Engagement In Transactional Sex Research Articles

Transactional Sex and the HIV Epidemic Among Men Who have Sex with Men (MSM): Results From a Systematic Review and Meta-analysis.

Engagement in transactional sex has been hypothesized to increase risk of HIV among MSM, however conflicting evidence exists. We conducted a systematic review and meta-analysis comparing HIV prevalence among MSM who engaged in transactional sex to those who did not (33 studies in 17 countries; n=78,112 MSM). Overall, transactional sex was associated with a significant elevation in HIV prevalence (OR1.34, 95% CI1.11-1.62). Latin America (OR2.28, 95% CI1.87-2.78) and Sub-Saharan Africa (OR1.72, 95% CI1.02-2.91) were the only regions where this elevation was noted. Further research is needed to understand factors associated with sex work and subsequent HIV risk in Latin America and Sub-Saharan Africa.

Transactional sex and prevalence of STIs: a cross-sectional study of MSM and transwomen screened for an HIV prevention trial.

Few studies have characterised the degree of engagement in transactional sex among men and transgender women who have sex with men and explored its association with sexually transmitted infections and human immunodeficiency virus in Ecuador. We screened 642 men who have sex with men and transgender women for a pre-exposure prophylaxis clinical trial (iPrEx) in Guayaquil, Ecuador, 2007-2009. We analysed the association of degree of engagement in transactional sex and prevalence of sexually transmitted infections including human immunodeficiency virus using chi-square and analysis of variance tests. Although just 6.2% of those who screened self-identified as sex workers, 52.1% reported having engaged in transactional sex. Compared to those who had never been paid for sex, those who had been paid were more likely to have a sexually transmitted infection (56.6% vs. 45.0%, p = 0.007) and trended towards a higher human immunodeficiency virus prevalence (16.6% vs. 10.4%, p = 0.082) at screening. Transgender women compared to other men who have sex with men were more likely to have sexually transmitted infections diagnosed at screening (75.6% vs. 50.0%, p = 0.001). Transactional sex is practiced widely but occasionally among the men who have sex with men and transgender women in Guayaquil who screened for the iPrEx study; however, engaging in transactional sex may not lead to a sex worker self-identification. Both transactional sex and being a transgender woman are associated with sexually transmitted infections prevalence.

Sexual and reproductive health and HIV in border districts affected by migration and poverty in Tanzania

Objectives To assess HIV knowledge, attitudes, sexual practices and sexual and reproductive health (SRH) service delivery in border areas of Tanzania, with a view to support the prioritisation of SRH interventions in border areas.Methods The target sample comprised randomly selected people living near the border, aged 15 to 49 years. To gather information, we utilised: (i) a standardised questionnaire (n = 86; 42 men and 44 women) previously used in national household surveys conducted by the Tanzanian government; (ii) focus group discussions (ten male groups, n = 47; ten female groups, n = 51); and (iii) semi-structured interviews with service providers (n = 37).Results The mean number of sexual partners, frequency of multiple concurrent partnerships and engagement in transactional sex were significantly higher in the border community than in the national population. Knowledge about HIV was comparable with that in the general population. Access to SRH services was limited in the border areas.Conclusion Efforts to reduce HIV transmission and to improve SRH in the border areas should focus on gaps in service delivery rather than education and information activities alone. In addition, multi-sectorial efforts spanning the health, social, legal and private sectors addressing gender imbalances and poverty alleviation are imperative for reducing poverty-driven unsafe transactional sex.Chinese 摘要 目的 为评估坦桑尼亚边境地区人群对于HIV的认知度与态度、性医学及性与生殖健康（sexual and reproductive health, SRH）工作的开展，优先支持边境地区的SRH干预。方法随机抽取边境地区15至49岁人群为目标样本。数据采集应用到：(i)标准化调查表（n = 86; 42男性与44女性），该调查表此前被坦桑尼亚政府用于全国家庭调查；(ii) 焦点小组讨论（10组男性，n = 47; 10组女性，n = 51）；(iii) 与医务人员的半结构式访谈（n = 37）。结果 边境地区人群的平均性伴侣数、同时多个性伴侣频率及参与性交易频率显著高于其他地区，对HIV的认知度与其他地区相当。边境地区SRH医疗水平低下。结论 要降低边境地区的HIV传播、提高SRH水平，应着重填补医疗空缺，而非单一进行教育、信息等宣传活动。此外，跨越多部门如卫生、社会、法律、私营部门，共同解决性别失衡与贫困扶持问题，是减少贫困驱使下不安全性交易的必要措施。

Forced Sexual Experiences as Risk Factor for Self-Reported HIV Infection among Southern African Lesbian and Bisexual Women

Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.

Alcohol consumption and risky sexual behaviour in the fishing communities: evidence from two fish landing sites on Lake Victoria in Uganda

BackgroundThe fishing communities are among population groups that are most at risk of HIV infection, with some studies putting the HIV prevalence at 5 to 10 times higher than in the general population. Alcohol consumption has been identified as one of the major drivers of the sexual risk behaviour in the fishing communities. This paper investigates the relationship between alcohol consumption patterns and risky behaviour in two fishing communities on Lake Victoria.MethodsFace-to-face interviews were conducted among 303 men and 172 women at the fish landing sites; categorised into fishermen, traders of fish or fish products and other merchandise, and service providers such as casual labourers and waitresses in bars and hotels, including 12 female sexual workers. Stratified random sampling methodology was used to select study units. Multivariable analysis was conducted to assess independent relationship between alcohol consumption and sexual risky behaviour. Measures of alcohol consumption included the alcohol use disorder test score (AUDIT), having gotten drunk in previous 30 days, drinking at least 2 times a week while measures for risky behaviour included engaging in transactional sex, inconsistent condom use, having sex with non-regular partner and having multiple sexual partners.ResultsThe level of harmful use of alcohol in the two fishing communities was quite high as 62% of the male and 52% of the female drinkers had got drunk in previous 30 days. The level of risky sexual behaviour was equally high as 63% of the men and 59% of the women had unprotected sex at last sexual event. Of the 3 occupations fishermen had the highest levels of harmful use of alcohol and risky sexual behaviour followed by service providers judging from values of most indicators. The kind of alcohol consumption variables correlated with risky sexual behaviour variables, varied by occupation. Frequent alcohol consumption, higher AUDIT score, having got drunk, longer drinking hours and drinking any day of the week were strongly correlated with engaging in transactional sex among fishermen but fewer of the factors exhibited the same correlation among traders and service providers. Fishermen who drank 2 or more times a week were 7.9 times more likely to have had transactional sex (95% CI: 2.05-30.24) compared to those who never drank alcohol. A similar pattern was observed for traders and service providers at the landing sites. Inconsistent condom use or none use of condoms was not significantly correlated with any of the alcohol consumption indicator variables in multivariate analysis except for day of drinking among men.ConclusionAlcohol consumption is strongly correlated with having multiple sexual partners, sex with non-regular partner and engagement in transactional sex but not with consistent condom use at fish landing sites. However, the pattern and strength of this correlation differs by occupation. HIV risk reduction programs targeting the fishing communities should address alcohol consumption, particularly alcohol consumption before sexual contact. Different occupations may need different interventions.

Sexual violence and HIV transmission: summary proceedings of a scientific research planning meeting.

This summarizes proceedings of a Scientific Research Planning Meeting on Sexual Violence and HIV transmission, convened by the Social Science Research Council on 19–20 March 2012 at the Greentree Foundation in New York. The Meeting brought together an interdisciplinary group of basic, clinical, epidemiological and social science researchers and policy makers with the aim of: (1) examining what is known about the physiology of sexual violence and its role in HIV transmission, acquisition and pathogenesis; (2) specifying factors that distinguish risks throughout the maturation of the female genital tract, the reproductive cycle and among post-menopausal women; and (3) developing a research agenda to explore unanswered questions. The Meeting resulted in a consensus Research Agenda and White Paper that identify priorities for HIV research, policy and practice as it pertains to the role of sexual violence and genital injury in HIV transmission, acquisition and pathogenesis, particularly among women and girls.

Gender Equity in Combating HIV

Almost 3 million people are newly diagnosed with HIV annually with only 1 in 8 receiving antiretroviral therapy.1 A new focus on this ongoing epidemic is needed. Healthcare personnel should examine what drives the spread of HIV in various populations to develop multifaceted prevention strategies. Differences in the social value of women power differences varying opportunities and behavioral expectations of men and women contribute to gender-related violence. The evidence supporting the role of gender-based violence and gender inequity in HIV spread in women has increased.1 Women in South Africa experiencing physical or sexual intimate partner violence or those in relationships with low equality are at a greater risk for HIV infections when compared with women who have not experienced these inequalities.2 One in 7 new HIV infections could have been prevented if the women in this study have avoided physical or sexual abuse; women who have experienced childhood sexual abuse are at a two-thirds greater risk for HIV infection.2 Women and girls constrained by poverty and limited opportunities are more likely to tolerate partners who are violent and controlling and to view engagement in transactional sex or prostitution as a viable choice. Women who are depressed abusing substances or experiencing posttraumatic stress disorder related to rape are more likely to engage in risky sex thus increasing their risk of HIV infection. Cultural complexities related to gender roles are difficult to address. Introducing women to the possibility of empowerment within their relationships or justifying the idea that relationships should be based on mutual respect is not an easy task. Empowerment of women requires an educational and financial base for the women to assert independence. Few long-term randomized controlled trials have addressed these issues. The IMAGE (Intervention with Microfinance for AIDS and Gender Equity Study) trial a 3-year study in South Africa that provided a program to economically empower women and assist with gender equality resulted in a 55% decrease in violence experienced by women. This study and the strategies used are worth noting. Decreasing gender inequities to address the spread of HIV requires political resources as well as political will. As difficult as this topic is to discuss we need to address these issues with our students and encourage involvement research and intervention in areas that are shown to make a difference in this devastating epidemic. Addressing gender equity as it relates to HIV can also help nursing students understand how cultural complexities and epidemiology relate. (full text)

Lack of HIV Seropositivity Among a Group of Rural Probationers: Explanatory Factors

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in rural America has been described as an epidemic, and the HIV prevalence rate among criminal justice populations is higher than the general population. Thus, criminally involved populations in Southern rural areas are at elevated risk for contracting HIV because of drug and sexual practices; however, little is known about HIV/AIDS in the fastest growing criminal justice population-probationers. To examine possible explanations for the lack of HIV seropositivity found in a purposive sample of rural probationers. Data were examined from 800 felony probationers from 30 counties in Kentucky's Appalachian region. Measures included HIV prevalence within the 30 counties, migration patterns, HIV knowledge, substance use, and sexual risk behaviors. These probationers had a high level of HIV knowledge, reported minimal injection drug use, practiced serial monogamy, and reported minimal engagement in transactional sex. However, these probationers also reported negligible condom use, and injection drug users shared needles and works. Findings suggest the importance of developing programs targeting safe sex practices in rural areas.