{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T16:42:51Z","timestamp":1783788171167,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA033866"],"award-info":[{"award-number":["R01DA033866"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Transactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high\u2010risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice\u2010involved Appalachian women who use drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants (N = 400) were randomly selected, screened, and interviewed face\u2010to\u2010face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>On average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Results suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice\u2010involved and may signal other HIV\u2010related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk\u2010reduction interventions, including jail\u2010based interventions, to educate vulnerable, hard\u2010to\u2010reach populations on the risks associated with HIV.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12741","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T15:54:04Z","timestamp":1673970844000},"page":"789-794","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Transactional sex among rural, justice\u2010involved Appalachian women who use drugs"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0527-6850","authenticated-orcid":false,"given":"Megan F.","family":"Dickson","sequence":"first","affiliation":[{"name":"Center on Drug and Alcohol Research University of Kentucky  Lexington Kentucky USA"},{"name":"Department of Behavioral Science University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Tillson","sequence":"additional","affiliation":[{"name":"Center on Drug and Alcohol Research University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Calvert","sequence":"additional","affiliation":[{"name":"Center on Drug and Alcohol Research University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Staton","sequence":"additional","affiliation":[{"name":"Center on Drug and Alcohol Research University of Kentucky  Lexington Kentucky USA"},{"name":"Department of Behavioral Science University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2016.09.023"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-010-9534-5"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1332-y"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-018-0309-8"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-016-0234-2"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2016.0054"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/10538712.2016.1167802"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2039-z"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2011.630342"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2011.07.009"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2100-y"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/00224499.2010.501916"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1557988315609110"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-010-9539-0"},{"key":"e_1_2_7_16_1","first-page":"303","article-title":"Intersecting motivations for leaving abusive relationships, substance abuse, and transactional sex among HIV high\u2010risk women","volume":"6","author":"David NS","year":"2016","journal-title":"J Ga Public Health Assoc"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.12.009"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002230"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0b013e32833864d5"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19073783"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00138894"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000658"},{"issue":"3","key":"e_1_2_7_23_1","first-page":"269","article-title":"Exploring gender and economic development in Appalachia","volume":"10","author":"Latimer M","year":"2004","journal-title":"J Appalach Stud"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001098"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02612-7"},{"key":"e_1_2_7_26_1","unstructured":"United States Department of Agriculture Economic Research Service.USDA ERS \u2010 2013 Rural\u2010Urban Continuum Codes.2020. 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