Transactional Sex Research Articles

Editorial: Thinking with Migration, Sexuality, Gender Identity, and Transactional Sex

This article introduces a special issue of Anti-Trafficking Review that bridges the fields of queer, migration, and critical trafficking studies by examining the implications of heightened juridical recognition of sexual orientation and gender identity for debates on migration, sex work, and human trafficking. The issue proceeds from the insight that, as the legibility of queer and trans* (i.e., lesbian, gay, bisexual, transgender, queer, intersex, and all non-binary and non-heteronormative forms of sexuality and gender identity) moves forward, it appears to de-emphasise the explicit connections that sexuality- and gender-based social movements have historically drawn between identity, governance, and material survival. In emphasising questions of survival, this issue both recuperates queer and non-cisnormative subjects within debates on transactional sex, and shows how a queer theoretical sensibility can offer new insights for established critiques in the field.

Safe spaces, vocational training, and prevention programs protect young Ugandan women: findings from Uganda Youth Development Link’s DREAMS initiative for rural communities

ABSTRACT Adolescent girls and young women (AGYW) in Uganda, especially those based in rural Africa, experience multiple interrelated adversities that may place them at risk of HIV, alcohol abuse, and being dependent on inequitable power relationships with men for survival and income. With funding from the DREAMS initiative in Africa, a multi-component, community-based intervention was designed to optimize AGYW’s abilities to care for themselves. From 2016 to 2019, the Uganda Youth Development Link established the DREAMS Initiative for Rural Communities in 10 rural sites in the Bukomansimbi, Gomba, and Ssembabule Districts, at which n = 8620 AGYW engaged in vocational training, cognitive-behavioral preventive interventions addressing HIV risk, interpersonal partner violence, substance abuse prevention, parenting classes, and recreational activities. Existing community leaders linked AGYW to these programs. Surveys at recruitment and two years later evaluated the program and assessed its impact on AGYW. AGYW reported multiple risk histories: 41.5% engaged in transactional sex (typically with two past partners); 30.3% were mothers; and 42.5% used alcohol often. There was high uptake of each program component: 89% completed vocational training; 61% received family planning services; 78% were tested for HIV (1% seropositive). Two years post intervention, 70% of those who had learnt to be a tailor were still working; 33% of those who had been trained in hair dressing. Multi-component interventions are required to address the multiple challenges experienced by AGYW. The broad range of experiences within each community allows multiple entry points to care and tailored programming for AGYW.

The Rise and Normalisation of Blessee/Blesser Relationships in South Africa: A Post-Colonial Feminist Analysis

Since 2015, young urban black women in South Africa have been posting images of luxury items on social media platforms such as Instagram. These women claim that their luxury items are gifts from their ‘blessers’/wealthy men in exchange for sex and companionship. This has led to the rise of the ‘blesser culture’ on social media and the prevalence of transactional sex for upward mobility and status. This article provides a post-colonial feminist evaluation of 10 young black women from northern Johannesburg. It examines their motivations for engaging in these relationships. It draws from Stoebenau et al.’s (2016) theoretical framework that describes the three paradigms of transactional sex, ‘sex for basic needs,’ ‘sex for upward mobility and status’ and ‘sex and material expressions of love’ as a continuum of deprivation, agency, and instrumentality. This analysis challenges research frameworks that limit transactional sex to matters of HIV/AIDS transmission, and the framing of women as powerless victims of men. The article reveals these women seek blessers based on relative deprivation, to access a more high-status lifestyle and upward social mobility and from a position of agency. They view blesser relationships as a mutually beneficial exchange that allows them to give sex to access the commodities of modernity.

Adoption of HIV pre-exposure prophylaxis among women at high risk of HIV infection in Kenya.

In 2017, Kenya became one of the first African countries to provide pre-exposure prophylaxis (PrEP) in its national HIV prevention plan. We sought to characterize factors associated with PrEP uptake and persistence among a cohort of women at risk of HIV infection during the early stages of PrEP scale-up in Kenya. HIV-negative women ≥18 years with ≥2 sexual partners in the past 4 weeks were recruited as part of an ongoing cluster randomized trial of an HIV self-testing intervention. PrEP use was assessed at baseline and at 6- and 12-month follow-up visits. Between June 2017 and August 2018, 2,086 were enrolled and had complete baseline data. 138 (6.6%) reported PrEP use during the first year of the study. Although PrEP use increased, persistence on PrEP was low, and less than half of individuals reported continuing PrEP at follow-up visits. In multivariate analyses, PrEP use was associated with recent STIs, having an HIV-positive primary partner, having regular transactional sex in the past 12 months, and being a female sex worker. In the early stages of PrEP scale-up in Kenya, uptake increased modestly among women with risk factors for HIV infection, but overall uptake and persistence was low.

Violence Exposure Among Adolescent Boys and Young Men in Colombia With a Lifetime History of Transactional Sex

PurposeThere is a paucity of research examining the contextual factors that shape the violence experienced by those engaged in transactional sex, particularly among adolescent boys and young men. Recognizing the acute vulnerability among youth engaged in transactional sex, this analysis examined the associations between lifetime transactional sex and experience of violence among 13- to 24-year-old males. MethodsUsing data from two strata of the 2018 Violence Against Children and Youth Survey from Colombia, logistic regressions were used to estimate the association between engagement in transactional sex and violence exposure. Three groups of violence outcomes were examined: violence victimization, violence perpetration, and witnessing violence. ResultsViolence victimization and witnessing violence were widespread. Adolescent boys and young men with a lifetime history of transactional sex were significantly more likely to experience violence victimization than those without a lifetime history of transactional sex, particularly intimate partner violence (adjusted odds ratio [aOR]: 5.23 and 5.41) and caregiver emotional violence (aOR: 7.23 and 8.74). In the national and priority samples respectively, those with a lifetime history of transactional sex were also significantly more likely to witness violence within the home (aOR: 4.42 and 4.99) and outside of the home (aOR: 7.24 and 28.32). DiscussionAlthough research is needed to determine causal pathways, our findings highlight the ubiquity of violence and the criticality of supporting this group of adolescent boys and young men. Interventions for those with a history of transactional sex should address factors that may contribute to drivers of violence and transactional sex.

Analysis of Heavy Rainfall in Sub-Saharan Africa and HIV Transmission Risk, HIV Prevalence, and Sexually Transmitted Infections, 2005-2017

Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown. To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa. A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022. Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level. HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners. The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas. The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment.

Sexual vulnerability of migrant women in the multicultural context of French Guiana: A societal issue.

BackgroundFrench Guiana is a multicultural French territory in Amazonia with an old migration history and a high prevalence of HIV infection. The objective of this study was to evaluate situations of sexual vulnerability and their associated factors among migrant women in French Guiana.MethodsA cross-sectional epidemiological study was carried out in 2021 in the French Red Cross Prevention and Health Centers of the two main cities of French Guiana (Cayenne and Saint Laurent du Maroni). Analysis was performed with multivariate stepwise logistic regression using Stata 15.0 software.FindingsA total of 382 migrant women were included, with a median age of 31 years, mainly born in Haiti (80%), Suriname (9%), or Dominican Republic (6%), undocumented (71%), and with financial difficulties (77%). Among the 20% having casual partners, 57% reported unprotected sexual intercourse, more often the Haitian and Surinamese women. A history of rape was reported by 20% of women, most often in the country of origin (71%). Lifetime rape was associated with being threatened [aOR = 3.69 (1.96–6.96)] or being physically abused [aOR = 12.95 (6.51–25.75)] in the multivariate analysis. Among the women surveyed, 30% reported having ever exchanged sex for money, food, or shelter in their lifetime. Transactional sex is more common among Dominican women [aOR = 5.59 (1.84–16.95)] and women living in French Guiana for more than 2 years [aOR = 2.32 (1.38–3.92)]. Transactional sex is also associated with alcohol misuse [aOR = 2.57 (1.46–4.53)], history of threats [aOR = 2.03 (1.14–3.63)], history of rape [aOR = 1.92 (1.03–3.60)], and depressive disorders [aOR = 2.08 (1.21–3.60)].InterpretationMigrant women in French Guiana are in a situation of sexual vulnerability. An intervention focused on sexual education and the promotion of prevention tools among Haitian women is advisable. Better prevention and support for transactional sex are needed to prevent violence and its mental health and alcohol misuse consequences for all women, especially Dominican women.

Alignment of PrEP adherence with periods of HIV risk among adolescent girls and young women in South Africa and Zimbabwe: a secondary analysis of the HPTN 082 randomised controlled trial

Adolescent girls and young women in southern and eastern Africa have adherence challenges with daily oral HIV pre-exposure prophylaxis (PrEP). High adherence is most important during periods of HIV risk (prevention-effective adherence). We aimed to describe HIV risk behaviour and to understand patterns in PrEP adherence during periods of risk among adolescent girls and young women from sub-Saharan Africa. We did a secondary analysis of the HPTN 082 trial, an open-label, interventional, randomised controlled trial of sexually active adolescent girls and young women (aged 16-25 years) testing negative for HIV in Johannesburg and Cape Town, South Africa, and in Harare, Zimbabwe. The primary outcomes were high cumulative PrEP adherence, dichotomised as intracellular tenofovir diphosphate concentrations of at least 700 fmol/punch in dried blood spots at weeks 13, 26, and 52, and high recent PrEP adherence, dichotomised as plasma tenofovir concentrations of at least 40 ng/mL at weeks 13, 26, and 52, among participants who accepted PrEP. We collected data on sexual behaviour every 3 months. We categorised visits into a binary variable of any HIV risk based on condomless sex, more than one sexual partner, primary partner's HIV status and antiretroviral use, transactional sex, drug or alcohol use around sexual activity, and laboratory-diagnosed STIs. We used generalised estimating equations to evaluate associations between HIV risk (reflecting behaviour during the previous 3 months) and high cumulative and recent adherence to PrEP and any PrEP use (quantifiable drug concentrations). The trial is registered with ClinicalTrials.gov, NCT02732730. Between Oct 12, 2016, and Oct 25, 2018, 451 women were recruited, and 427 participants (median age 21·0 years [IQR 19·0-22·0]) were eligible for inclusion in this analysis. The proportion of participants reporting at least one HIV risk factor decreased significantly over follow-up, from 364 (85%) participants at enrolment, 226 (60%) at week 13, and 243 (65%) at week 26, to 224 (61%) at week 52 (p<0·0001). Any HIV risk was significantly associated with high PrEP adherence, measured by both tenofovir diphosphate concentrations of at least 700 fmol/punch (adjusted relative risk 1·57 [95% CI 1·09-2·25]; p=0·014) and plasma tenofovir concentrations of at least 40 ng/mL (1·36 [1·11-1·65]; p=0·0025). Any HIV risk was also associated with quantifiable concentrations of tenofovir diphosphate (1·15 [1·03-1·29]; p=0·013) and tenofovir (1·27 [1·09-1·49]; p=0·0022). We observed significant dose-response relationships between number of HIV risk factors and PrEP drug concentrations. The association between any HIV risk and high PrEP adherence suggests that adolescent girls and young women were able to use PrEP during periods of risk, an indicator of prevention-effective PrEP adherence. Our findings support a shift in the PrEP framework to acknowledge prevention-effective adherence practices, which might improve PrEP delivery and adherence support for adolescent girls and young women in HIV-endemic settings. US National Institutes of Health.

Associations of Transactional Sex and Sexually Transmitted Infections Among Treatment-Seeking Individuals With Opioid Use Disorder

Coinciding with the rise in opioid use across the U.S., the rates of sexually transmitted infections have reached historically high levels, underscoring the need to understand multiple pathways of disease spread. Although prevention is often focused on injection-related behaviors, this study sought to identify the prevalence and associations of a little understood pathway, transactional sex, among individuals with opioid use disorder, including associations of transactional sex with the prevalence of sexually transmitted infection diagnoses. Data were sourced from a nationwide opioid surveillance program of treatment-seeking individuals with opioid use disorder utilizing a serial, cross-sectional survey of 4,366 new entrants to 1 of 99 substance use treatment programs for opioid use disorder in 37 states from October 2018 to June 2021. A quarter of the sample (24.9%) self-reported a lifetime history of transactional sex for drugs, with rates highest for sexual (56.6%) and gender (53.8%) minority, female (33.4%), Latinx (30.4%), and Black (29.6%) subgroupings. Lifetime diagnoses of all specific sexually transmitted infections analyzed were significantly higher (p<0.001) among those reporting transactional sex, particularly syphilis (14.3% vs 4.4%) and HIV (4.0 vs 0.9%). Financial hardship, trauma, and psychiatric disorder were significantly associated with transactional sex engagement. Transactional sex is relatively common among patients with opioid use disorder, particularly among sexual/gender minorities, which was associated with a greater lifetime prevalence of all sexually transmitted infections assessed. Sexually transmitted infection testing remains at low levels within substance use treatment programs, occurring in just 26.3% of programs; sexual health screenings and sexually transmitted infection prevention/testing need to be prioritized and integrated into opioid use disorder patient care.

"Girls Are the Ones Who Save the Family": Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships.

The 2019 Kenya Violence Against Children Survey highlighted the increased prevalence of sexual violence experienced by girls; 62.6% of girls who have experienced childhood sexual violence reported multiple incidents before age 18. Studies have shown that transactional sex (TS) relationships are a source of sexual violence, particularly age-disparate TS. TS is defined as sex that is a nonmarital, noncommercial relationship driven by the assumption that sex is exchanged for material support or other benefits. TS is common among adolescents and young women in sub-Saharan Africa, with the prevalence varying from as low as 5% to as high as 80%. This qualitative study explored the factors influencing age-disparate TS relationships in two rural districts, Mutomo and Ikutha Wards of Kitui South Sub County, Kenya. Four focus group discussions were conducted with primary (12-14 years of age) and secondary schoolgirls (15-18 years of age). The study results identified several main themes, which were grouped into two major themes: influencing factors and consequences. Influencing factors include material/basic needs, school-related influences, parental influence, peer pressure, and perpetrator access, while consequences include health and social consequences. Our study found that girls' sense of agency, social pressure, and economic vulnerability impacted their decision to engage in age-disparate TS. These relationships' power dynamics and exploitative nature increase girls' risk of experiencing gender-based sexual violence and adverse health and social outcomes. Our study suggests that explicitly addressing individual risk behaviors will not effectively reduce the incidence of TS relationships. Interventions should be focused on understanding the social-cultural beliefs of TS and shifting the narrative that has continued to fuel a patriarchal society in which women and girls have limited decision-making power in relationships.

From a drought to HIV: An analysis of the effect of droughts on transactional sex and sexually transmitted infections in Malawi

Each year there are over 300 natural disasters globally with millions of victims that cost economic losses near USD$100 billion. In the context of climate change, an emerging literature linking extreme weather events to HIV infections suggests that efforts to control the HIV epidemic could be under threat. We used Demographic and Health Survey (DHS) data collected during the 2015–2016 harsh drought that affected several areas of Malawi to provide new evidence on the effect of an unanticipated economic shock on sexual behaviours of young women and men. We find that amongst women employed in agriculture, a six-months drought doubles their likelihood of engaging in transactional sex compared to women who were not affected by the drought and increases their likelihood of having a sexually transmitted infections (STI) by 48% in the past twelve months. Amongst men employed outside of agriculture, drought increases by 50% the likelihood of having a relationship with a woman engaged in transactional sex. These results suggest that women in agriculture experiencing economic shocks as a result of drought use transactional sex with unaffected men, i.e. men employed outside agriculture, as a coping mechanism, exposing themselves to the risk of contracting HIV. The effect was especially observed among non-educated women. A single drought in the last five years increases HIV prevalence in Malawi by around 15% amongst men and women. Overall, the results confirm that weather shocks are important drivers of risky sexual behaviours of young women relying on agriculture in Africa. Further research is needed to investigate the most adequate formal shock-coping strategies to be implemented in order to limit the negative consequences of natural disasters on HIV acquisition and transmission.

Food Insecurity and Risky Sexual Behaviors among University Students in KwaZulu-Natal, South Africa

Objective: Risky sexual behavior (RSB) is associated with increased rates of sexually transmitted infections (STIs), Human Immunodeficiency Virus (HIV) infection, and unwanted pregnancies among university students. In view of its global impact on public health, the potential association between food insecurity and RSBs among university students requires investigation. This study aimed to determine the association between food security status and the likelihood to engage in RSBs amongst university students in KwaZulu-Natal (KZN), South Africa (SA). Methods: This cross-sectional study was conducted at four public sector higher educational institutions (HEIs) in KZN. A convenience sampling strategy was used to recruit participants (N = 375). All data were analyzed using STATA version 15 software. Results: Our data shows that food insecurity increased the odds of students engaging in transactional sex for “money” or “to meet basic material needs.” Participants who were food insecure were two times more likely to have multiple sexual partners. Conclusions: Our findings demonstrate a significant association between food insecurity and RSBs. It is recommended that interventions targeting the alleviation of food insecurity, should be developed and implemented by HEIs to reduce RSB participation.

Predictors and screening of cervical cancer among HIV positive transactional female sex workers in Nigeria

Introduction: In middle and low income regions of the world, there are approximately 90% of cervical cancer deaths. Factors contributing to the striking disproportionate cancer burden in the developing countries as opposed to the developed countries may include lack of effective large scale preventive interventions such as Cytology based screening programs, Visual Inspection with acetic acid (VIA) that emphasize patient education, accessible diagnostic treatment centres and established vaccination programs especially among Most at risk populations like female sex workers (FSWs). Methodology: The study was conducted in Calabar, South-Southern Nigeria. Calabar is a port city near the Cameroon border. This is a cross sectional retrospective study among 124 Human Immune Virus (HIV)Positive female sex workers receiving ART services, in which secondary data was obtained from the Clinic Data repository for a periodspanning from October 2018- October 2019. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 22. Result: 36.30% of the respondents are between the ages of 21-30 years, 78.20% had 0-4 sexual partners, and 76.60% of the respondents use condom. 89.50% were virally suppressed while 3.20% of the study population tested positive to cervical cancer. In the regression analysis, there were non-significant negative correlation linking Age, Parity groups and viral suppression to cervical cancer, and a positive non-significant correlation linking sex partners, smoking, previous STI and educational status to cervical cancer. However, a positive significant correlation was noted between family planning method and risk of cervical cancer. Conclusion: HIV-positive Nigerian FSWs are at marginally increased risk for cervical pre-cancer and cancer. The ‘screen and treat approach’ using VIA had been shown to be effective for the detection of cervical pre-cancer and cancer, and has shown to reduce loss to follow-up. This should be rapidly incorporated into HIV-treatment programs in resource-constraint settings.

Predictors and screening of cervical cancer among HIV positive transactional female sex workers in Nigeria

Predictors and screening of cervical cancer among HIV positive transactional female sex workers in Nigeria

Prevalence and Factors Associated with Risky Sexual Behaviors Among Sexually Active Female Adolescents in Zambia.

Despite decades long commitment to women's reproductive health rights, sexually transmitted diseases and unintended pregnancies continue to be major public health concerns in sub-Saharan Africa. In order to provide an evidence base for future policy and services, this study aims to explore the prevalence and factors associated with risky sexual behaviors (RSB) among sexually active Zambian female adolescents using a nationally representative sample. Data on females, aged 15-19 (n = 3000), were obtained from the 2018 Zambia Demographic and Health Survey, an interviewer-administered, nationally representative survey that used multistage sampling. The study conducted multiple logistic regression to explore the correlates of RSB. Of the 3000 respondents, 49.7% (1490) reported ever having sexual intercourse of which 71.1% reported engaging in RSB. Among sexually active female adolescents, the following RSB percentage were reported: intercourse before age 16 (50.6%), nonuse of condoms at last intercourse (37.8%), engaging in transactional sex (6.2%), alcohol use at last intercourse (4.6%), and multiple sexual partners (1.9%). Educational attainment and household wealth showed strong inverse trends with RSB risk and there were notably large geographic differences in RSB within Zambia (22.1% in Lusaka region vs. 62.4% in Western province). The multiple logistic regression results revealed that those who were younger, unmarried, with less than secondary education, without access to Internet, and residents of Western Zambia were significantly more likely to have engaged in RSB (AOR: 1.74-7.69, p < 0.05). Given the negative health outcomes associated with RSB, Zambian adolescent health care programs may strategically target limited resources to the identified risk groups.

Young people’s choice and voice concerning sex and relationships: effects of the multicomponent Get Up Speak Out! Programme in Iganga, Uganda

BackgroundYoung people in Uganda face challenges in achieving their sexual and reproductive health and rights (SRHR), such as lack of information, limited access to services, teenage pregnancy and sexually transmitted infections. To address this, their empowerment – including their ability to express themselves and make decisions, is a key strategy. This study assessed how young people’s voice and choice concerning sex and relationships changed over the period of 3 years of implementation of the Get Up Speak Out! programme.MethodsData were collected through a household survey with young people (15-24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders in 2017 for the baseline and 2020 for the end-line. Using the difference-in-difference technique and thematic analysis, changes in key outcomes were assessed over time between intervention and control area.ResultsThere were limited changes over time in the intervention area, which did not differ from changes in the control area. Young people were able to express themselves and expand their decision-making space on sex and relationships, in particular if they were older, male and in a relationship. Young women negotiated their agency, often by engaging in transactional sex. However, youth were still restricted in their self-expression and their choices as speaking about sexuality was taboo, particularly with adults. This was influenced by the political and religious climate around SRHR in Uganda, which emphasised abstinence as the best option for young people to prevent SRHR-related problems.ConclusionsYoung people’s SRHR remains a challenge in Uganda in the context of a conservative political and religious environment that reinforces social and gender norms around youth and young women’s sexuality. The limited effect of the programme on increasing young people’s voice and choice concerning relationships in Uganda can be understood in the context of a ban on comprehensive sexuality education (CSE) and the COVID-19 pandemic. These structural and emerging contextual factors enforce the taboo around youth sexuality and hinder their access to SRHR information and services. Multi-component and targeted programmes are needed to influence changes at the structural, community and individual level.

Sexual history of human monkeypox patients seen at a tertiary hospital in Bayelsa, Nigeria.

Background: Human monkeypox (HMPX) is currently spreading outside endemic countries in Africa and the majority of those affected are gay and bisexual men within interconnected sexual networks. We investigated the sexual history of HMPX cases seen at a tertiary hospital in Bayelsa State during the 2017-2018 outbreak in Nigeria.Method: A cross-sectional study was conducted between 20 October 2017 and 2 January 2019 among adult confirmed/probable HMPX cases. A questionnaire was used to collect data on the sexual history of participants, including sexual contact in relation to the first symptom, and high-risk behaviours (HRB) such as a history of condomless casual sex, multiple sexual partners, and transactional sex.Results: Of 21 patients, 16 (76.2%) gave consent to participate in the study: age range of 22-43years, 75% males, three (18.8%) HIV-1 positive, and 13 (81.2%) with genital ulcers. Nine (56.2%) of participants reported HRB, and all were male heterosexuals. Eight of the 16 participants (50%) reported having sex within a month before their first symptom, and five (62.5%) of this number reported HRB. There were two cases of sex with a partner with a non-genital rash, and a spouse who developed a vulval ulcer four days after sex with her husband.Conclusion: Our results support the role of sexual contact in the transmission of monkeypox among some confirmed cases from Nigeria. However, future elaborate studies are required to confirm if sexual behaviour and sexual transmission are associated with HMPX in Nigeria.

Gender-based violence and depressive symptoms among female entertainment workers in Cambodia: A cross-sectional study.

Female entertainment workers (FEWs) are at higher risk of gender-based violence (GBV) than the general population. The prolonged stress and fear caused by GBV increase the likelihood of depression, a major mental health problem among FEWs. However, their mental health issue has received limited attention and remains poorly researched in the context of GBV. We examined the association between GBV and depressive symptoms among FEWs in Cambodia. We conducted this cross-sectional study in 2017. We used a two-stage cluster random sampling method to select FEWs from the municipality and six provinces for face-to-face interviews. We used the Centre for Epidemiologic Studies Depression Scale (CES-D) to measure depressive symptoms. We conducted a multivariable logistic regression analysis to identify factors associated with depressive symptoms. We included a total of 645 FEWs in data analyses. The proportions of FEWs experiencing emotional, physical, and sexual violence were 36.1%, 11.6%, and 17.2%, respectively. Of the total participants, 65.9% had high levels of depressive symptoms. The adjusted odds of having high levels of depressive symptoms were higher among FEWs who engaged in transactional sex (AOR 1.79, 95% CI 1.09-2.94), experienced emotional abuse (AOR 3.15, 95% CI 1.90-5.23), and experienced two (AOR 7.89, 95% CI 3.28-18.99) and three overlapping types of GBV (AOR 12.12, 95% CI 2.47-59.25) than those who did not. FEWs in this study experienced high levels and overlapping types of GBV associated with high levels of depressive symptoms. Policy interventions and services should be designed to prevent GBV and support the victims of GBV to mitigate depressive symptoms among FEWs in Cambodia.

Associations Between Mobility, Food Insecurity, and Transactional Sex Among Women in Cohabitating Partnerships: An Analysis From 6 African Countries 2016-2017.

Mobile women are at risk of HIV infection in sub-Saharan Africa, although we lack evidence for HIV risk among women in mobile partnerships, especially in the context of household food insecurity, a growing concern in the region. Women aged 15-59 years with a cohabitating male partner who participated in population-based HIV impact assessment surveys in Eswatini, Lesotho, Namibia, Tanzania, Uganda, and Zambia. We evaluated the association between women's and their partner's mobility (being away from home for more than 1 month or staying elsewhere) and transactional sex (selling sex or receiving money or goods in exchange for sex). We examined associations for effect measure modification by food insecurity level in the household in the past month. We used survey-weighted logistic regression, pooled and by country, adjusting for individual, partner, and household-level variables. Among women with a cohabitating male partner, 8.0% reported transactional sex, ranging from 2.7% in Lesotho to 13.4% in Uganda. Women's mobility [aOR 1.35 (95% CI: 1.08 to 1.68)], but not their partner's mobility [aOR 0.91 (0.74-1.12)], was associated with transactional sex. Food insecurity was associated with transactional sex independent of mobility [aOR 1.29 (1.10-1.52)]. Among those who were food insecure, mobility was not associated with increased odds of transactional sex. Food insecurity and women's mobility each increased the odds of transactional sex. Because transactional sex is associated with HIV risk, prevention programs can address the needs of mobile and food-insecure women, including those in cohabitating relationships.

Substantial Increase in Transactional Sex and HIV Risk Among Adolescents During the COVID-19 Pandemic: Results From a Repeated Cross-Sectional Study in Botswana.

The COVID-19 pandemic and resulting public health response has disrupted the lives of adolescents and their families worldwide. We evaluated the impact of the pandemic on attitudes, beliefs, and sexual risk behavior among adolescents in Botswana. Participants were recruited using household-based sampling across residential districts (blocks) in and around Gaborone, Botswana, and completed surveys on laptop computers at a private, central location. We compared baseline survey data from 380 adolescents who completed the survey pre-pandemic (n = 139) to those who completed the survey intra-pandemic (n = 241). Participants had a mean age of 15.2 years; 58.6% were girls and 41.4% were boys. Intra-pandemic, participants reported greater engagement in transactional sex (38.1% compared to 13.6% pre-pandemic, p <. 05), more favorable attitudes toward transactional sex with sugar daddies and sugar mommies (p <. 05), greater intentions to remain sexually active in the future (29.2% vs.13.6%, respectively, p <.05), and lower self-efficacy in handling risky sexual situations (p < .01). Public health interventions that lessen these concerning shifts in attitudes and behaviors will be key to protecting the sexual health of adolescents and to supporting their safe transition to adulthood.