Abstract
BackgroundAge-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores the motivations and perceived benefits of such relationships for AGYW and older men, plus the social and sexual and reproductive health (SRH) consequences.MethodsThis study held 37 participatory focus group discussions and 87 in-depth interviews with young people aged 14–24 and adult community members aged 25–49 in rural and urban Tanzania and Uganda. Participants were sampled using purposive and snowball techniques. Thematic analysis was conducted with the aid of NVIVO 10 software.ResultsMotivations, perceived benefits and costs for AGYW centred around four main themes: financial motivations, emotional support, meeting social expectations and reflections on sexual health. Specifically, AGYW noted that older partners gave gifts/money of higher value compared with younger men. Men’s perceived benefits and costs revolved around the need to satisfy their sexual desire, the perception that AGYW were capable of engaging in new and creative sexual styles and their desire for prestige among male peers. Both AGYW and men recognised the social and SRH consequences as: risk of violence, social stigma, risk of unplanned pregnancy and risk of sexually transmitted infections including HIV.ConclusionInterventions need to acknowledge the perceived benefits of age-disparate sexual relationships for AGYW and older men and engage them in critical reflection on the medium- to longer-term consequences versus the shorter-term satisfaction of needs, desires and aspirations, as a way to navigate the constrained opportunities they face given existing structural limitations. Interventions should also tackle the structural constraints AGYW face by helping them access resources, become empowered and challenge the expectation of having to depend financially on men. Interventions with men should unpack the assumption that men are naturally hypersexual. The role of peers for both girls and men should be acknowledged, and a shift from individual targeted interventions to changing norms at the community level should be considered.
Highlights
Age-disparate sex is associated with increased Human Immunodeficiency Virus (HIV) risk among adolescent girls and young women (AGYW) in sub-Saharan Africa
Despite awareness of the negative health and social consequences of age-disparate sex, Adolescent Girls and Young Women (AGYW) and older men are motivated to engage in these relationships for several reasons
There is a need for interventions to acknowledge the perceived benefits of age-disparate sex from the perspective of the AGYW and older men who engage in it
Summary
Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Evidence points to higher incidence of HIV among adolescent girls and young women (AGYW) relative to their male peers in sub-Saharan Africa (SSA) [1] This difference has been attributed in part to age-disparate sex [2, 3] ( referred to as intergenerational sex or cross-generational sex), [2, 4] which the literature generally defines as heterosexual intercourse with a non-marital partner ten or more years older [1, 2, 4,5,6], and in part to transactional sex [7]. The social exchange framework is useful for understanding sexuality within a relational context as it focuses on what each partner gives to and receives from the other This framework offers a way of explaining how both AGYW and men view age-disparate relationships. AGYW may decide to have an older partner not because they like it but because it is the most feasible beneficial option they have at a particular moment within the limited opportunities that society provides them
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