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For Young Women in Sub-Saharan Africa Addressing Transactional Sex May be Key to Reducing HIV Infections

Transactional Sex and HIV Risk: From Analysis to Action

Faculty Associate Dr. Kirsten Stoebenau is co-chair of a working group under STRIVE, a UNAIDS research partner consortium which addresses the Structural Drivers of HIV / AIDS and focuses on understanding and alleviating the role of transactional sex in the ongoing high levels of HIV incidence among young girls and young women in the sub-Saharan Africa region.

In a STRIVE report, “Transactional Sex and HIV Risk: From Analysis to Action,” Dr. Stoebenau and her colleagues provide a deep analysis of young women’s engagement in transactional sex and discusse policy options and principles of engagement about transactional sex in the light of HIV prevention. “Both epidemiological evidence and intervention efforts have been hampered by confusion over the definition and approach to measuring transactional sex. We hope this report contributes to resolving some of that confusion, as well as enables effective combination intervention efforts that account for the structural drivers of transactional sex, along with interpersonal and individual-level approaches,” Dr. Stoebenau said.

According to the report, the practice of transactional sex among young women in African countries can reach 52 percent. Gender inequality contributes to young women’s involvement in transactional sex: increasing by 50 percent the risk of being infected with HIV and carrying along other determinants of participation, “unequal customary and legal rights, uneven distribution of wealth and opportunities for its accumulation, and women’s lower levels of social and political power.” Transactional sex, thus, is associated with HIV risk factors such as having multiple sexual partners, intimate partner violence, abuse, alcohol consumption, and lack of condom use.

In addition, the report emphasizes that transactional sex has often being overlooked. “Transactional sex likely accounts for a higher proportion of HIV cases than previously appreciated because earlier work did not separate transactional sex from sex work or casual partnerships without transactions,” the researchers say. 

Finally, to reduce the burden of new infections in young women, the researchers call for "greater emphasis on the role that transactional sex plays in HIV risk." They recommend that countries with high HIV prevalence address transactional sex directly within existing HIV prevention and intervention programs.

For more information see the complete UNAIDS Report