transactional sex

Creating HIV risk profiles for men in South Africa: a latent class approach using cross‐sectional survey data

Introduction

Engaging at‐risk men in HIV prevention programs and services is a current priority, yet there are few effective ways to identify which men are at highest risk or how to best reach them. In this study we generated multi‐factor profiles of HIV acquisition/transmission risk for men in Durban, South Africa, to help inform targeted programming and service delivery.

Methods

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Young women’s perceptions of transactional sex and sexual agency: a qualitative study in the context of rural South Africa

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Author
Meghna Ranganathan, Catherine MacPhail, Audrey Pettifor, Kathleen Kahn, Nomhle Khoza, Rhian Twine, Charlotte Watts and Lori Heise

Evidence shows that HIV prevalence among young women in sub-Saharan Africa increases almost five-fold between ages 15 and 24, with almost a quarter of young women infected by their early-to mid-20s. Transactional sex or material exchange for sex is a relationship dynamic that has been shown to have an association with HIV infection.

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Sex in the shadow of HIV: A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa

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Author
Toska, E., Pantelic, M., Meinck, F., et al.

Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa.

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Trading sex for security: Unemployment and the unequal HIV burden among young women in developing nations

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Author
Kelly F Austin, Michelle M Choi, Virginia Berndt

Young women in their late teens and early twenties are especially susceptible to HIV infection in developing nations, as incidence of HIV is growing most rapidly among females aged 15–24 years. While prior research considers the role of various social and economic gender stratification measures to explain trends in the female HIV burden, the potential influence of unemployment has not yet been considered, nor has there been explicit focus on the empirical drivers of young women’s HIV.

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Sexual Behavior among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings

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Author
Embleton, L., Nyandat, J., Ayuku, D., et al.

This study used baseline data from the Orphaned and Separated Children’s Assessment Related to their Health and Well-Being Project to examine whether risky sexual behaviors and sexual exploitation in orphaned adolescents differed between family-based and institutional care environments. It included a cohort of 1,365 orphaned adolescents aged 10–18 years, 712 (52%) living in institutional environments and 653 (48%) in family-based care in Uasin Gishu County, Kenya.

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Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis

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Yes
Author
Joyce Wamoyi, Kirsten Stoebenau, Natalia Bobrova, Tanya Abramsky, Charlotte Watts

Young women aged 15 to 24 years in sub-Saharan Africa continue to be disproportionately affected by HIV. A growing number of studies have suggested that the practice of transactional sex may in part explain women’s heightened risk, but evidence on the association between transactional sex and HIV has not yet been synthesized. We set out to systematically review studies that assess the relationship between transactional sex and HIV among men and women in sub-Saharan Africa and to summarize the findings through a meta-analysis.

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Revisiting the understanding of "transactional sex" in sub-Saharan Africa: A review and synthesis of the literature

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Author
Stoebenau K, Heise L, Wamoyi J, Bobrova N

In sub-Saharan Africa, young women ages 15-24 have more than twice the risk of acquiring HIV as their male counterparts. A growing body of epidemiological evidence suggests that the practice of "transactional sex" may contribute to this disparity. Over the last 15 years, the social sciences have contributed significantly to understanding the meaning of and motivations for this practice. The findings from these studies are rich, but varied, rendering lessons difficult to navigate for intervention and further research.

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Individual and Population Level Impact of Key HIV Risk Factors on HIV Incidence Rates in Durban, South Africa

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Author
Gita Ramjee , Suri Moonsamy, Nathlee Samantha Abbai, Handan Wand

We aimed to estimate the individual and joint impact of age, marital status and diagnosis with sexually transmitted infections (STIs) on HIV acquisition among young women at a population level in Durban, KwaZulu-Natal, South Africa. A total of 3,978 HIV seronegative women were recruited for four biomedical intervention trials from 2002–2009. Point and interval estimates of partial population attributable risk (PAR) were used to quantify the proportion of HIV seroconversions which can be prevented if a combination of risk factors is eliminated from a target population.

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A Randomized Control Trial of a Conditional Cash Transfer to Reduce HIV Infection in Young Women in South Africa: Study Design and Baseline Results

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Author
Pettifor, A., MacPhail, C., Selin, A., et al.

This individually randomized controlled trial was the first study to examine the impact of a conditional cash transfer intervention on HIV infection among young women. In a rural area in northeastern South Africa, 2,533 women (age 13–20 years) and their households were randomized in a 1:1 ratio to the intervention arm (monthly cash payments, conditional on the young woman completing 80 percent school attendance), or the control arm (no cash payments). HIV testing was performed at enrollment and at 12-, 24-, and 36-month visits.

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