STRIVE Tackling the structural drivers of HIV

Engagement in transactional sex is significantly associated with increased HIV prevalence in women. In a review of this association, across eligible studies, women who had ever practiced transactional sex were on average 50% more likely to be living with HIV than women who had never practiced transactional sex.

This technical brief, produced by STRIVE and UNAIDS, provides a detailed analysis of transactional sex and discusses policy options and principles of engagement around transactional sex in the context of HIV prevention. Although transactional sex is practiced by men and women in all regions of the world, this document focuses specifically on the determinants and consequences of adolescent girls' and young women's engagement in the transactional sex in sub-Saharan Africa.

We focus on this population because of the potential importance of transactional sex for young women's HIV risk in this region. 

The brief provides a situation analysis of transactional sex, including its links to HIV transmission for women and explores which approaches are likely to be effective in addressing transactional sex and HIV among adolescent girls and young women, and how they can be implemented. It provides answers to the following questions:

• What is transactional sex?
• Why does transactional sex matter?
• What links transactional sex with HIV?
• What shapes transactional sex?
• How can we address adolescent girls' and young women's HIV risk associated with transactional sex?

“Sexual relationships involving exchange are not necessarily inherently risky. The emphasis should be placed not on eliminating all relationships that are characterized by exchange, but rather on identifying the conditions and circumstances in which transactional sex imparts risk.”