Abstract
Transactional sex increases HIV risk among adolescent girls and young women (AGYW). Understanding the individual and dyadic nature of transactional sex may provide evidence for risk reduction interventions. Multilevel logistic regression was used to cross-sectionally examine correlates of transactional sex among AGYW in Lilongwe, Malawi. Participants (N = 920) reported 1227 relationships. Individual-level associations were found between being divorced/widowed (AOR 5.07, 95% CI 1.93, 13.25), married (AOR 0.26, 95% CI 0.09, 0.72), or unstably housed (AOR 7.11, 95% CI 2.74, 18.47) and transactional sex. At the relationship-level, transactional sex occurred in relationships with: non-primary primary partners (AOR 4.06, 95% CI 2.37, 6.94), perceived partner concurrency (AOR 1.85, 95% CI 1.11, 3.08), and feared violence with couples HIV testing (AOR 2.81, 95% CI 1.26, 6.29), and less likely to occur in relationships with children (AOR 0.15, 95% CI 0.06, 0.38). Multiple co-occurring social and structural vulnerabilities increase transactional sex engagement warranting the need for social protection and gender transformative approaches.
Highlights
Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) are a population at increased risk of HIV infection
This study provides an in-depth analysis of transactional sexual relationships among AGYW in Malawi
We found that AGYW receive similar types of items from transactional versus non-transactional partners, they receive more money from transactional partners
Summary
Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) are a population at increased risk of HIV infection. AGYW ages 15–24 years old account for a quarter of new HIV infections in the region [1]. Transactional sex, defined as, “noncommercial, nonmarital sexual relationships motivated by an implicit assumption that sex will be exchanged for material support or other benefits [2, 3],” increases AGYW’s risk of acquiring HIV [4, 5]. Understanding the nature of transactional sex may allow us to reduce the risk within these relationships, which may in turn have an impact on HIV transmission rates among AGYW. Male provision of gifts to their female partners is integral role to the quality and duration of relationships of young rural Malawians.
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