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

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Abstract

Transactional sex is associated with incident HIV infection among adolescent girls and young women (AGYW) in sub-Saharan Africa. Evidence on the dimensions of socioeconomic status (SES) which predict transactional sex are mixed and primarily come from cross-sectional studies. This study examined the association between SES and transactional sex in a longitudinal cohort (n = 844) of AGYW ages 15–24 years enrolled in a quasi-experimental study in Lilongwe, Malawi. Prevalence of transactional sex was 22% at baseline, 15% at 6-months and 20% at 12-months. Being divorced or widowed, being food insecure, living in a home without electricity or running water, and having few assets were associated with transactional sex. Higher educational attainment and school enrollment were protective. Having 6–7 socioeconomic risk factors increased odds of transactional sex (AOR = 4.13, 95% CI 2.45, 6.98). Structural interventions which address multiple dimensions of SES may reduce transactional sex and ultimately prevent HIV transmission among AGYW.

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References

  1. National Statistical Office (NSO) [Malawi] and ICF. Malawi Demographic and Health Survey 2015–16. Zomba, Malawi and Rockville, Maryland, USA: NSO and ICF; 2017

  2. UNAIDS. HIV prevention among adolescent girls and young women: putting HIV prevention among adolescent girls and young women on the Fast-Track and engaging men and boys. Geneva: UNAIDS; 2016.

    Google Scholar 

  3. Jewkes R, Dunkle K. Transactional sex and HIV incidence in a cohort of young women in the stepping stones trial. J AIDS Clin Res. 2012;03:05.

    Google Scholar 

  4. Kilburn K, Ranganathan M, Stoner MCD, Hughes JP, MacPhail C, Agyei Y, et al. Transactional sex and incident HIV infection in a cohort of young women from rural South Africa. AIDS. 2018;32(12):1669–777.

    PubMed  PubMed Central  Google Scholar 

  5. Kudowa E, Chagomerana M, Phanga T, Maseko B, Price JT, Hosseinipour MC et al. Incidence rate and predictors of HIV Incidence among adolescent girls and young women in Lilongwe, Malawi. Mexico City: International AIDS Society Conference; 2019

  6. Wamoyi J, Ranganathan M, Kyegombe N, Stoebenau K. Improving the measurement of transactional sex in sub-Saharan Africa: a critical review. J Acquir Immune Defic Syndr. 2019;80(4):367.

    PubMed  PubMed Central  Google Scholar 

  7. Ankomah A. Premarital sexual relationships in Ghana in the era of AIDS. Health Policy Plan. 1992;7(2):135–43.

    Google Scholar 

  8. Hunter M. The materiality of everyday sex: thinking beyond 'prostitution'. Afr Stud. 2002;61(1):99–120.

    Google Scholar 

  9. Stoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of "transactional sex" in sub-Saharan Africa: a review and synthesis of the literature. Soc Sci Med. 2016;168:186–97.

    PubMed  Google Scholar 

  10. Kamndaya M, Vearey J, Thomas L, Kabiru CW, Kazembe LN. The role of material deprivation and consumerism in the decisions to engage in transactional sex among young people in the urban slums of Blantyre. Malawi Glob Public Health. 2016;11(3):295–308.

    PubMed  Google Scholar 

  11. MacPherson EE, Sadalaki J, Njoloma M, Nyongopa V, Nkhwazi L, Mwapasa V, et al. Transactional sex and HIV: understanding the gendered structural drivers of HIV in fishing communities in Southern Malawi. J Int AIDS Soc. 2012;15(Suppl 1):17364.

    PubMed Central  Google Scholar 

  12. Okigbo CC, McCarraher DR, Chen M, Pack A. Risk factors for transactional sex among young females in post-conflict Liberia. Afr J Reprod Health. 2014;18(3):133–41.

    PubMed  Google Scholar 

  13. Moore AM, Biddlecom AE, Zulu EM. Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. Afr J Reprod Health. 2007;11(3):44–61.

    PubMed  PubMed Central  Google Scholar 

  14. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92.

    PubMed  Google Scholar 

  15. Greif MJ. Housing, medical, and food deprivation in poor urban contexts: implications for multiple sexual partnerships and transactional sex in Nairobi's slums. Health Place. 2012;18(2):400–7.

    PubMed  Google Scholar 

  16. Chatterji M, Murray N, London D, Anglewicz P. The factors influencing transactional sex among young men and women in 12 sub-Saharan African countries. Soc Biol. 2005;52(1–2):56–72.

    PubMed  Google Scholar 

  17. Cluver L, Orkin M, Boyes M, Gardner F, Meinck F. Transactional sex amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty. J Acquir Immune Defic Syndr. 2011;58(3):336–43.

    PubMed  Google Scholar 

  18. Kang M, Dunbar M, Laver S, Padian N. Maternal versus paternal orphans and HIV/STI risk among adolescent girls in Zimbabwe. AIDS Care. 2008;20(2):214–7.

    PubMed  CAS  Google Scholar 

  19. Thurman TR, Brown L, Richter L, Maharaj P, Magnani R. Sexual risk behavior among South African adolescents: is orphan status a factor? AIDS Behav. 2006;10(6):627–35.

    PubMed  Google Scholar 

  20. Birdthistle IJ, Floyd S, Machingura A, Mudziwapasi N, Gregson S, Glynn JR. From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. AIDS. 2008;22(6):759–66.

    PubMed  Google Scholar 

  21. Operario D, Underhill K, Chuong C, Cluver L. HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis. J Int AIDS Soc. 2011;14(1):25.

    PubMed  PubMed Central  Google Scholar 

  22. Malawi National AIDS Commission. Malawi AIDS Response Progress Report Lilongwe, Malawi; 2015.

  23. Rosenberg NE, Bhushan NL, Vansia D, Phanga T, Maseko B, Nthani T, et al. Comparing Youth-Friendly Health Services to the Standard of Care Through “Girl Power-Malawi”: a quasi-experimental cohort study. J Acquir Immune Defic Syndr. 2018;79(4):458–66.

    PubMed  PubMed Central  Google Scholar 

  24. Rosenberg NE, Gichane MW, Vansia D, Phanga T, Bhushan NL, Bekker L-G, et al. Assessing the impact of a small-group behavioral intervention on sexual behaviors among adolescent girls and young women in Lilongwe Malawi: A quasi-experimental cohort study. AIDS Behav. 2019;24:1–9.

    Google Scholar 

  25. Rosenberg NE, Pettifor AE, Myers L, Phanga T, Marcus R, Bhushan NL, et al. Comparing four service delivery models for adolescent girls and young women through the ‘Girl Power’study: protocol for a multisite quasi-experimental cohort study. BMJ Open. 2017;7(12):e018480.

    PubMed  PubMed Central  Google Scholar 

  26. Twisk JW. Applied longitudinal data analysis for epidemiology: a practical guide. Cambridge: Cambridge University Press; 2013.

    Google Scholar 

  27. Choudhry V, Ambresin AE, Nyakato VN, Agardh A. Transactional sex and HIV risks—evidence from a cross-sectional national survey among young people in Uganda. Glob Health Action. 2015;8:27249.

    PubMed  Google Scholar 

  28. Poulin M. Sex, money, and premarital partnerships in southern Malawi. Soc Sci Med. 2007;65(11):2383–93.

    PubMed  PubMed Central  Google Scholar 

  29. Van de Walle D. Lasting welfare effects of widowhood in a poor country. Washington: The World Bank; 2011.

    Google Scholar 

  30. Reniers G. Divorce and remarriage in rural Malawi. Demogr Res. 2003;1(1):175–206.

    Google Scholar 

  31. Nalugoda F, Guwatudde D, Bwaninka JB, Makumbi FE, Lutalo T, Kagaayi J, et al. Marriage and the risk of incident HIV infection in Rakai. Uganda J Acquir Immune Defic Syndr. 2014;65(1):91–8.

    PubMed  Google Scholar 

  32. Weiser SD, Leiter K, Bangsberg DR, Butler LM, Percy-de Korte F, Hlanze Z, et al. Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLOS Med. 2007;4(10):e260.

    PubMed Central  Google Scholar 

  33. Gorgens M, Ketende S, Tsododo V, Heard W, Mabuza M, Longosz A, et al. Mexico Sitakhela Likusasa Impact Evaluation: results of a cluster randomized control trial (cRCT) of financial incentives for HIV prevention among adolescent girls and young women (AGYW) in Eswatini. Mexico City: International AIDS Society; 2019.

    Google Scholar 

  34. Cho H, Mbai I, Luseno WK, Hobbs M, Halpern C, Hallfors DD. School support as structural hiv prevention for adolescent orphans in Western Kenya. J Adolesc Health. 2018;62(1):44–51.

    PubMed  Google Scholar 

  35. De Neve J-W, Fink G, Subramanian SV, Moyo S, Bor J. Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment. Lancet Glob Health. 2015;3(8):e470–e477477.

    PubMed  PubMed Central  Google Scholar 

  36. Stoner MCD, Edwards JK, Miller WC, Aiello AE, Halpern CT, Julien A, et al. Effect of schooling on age-disparate relationships and number of sexual partners among young women in Rural South Africa enrolled in HPTN 068. J Acquir Immune Defic Syndr. 2017;76(5):e107–e114114.

    PubMed  PubMed Central  Google Scholar 

  37. Jukes M, Simmons S, Bundy D. Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa. AIDS. 2008;22:S41–S56.

    PubMed  Google Scholar 

  38. Mpoola D, Chanza C, Nankuyu F, Kamela H, Kaunda M, Chirambo A, Kabanga L, Tembo MD, Kamlomo D, Chome J. Malawi: Lilongwe Urban Profile. Nairobi: UN-HABITAT; 2011.

    Google Scholar 

  39. Cluver LD, Orkin FM, Meinck F, Boyes ME, Sherr L. Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents. J Int AIDS Soc. 2016;19(1):20646.

    PubMed  PubMed Central  Google Scholar 

  40. Cluver LD, Orkin FM, Boyes ME, Sherr L. Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa. AIDS. 2014;28(Suppl 3):S389–S397397.

    PubMed  Google Scholar 

  41. Cluver LD, Orkin FM, Yakubovich AR, Sherr L. Combination social protection for reducing HIV-risk behavior among adolescents in South Africa. J Acquir Immune Defic Syndr. 2016;72(1):96–104.

    PubMed  PubMed Central  Google Scholar 

  42. Toska E, Gittings L, Hodes R, Cluver LD, Govender K, Chademana KE, et al. Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa. Afr J Reprod Health. 2016;15(2):123–40.

    Google Scholar 

  43. Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379(9823):1320–9.

    PubMed  Google Scholar 

  44. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank the District Health Office, the Lighthouse Trust, and Girl Power-Malawi participants and staff for their integral contributions to this study.

Funding

The study was funded by Evidence for HIV Prevention in Southern Africa (EHPSA), a DFID program managed by Mott MacDonald; National Institute of Mental Health [R00 MH104154]; and the National Institute of Allergy and Infectious Diseases [P30 AI50410].

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Authors and Affiliations

  1. Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA

    Margaret W. Gichane

  2. Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Margaret W. Gichane, Kathryn E. Moracco, Suzanne Maman & Nora E. Rosenberg

  3. Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Audrey E. Pettifor

  4. HW Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Catherine Zimmer

  5. UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi

    Twambilile Phanga, Tiyamike Nthani & Nora E. Rosenberg

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  1. Margaret W. Gichane
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  8. Nora E. Rosenberg
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Correspondence to Margaret W. Gichane.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Gichane, M.W., Moracco, K.E., Pettifor, A.E. et al. Socioeconomic Predictors of Transactional Sex in a Cohort of Adolescent Girls and Young Women in Malawi: A Longitudinal Analysis. AIDS Behav 24, 3376–3384 (2020). https://doi.org/10.1007/s10461-020-02910-5

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