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

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.

Download Full-text

Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort

AIDS and Behavior ◽

10.1007/s10461-021-03535-y ◽

2021 ◽

Author(s):

Anna M. Leddy ◽

Amanda Selin ◽

Sheri A. Lippman ◽

Linda J. Kimaru ◽

Rhian Twine ◽

...

Keyword(s):

Alcohol Use ◽

Young Women ◽

Hiv Risk ◽

Partner Violence ◽

Transactional Sex ◽

Hiv Risk Behavior ◽

Future Research ◽

Cross Sectional ◽

Logistic Regression Models ◽

Condomless Sex

AbstractLimited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.

Download Full-text

Socioeconomic Predictors of Transactional Sex in a Cohort of Adolescent Girls and Young Women in Malawi: A Longitudinal Analysis

AIDS and Behavior ◽

10.1007/s10461-020-02910-5 ◽

2020 ◽

Vol 24 (12) ◽

pp. 3376-3384

Author(s):

Margaret W. Gichane ◽

Kathryn E. Moracco ◽

Audrey E. Pettifor ◽

Catherine Zimmer ◽

Suzanne Maman ◽

...

Keyword(s):

Adolescent Girls ◽

Young Women ◽

Longitudinal Analysis ◽

Transactional Sex

Download Full-text

HIV testing and ethnicity among adolescent girls and young women aged 15–24 years in Ghana: what really matters?

Journal of Biosocial Science ◽

10.1017/s0021932021000456 ◽

2021 ◽

pp. 1-17

Author(s):

Ucheoma Nwaozuru ◽

Thembekile Shato ◽

Chisom Obiezu-Umeh ◽

Florida Uzoaru ◽

Stacey Mason ◽

...

Keyword(s):

Logistic Regression ◽

Condom Use ◽

Hiv Testing ◽

Adolescent Girls ◽

Young Women ◽

Sexual Partners ◽

Bivariate Analysis ◽

Multiple Sexual Partners ◽

Socioeconomic Determinants ◽

The Relationship

Abstract Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15–24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15–24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46–6.08) or previously married (aOR = 4.30, CI: 2.00–9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20–0.85) and condom use (aOR = 0.56, CI: 0.38–0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.

Download Full-text

Individual and Relationship-Level Correlates of Transactional Sex Among Adolescent Girls and Young Women in Malawi: A Multilevel Analysis

AIDS and Behavior ◽

10.1007/s10461-021-03442-2 ◽

2021 ◽

Author(s):

Margaret W. Gichane ◽

Nora E. Rosenberg ◽

Catherine Zimmer ◽

Audrey E. Pettifor ◽

Suzanne Maman ◽

...

Keyword(s):

Adolescent Girls ◽

Young Women ◽

Hiv Risk ◽

Social Protection ◽

Transactional Sex ◽

Individual Level ◽

And Gender ◽

The Individual ◽

Partner Concurrency ◽

The Relationship

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

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

Download Full-text

Prevalence and correlates of sexual violence among adolescent girls and young women: findings from a cross-sectional study in a South African university

BMC Women s Health ◽

10.1186/s12905-021-01445-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anthony Idowu Ajayi ◽

Elmon Mudefi ◽

Eyitayo Omolara Owolabi

Keyword(s):

Sexual Violence ◽

South African ◽

Adolescent Girls ◽

Young Women ◽

Financial Support ◽

Epidemiological Data ◽

Cross Sectional Study ◽

Cross Sectional ◽

Logistic Regression Models ◽

Factors Associated

Abstract Background Epidemiological data on the prevalence and factors associated with sexual violence is critical to understanding the magnitude of the problem and designing effective interventions. Drawing from cross-sectional data from a South African university, we examined the prevalence and correlates of sexual violence among adolescent girls and young women (AGYW). Methods We analysed data of 451 AGYW selected using stratified sampling. Sexual violence was defined as any sexual acts, and attempt to obtain sexual acts without consent. We used adjusted and unadjusted logistic regression models to examine the factors associated with exposure to sexual violence while controlling for relevant covariates. Results The lifetime and past-year prevalence of sexual violence was 37.9% and 25.3%, respectively. A higher prevalence of sexual violence was reported by heavy episodic drinkers of alcohol (lifetime 48.4% and past year 34.0%), those who received insufficient financial support (lifetime 58.0% and past year 35.8%) compared to non-users of alcohol (lifetime 27.2% and past year 17.2%),) and those who received adequate financial support (lifetime 20.8% and past year 13.1%). AGYW who reported heavy episodic use of alcohol had higher odds of reporting lifetime (AOR: 1.86; 95% CI: 1.07–3.25) and past year (AOR: 2.03; 95% CI: 1.10–3.75) experience of sexual violence compared to non-users. However, individuals who received adequate family financial support were 76% and 65% less likely to report lifetime and past year experience of sexual violence than those who received inadequate family financial support. Also, AGYW who rated themselves as very religious were 80% and 75% less likely to report lifetime and past year experience of sexual violence compared to those who were not religious. Conclusion Our study shows that sexual violence affects a large proportion of girls, requiring intervention that not only focuses on increasing social support for survivors, facilitating reporting, and ensuring perpetrators are convicted, but also target alcohol use reduction and poverty alleviation.

Download Full-text