Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection

Ranganathan, M; Heise, L; Pettifor, A; Silverwood, R; Selin, A; MacPhail, C; Delany-Moretlwe, S; Kahn, K; Gómez-Olivé, X; Hughes, J; Piwowar-Manning, E; Laeyendecker, O; Watts, C Journal of the International AIDS Society, 2016;

Transactional sex (TS) has received increasing attention in the public health literature, as it is believed to be an important contributing factor to the high HIV infection rates observed among young women in sub-Saharan Africa.

This paper presents data on the prevalence of self-reported engagement in TS and explores whether TS is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. It also explores whether this relationship is mediated through certain HIV-related risk behaviours.

The study analyses baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13-20 years in rural South Africa. It examines the association between young women’s engagement in TS and HIV infection and provides quantitative support demonstrating that TS is associated with HIV infection in young women.

Even though the specific variables tested do not mediate the relationship, a potential explanation for this association may be that the men with whom young women are having sex belong to networks of sexually connected individuals who are at a ‘‘high risk’’ for HIV infection. The results highlight the importance of structural intervention approaches that can alter the context of young women’s HIV risk.

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