.004_bib38","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1007\/s10508-020-01828-2","article-title":"Syndemic health disparities and sexually transmitted infection burden among black men who have sex with men engaged in sex work in the U.S","volume":"50","author":"Chandler","year":"2021","journal-title":"Arch Sex Behav"},{"issue":"1","key":"10.1016\/j.annepidem.2024.02.004_bib39","first-page":"61","article-title":"Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a canadian setting","volume":"164","author":"Shannon","year":"2010","journal-title":"Arch Pedia Adolesc Med"},{"key":"10.1016\/j.annepidem.2024.02.004_bib40","doi-asserted-by":"crossref","DOI":"10.1177\/1178633719883282","article-title":"Resurgence of syphilis in the United States: an assessment of contributing factors","volume":"12","author":"Schmidt","year":"2019","journal-title":"Infect Dis (Auckl)"},{"key":"10.1016\/j.annepidem.2024.02.004_bib41","unstructured":"Chen C. Syphilis is resurging in the U.S., a sign of public health's funding crisis: NPR; 2021 [Available from: https:\/\/www.npr.org\/sections\/health-shots\/2021\/11\/01\/1050568646\/syphilis-std-public-health-funding."}],"container-title":["Annals of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S104727972400022X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S104727972400022X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T21:52:24Z","timestamp":1778795544000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S104727972400022X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":41,"alternative-id":["S104727972400022X"],"URL":"https:\/\/doi.org\/10.1016\/j.annepidem.2024.02.004","relation":{},"ISSN":["1047-2797"],"issn-type":[{"value":"1047-2797","type":"print"}],"subject":[],"published":{"date-parts":[[2024,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Transactional sex among adults accessing sexual health services in Alabama, 2008\u20132022: Prevalence, associated risk factors, and associations with HIV, HCV, and STI diagnosis","name":"articletitle","label":"Article Title"},{"value":"Annals of Epidemiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.annepidem.2024.02.004","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}