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Loveless Love Affairs

Adolescent girls and young women’s HIV risk associated with transactional sex

Transactional sex is not sex work but refers to non-marital, non-commercial sexual relationships motivated by an implicit assumption that sex will be exchanged for material support or other benefits. Most women and men involved in transactional sex relationships consider themselves as partners or lovers rather than sellers or buyers. Conflating transactional sex and sex work in intervention design and funding may be counterproductive, as interventions designed for sex workers will not reach people engaged in transactional sex.

Why does transactional sex matter?

The practice of transactional sex matters and requires intervention to the extent that it is associated with HIV and related risk behaviours and therefore endangers the health and well-being of adolescent girls and young women and their male partners.

Although sex work carries a higher level of risk than transactional sex, the number of women engaging in transactional sex is much larger than the number involved in sex work. Transactional sex is, to varying degrees, associated with HIV risk behaviours such as multiple sexual partners and other determinants of HIV risk, including partner violence, abuse, alcohol consumption, and varying levels of condom use.  Women practice transactional sex in response to gender-unequal systems across a range of economic conditions and perceived levels of control over their relationships. Relationships vary in the level of intimacy shared between partners. Generalizations of women’s motivations for engaging in transactional sex have included fulfilment of basic needs in impoverished settings; attempts to improve one’s social status; and the expectation that men should provide for their partners in relationships. Motivation for engagement in transactional sex is driven by many factors such as;

Economic vulnerability: Women engage in transactional sex in contexts that range from those characterized as uniformly impoverished to those that are highly unequal. Programming should be relevant to the economic context. This common description of transactional sex stresses gendered poverty as constraining women’s options and forcing many to rely on transactional sex, as they are understood to have little choice but to exchange sex for food or shelter, as victims of men’s privileged status.

Social status influence: The extent to which social pressures to access modern goods and lifestyles influence transactional sex varies by context. In contrast to ‘basic needs’, this description stresses how in the context of rising economic inequality increasing social importance is placed on the ownership of material goods. This description of transactional sex emphasizes women’s agency and use of ‘sexual agency’ toward attaining social status.

Gender inequality: Gender norms direct expectations around the role of men as providers in relationships and guide relationship-level power dynamics and individual beliefs about women’s and men’s roles in transactional sex relationships. Women’s agency and perceived level of power within transactional sex relationships can vary from low to high. Not all sexual relationships characterized by or involving exchange are inherently risky. The emphasis should be placed not on eliminating transactional sex but rather on identifying the conditions and circumstances in which transactional sex imparts risk. For interventions, it is important to identify those that are motivated by exchange, and to further address the reasons why transactional sex relationships increase HIV risk.

Sex and material expressions of love

This description emphasizes that transactional sex is rooted in the expectation that men provide financial support and gifts in romantic relationships, and women offer sex in return. In addition, male provision is associated with, and/or deepens emotional intimacy.

What links transactional sex with HIV?

 Evidence on transactional sex and its role in HIV transmission for adolescent girls and young women has been hindered by poor and inconsistent measures of the practice—a limitation that is even more problematic for understanding HIV risks associated with transactional sex for men . Despite these limitations, a growing body of research has shown that transactional sex is a fairly prevalent sexual practice associated with a number of HIV risk behaviours and increases women’s risk of HIV. Transactional sex is more prevalent than sex work. There is a reported range in the practice of transactional sex. For example, in a trial, 8.7% of adolescent girls and young women from rural South Africa reported having practiced transactional sex with a casual partner. In Kenya, 52% of sexually active girls aged 14–17 years reported having practiced transactional sex. Among urban, sexually active secondary and university students aged 18–24 years in the United Republic of Tanzania, 57% reported having practiced transactional sex with a “sugar daddy” . The percentage of women engaging in sex work is much lower. For example, in South Africa, 0.8–1.0% of women aged 15–49 years were estimated to engage in sex work , while estimates of ever practicing transactional sex among adult women range from 3% to over 20% (18–20).

Combining approaches to address gender inequality and economic vulnerability

Three basic steps in addressing transactional sex within existing combination HIV prevention programmes.

1. Assess the prevalence of transactional sex, the interrelated motivations for engaging in transactional sex, including gender norms and expectations, and the circumstances in which transactional sex increases HIV risk.

 2. Prioritize the delivery of HIV prevention programme packages in contexts where transactional sex increases HIV risk for adolescent girls and young women and their male partners.

 3. Implement and integrate actions to address the interrelated motivations for transactional sex within existing multicomponent HIV prevention (structural, behavioural, biomedical) and wider social development programmes: Integrate risk assessment tools and interpersonal communication on transactional sex, related relationship dynamics, and short-term benefits versus long-term risks of transactional sex into existing HIV prevention outreach programmes. Support change in underlying economic vulnerability factors for adolescent girls and young women in contexts where transactional sex is driven largely by basic needs through enhanced access to education and social or cash transfers. Address social norms around gender and power that influence transactional sex in the context of community-based HIV and gender programmes.