Dissolution of transactional sex relationships during COVID-19: a qualitative study of Ugandan men’s experiences during COVID-19 lockdowns
Holly NishimuraNeema NakyanjoWilliam DdaakiAnne Catherine KiyingiEmmanuel MukwanaFred NalugodaCharles SsekyewaJulie A. DenisonM. Kate GrabowskiJoseph KagaayiCaitlin E. Kennedy
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AbstractThe COVID-19 pandemic and subsequent mitigation measures led to social disruption and negative economic shocks for a large proportion of Uganda's population. The social and economic consequences of COVID-19 on Ugandan men's sexual behaviours, including transactional sex relationships, are unclear. We conducted in-depth interviews between November 2021–February 2022 with 26 men in a high HIV prevalence region of Uganda. Data were analysed thematically to understand how sexual relationships, including transactional sex, were impacted by COVID-19. We found that COVID-19 mitigation measures had far-reaching social and economic impacts on most respondents, particularly those employed in the informal economy. Men described experiencing job loss, food insecurity and restricted mobility, which limited opportunities to provide for and meet with transactional sex partners. Inability to provide financial resources meant that men could not form new transactional sex relationships and men who could no longer provide for their existing transactional sex partners consistently reported relationship dissolution. Men who reported stable employment during the pandemic described few changes in transactional sex relationships. Similarly, men in non-transactional relationships did not report relationship dissolution despite decreased financial provision. Further research should assess the potential short- and long-term impacts of COVID-19 mitigation measures on transactional sex relationships.Keywords: UgandamenCOVID-19Africasexual relationshipstransactional sexheterosexual men AcknowledgementsA thank you goes to the study participants who shared their time and experiences to make this study possible. We are grateful to the Rakai Health Sciences Program staff, particularly those in Social and Behavioral Sciences Department for their support of this project. Finally, we thank, Kirsten Stoebenau for her thoughtful reflections and feedback on the research and manuscript.Disclosure statementNo potential conflict of interest was reported by the author(s).Data availability statementThe participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.Additional informationFundingThis work was funded by a US National Institutes of Mental Health Ruth L. Kirstein Pre-Doctoral Fellowship under grant number F31MH124535 to the Center for Qualitative Studies in Health and Medicine at the Johns Hopkins Bloomberg School of Public Health, as well as by a Johns Hopkins University COVID-Relief Fellowship.Keywords:
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Transactional sex, or informal sexual exchange, is considered to be an important contributing factor to the disproportionately high HIV infection rates experienced by adolescent girls and young women in sub-Saharan Africa. Nonetheless, confusion remains over how best to define and measure this practice, hindering efforts to mitigate the role of transactional sex in the epidemic. We critically review current measures and offer evidence-based recommendations for improvement.Although transactional sex is practiced around the world, we focus attention on the definition and measurement of this practice in sub-Saharan Africa, given the role it plays in young women's risk of HIV in this region.We relied on both secondary and primary data sources. We draw on a systematic review of literature on transactional sex from sub-Saharan Africa and interview data from both key informants and cognitive interviews (n = 160) with young women (ages 14-24) and men (ages 18-35) in Uganda and Tanzania.We find current measures are inconsistent, conflate transactional sex with sex work, and fail to capture the gendered nature of the practice. We provide an evidence-based definition of transactional sex that guides our measurement recommendations. We then detail the development of improved measures through cognitive interviews. Finally, we offer recommended approaches to improved measurement of transactional sex for women and men in large-scale surveys.Improved measures are critical for accurate estimation of the prevalence of transactional sex and assessment of the extent to which transactional sex determines HIV risk.
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Standard labor market models predict that the likelihood of employment increases, hours worked increase, and individuals transition from less-skilled and temporary jobs to more skilled and more stable employment as they age. I examine the association between age and transactional sex work using national household surveys from Zambia, one of the few settings with general population surveys asking women about transactional sex and a relatively high documented prevalence of employment in transactional sex. My results indicate that the likelihood of employment in transactional sex sharply falls with age. Increased employment opportunities outside of transactional sex do not appear to explain the transactional sex employment-age profile and marital status appears to explain only a portion of it. These findings are consistent with the hypothesis that clients prefer younger females and suggest that interventions designed to reduce client demand younger females may be particularly effective at reducing transactional sex.
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This chapter examines transactional sex as a distinctive feature of traditional “dating” in Malawi. It begins with a review of the existing literature on transactional sex in sub-Saharan Africa, with particular emphasis on the distinction between commercial sex work, informal sex work, and transactional sex. It then analyzes transactional sex among a sample of 13- to 22-year-old, initially never-married females in southern Malawi. It also considers the role that cash-transfer programs in particular and social safety-net programs in general might play in mitigating transactional sex. The findings suggest that cash-transfer programs that focus on adolescent girls can allow them to steer away from “relationships of need” toward “relationships of want,” reduce risky sexual behavior as a result, and thus reduce their subsequent risk of HIV infection.
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This article examines the extent to which expressed emotion (EE) indexes not only relatives' behavior toward schizophrenic patients but also patients' behavior toward their relatives. The coping styles (CS) of schizophrenic patients were assessed during interactions with their parents and were compared with parental EE attitudes assessed during an acute hospitalization and during the aftercare period. It was found that parental EE attitudes measured during the inpatient period strongly predicted patients' outpatient transactional behavior: patients interacting with low‐EE relatives showed significantly fewer critical and more autonomous statements than patients interacting with high‐EE relatives. Further, the dominant patient coping style (autonomous, neutral, externalizing, or internalizing) was strongly related to the relatives' interactional affective style (AS) and to their pattern of EE attitudes. Patient coping style was not related to clinical attributes of these patients themselves. This article and its preceding companion ( 17 ) together suggest that EE indexes a transactional process so that the quality of both parents' and patients' transactional behaviors may predict subsequent patient functioning.
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Abstract Transactional sex may put young women and young men in sub‐Saharan Africa at increased risk of contracting sexually transmitted infections (STIs), including HIV/AIDS. This behavior may also put young women at higher risk of pregnancy and childbearing. Policymakers and program managers need to know what factors put youth at increased risk. We investigated this issue using logistic regression analyses of data from male and female modules of Demographic and Health Surveys from 12 sub‐Saharar African countries. We found that young men and young women are at greater risk of engaging in transactional sex than are older people. Unmarried young women and young men were significantly more likely to engage in transactional sex than married youth. Based on these results, our conclusions were that programs geared toward reducing the incidence of transactional sex or protecting men and women already in transactional sexual relationships should be aimed at both young women and young men. Due to our finding that unmarried young women and young men are more vulnerable to experiencing transactional sex, programs to prevent transactional sex should be specifically directed to this subgroup of young people.
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This latest book edited by Richard Erskine grew out of a symposium he organized on “Therapeutic Methods in Transactional Analysis: Current Perspectives and Emerging Developments” for the 2014 Trans...
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Transactional Sex among Young Women in Post-Earthquake Haiti: Prevalence and Vulnerability to HIV Carol Ann Daniel, Ph.D; Carmen Logie, Ph.D. Abstract Vulnerability is a concept widely used in HIV research to describe individuals who experience elevated exposure to HIV acquisition. Yet there are no uniformly accepted measures with regard to understanding vulnerability and its application with individuals who are in actual situations of risk for HIV. To explore the relationship between vulnerability and HIV risk we used a framework developed by Watts and Bohle (1993). The framework allowed us to account for the specific ways that internally displaced women who exchange money or other consumptive goods for sex experience increased vulnerability to HIV acquisition. Material exchange for sex (transactional sex) is widely understood as a significant driver of HIV and other sexually transmitted infections (STIs) for women in Haiti. However the mechanisms and conditions that contribute to internally displace young women's engagement in transactional sex, and experiences of transactional sex are not well understood. We examine the types of pressures that lead internally displaced women to engage in transactional sex, their capacity to cope with HIV risks and the potential consequences. Our analysis suggests that material exchange for sex underlies sexual relationships among many ID women and that their motivations varied from survival needs, parental pressure to help support their household, and peer pressure to satisfy their socio-emotional needs. Yet not all internally displaced women who engage in transactional sex are equally vulnerable. A complex system of interrelated micro and macro-level social and economic factors accounted for why some internally displaced women are more vulnerable. By highlighting the differences among young women, this paper demonstrates that HIV prevention interventions need to be contextually targeted to address ID women's particular level of vulnerability. Full Text: PDF DOI: 10.15640/jssw.v5n1a6
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(1999). Book Review: Theories and Methods of an Integrative Transactional Analysis. Transactional Analysis Journal: Vol. 29, No. 3, pp. 228-230.
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Abstract Introduction Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub‐Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use. Methods We use data from a mixed‐method, cluster randomised controlled trial of the Ujana Salama cash “plus” intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017–2019). The impact evaluation consisted of a parallel mixed‐methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the “plus” intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts. Results The prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905). Conclusions The mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.
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Background: ‘Transactional sex’, is generally defined as a sexual relationship in which money or material goods are exchanged for sex. As this may entail sex with older or multiple partners, it is likely to be associated with young women’s increased vulnerability to HIV or HSV-2 infection. Existing research illustrates that the motivations for young women’s engagement in transactional sex are complex. This PhD study explores the socio-demographic factors that motivate young women to engage in transactional sex and the relationship with HIV or HSV-2 infection.
Methods: This thesis uses a combination of quantitative and qualitative methods. The quantitative analysis uses baseline data from HPTN 068, an ongoing randomised controlled trial (RCT) in rural Mpumalanga province, South Africa. Using both descriptive statistics and multivariable logistic regression analysis, I have quantitatively explored the relationship between household socio-economic status and socio-demographics, young women’s self- reported engagement in transactional sex, specific characteristics of her consumption patterns and the relationship between transactional sex and HIV and HSV-2 infection. I have also used qualitative methods to explore the strategies young women deploy for accessing money or gifts, the role that transactional sex plays in meeting these aspirations and the agency she exhibits in these encounters.
Results: Multivariable analysis shows that young women from low socio-economic status households who engage in transactional sex have higher odds of consuming a combination of both high cost essential items (such as school fees, transport to school and food and groceries) and entertainment related items (such as beer/alcohol, movie tickets and birth control/condoms) compared to young women who do not engage in transactional sex. In addition, after adjusting for age and household level socio-demographics, young women who report engaging in transactional sex had significantly increased odds of being HIV seropositive. No association with HSV-2 infection was seen. The association between transactional sex and HIV does not appear to be mediated by any of the other dimensions of HIV risk that might ordinarily overlap with transactional sex.
Qualitative findings suggest that belongingness, peer acceptance and status were all factors that motivated young women to aspire for items considered needs or wants. In-depth interviews also showed how young women have a deep-seated need to feel financially independent and have aspirations for lucrative job opportunities in the future, which they hope to achieve through education. But, given their current context where economic opportunities are circumscribed, young women use the money received from transactional sex to fill gaps in their needs and wants. Most of them appear to be in “love” with their boyfriends and have romantic notions of what they want from the relationship, but underlying it all very clearly is the need to be provided for by the man, in the form of money. Thus, the balance between the emotional and transactional elements in a relationship is blurred. Young women appear to express considerable agency when it comes to partner choice, but not necessarily after the choice of partner is made; as within the relationship they invariably submit to male authority within unequal gendered power structures.
Discussion: Findings suggest that there is not a clear dichotomy between the survival sex of the passive victim and the consumption sex of the active sexual agent; rather, these distinctions are far more nuanced. Engagement in transactional sex seems to be driven by poverty and economic need, but also by aspirations within the context of a globalising emerging economy like South Africa. In addition, these findings also indicate the subtle position that transactional sex or sexual exchange occupies within a continuum of adolescent sexual relationships in South Africa where sexual exchange occurs within the context of loving peer relationships. This potentially weakens the negotiating or bargaining position of young women if they are receiving money or items, thus having implications on HIV prevention and programming.
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