Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda

AbstractTransactional sex increases HIV risk among adolescent girls and young women (AGYW). Understanding the individual and dyadic nature of transactional sex may provide evidence for risk reduction interventions. Multilevel logistic regression was used to cross-sectionally examine correlates of transactional sex among AGYW in Lilongwe, Malawi. Participants (N = 920) reported 1227 relationships. Individual-level associations were found between being divorced/widowed (AOR 5.07, 95% CI 1.93, 13.25), married (AOR 0.26, 95% CI 0.09, 0.72), or unstably housed (AOR 7.11, 95% CI 2.74, 18.47) and transactional sex. At the relationship-level, transactional sex occurred in relationships with: non-primary primary partners (AOR 4.06, 95% CI 2.37, 6.94), perceived partner concurrency (AOR 1.85, 95% CI 1.11, 3.08), and feared violence with couples HIV testing (AOR 2.81, 95% CI 1.26, 6.29), and less likely to occur in relationships with children (AOR 0.15, 95% CI 0.06, 0.38). Multiple co-occurring social and structural vulnerabilities increase transactional sex engagement warranting the need for social protection and gender transformative approaches.

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Is transactional sex exploitative? A social norms perspective, with implications for interventions with adolescent girls and young women in Tanzania

PLoS ONE ◽

10.1371/journal.pone.0214366 ◽

2019 ◽

Vol 14 (4) ◽

pp. e0214366 ◽

Cited By ~ 6

Author(s):

Joyce Wamoyi ◽

Lori Heise ◽

Rebecca Meiksin ◽

Nambusi Kyegombe ◽

Daniel Nyato ◽

...

Keyword(s):

Social Norms ◽

Adolescent Girls ◽

Young Women ◽

Transactional Sex

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Sexual risk behaviors, mental health outcomes and attitudes supportive of wife-beating associated with childhood transactional sex among adolescent girls and young women: Findings from the Uganda Violence Against Children Survey

PLoS ONE ◽

10.1371/journal.pone.0249064 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0249064

Author(s):

Laura Chiang ◽

Ashleigh Howard ◽

Kirsten Stoebenau ◽

Greta M. Massetti ◽

Rose Apondi ◽

...

Keyword(s):

Adolescent Girls ◽

Young Women ◽

Spousal Abuse ◽

Transactional Sex ◽

Wife Beating ◽

Multiple Sexual Partners ◽

Logistic Regression Models ◽

Violence Against Children ◽

The Past ◽

Using Data

Compared to young men, Ugandan young women are disproportionately impacted by HIV. Childhood transactional sex may contribute to this disparity. Using data from the 2015 Uganda Violence Against Children Survey, we used logistic regression models to assess the association between childhood transactional sex and negative outcomes. Among 18-24-year-old young women who had sex prior to 18 (n = 982), those who ever engaged in transactional sex had 5.9 times [adjusted odds ratio (AOR); confidence interval (CI): 1.6–22.2] higher odds of having multiple sexual partners in the past year; 5.2 times (AOR; CI: 2.1–12.9) higher odds of infrequent condom use in the past year; 3.0 times (AOR; CI: 1.2–7.9) higher odds of hurting themselves intentionally; and 3.2 times (AOR; CI: 1.3–7.7) higher odds of having attitudes justifying spousal abuse than young women who never engaged in transactional sex. Interventions for transactional sex and HIV in Uganda should consider prioritizing prevention, harm-reduction and continued investment in adolescent girls’ and young women’s futures.

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Modeling Combination Interventions to Prevent Human Immunodeficiency Virus in Adolescent Girls and Young Women in South Africa (HIV Prevention Trials Network 068)

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1598 ◽

2020 ◽

Author(s):

Marie C D Stoner ◽

Daniel Westreich ◽

Jennifer Ahern ◽

Jessie Edwards ◽

F Xavier Gómez-Olivé ◽

...

Keyword(s):

Risk Factors ◽

South Africa ◽

Human Immunodeficiency Virus ◽

Risk Factor ◽

Adolescent Girls ◽

Young Women ◽

Transactional Sex ◽

Hiv Incidence ◽

Immunodeficiency Virus ◽

Prevention Trials

Abstract Background Combination interventions may be an effective way to prevent human immunodeficiency virus (HIV) in adolescent girls and young women. However, current studies are not designed to understand which specific interventions and combinations will be most effective. We estimate the possible impacts of interventions on a combination of factors associated with HIV. Methods We used the g-formula to model interventions on combinations of HIV risk factors to identify those that would prevent the most incident HIV infections, including low school attendance, intimate partner violence, depression, transactional sex, and age-disparate partnerships. We used data from the HIV Prevention Trials Network (HPTN) 068 study in rural South Africa from 2011 to 2017. We estimated HIV incidence under a potential intervention that reduced each risk factor and compared this to HIV incidence under the current distribution of these risk factors. Results Although many factors had strong associations with HIV, potential intervention estimates did not always suggest large reductions in HIV incidence because the prevalence of risk factors was low. When modeling combination effects, an intervention to increase schooling, decrease depression, and decease transactional sex showed the largest reduction in incident infection (risk difference, –1.4%; 95% confidence interval [CI], –2.7% to –.2%), but an intervention on only transactional sex and depression still reduced HIV incidence by –1.3% (95% CI, –2.6% to –.2%). Conclusions To achieve the largest reductions in HIV, both prevalence of the risk factor and strength of association with HIV must be considered. Additionally, intervening on more risk factors may not necessarily result in larger reductions in HIV incidence.

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Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex

Sexual and Reproductive Health Matters ◽

10.1080/26410397.2019.1700770 ◽

2020 ◽

Vol 28 (1) ◽

pp. 1700770 ◽

Cited By ~ 3

Author(s):

Nambusi Kyegombe ◽

Rebecca Meiksin ◽

Joyce Wamoyi ◽

Lori Heise ◽

Kirsten Stoebenau ◽

...

Keyword(s):

Sexual Health ◽

Adolescent Girls ◽

Young Women ◽

Transactional Sex

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Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

Conflict and Health ◽

10.1186/s13031-020-00336-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Carmen H. Logie ◽

Moses Okumu ◽

Maya Latif ◽

Daniel Kibuuka Musoke ◽

Simon Odong Lukone ◽

...

Keyword(s):

Focus Groups ◽

Adolescent Girls ◽

Young Women ◽

Contextual Factors ◽

Gender Norms ◽

Resource Scarcity ◽

Refugee Youth ◽

Relational Context ◽

Factors Associated ◽

Individual Interviews

Abstract Background Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths’ wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda’s 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16–24 in Bidi Bidi refugee settlement. Methods We conducted 6 focus groups (n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16–24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion. Results Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16–24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures. Conclusions Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.

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