HIV Prevention Knowledge Base
Behavioral Interventions: Transactional and Age-disparate Sex in Hyperendemic Countries
Community views of inter-generational sex: Findings from focus groups in Botswana, Namibia and Swaziland
Focus group discussions among women ages 15–24 and men ages 40–55 in Botswana, Namibia, and Swaziland about intergenerational (IG) sex confirm previous findings from southern Africa: the practice is common; rural and urban diffferences exist in the nature of the goods for which women exchange sex; men engage in the practice seeking physical gratification; and condoms are infrequently used in these relationships. This study also found that men and young women engaging in IG sex felt their partners were more likely to be infected with HIV than a partner their own age. Despite this knowledge, they were willing to continue involvement in such relationships without using condoms. Women often discussed their older partners in depersonalized and disparaging ways, using various nicknames such as “ATM” or “my stupid one.” The researchers conclude that HIV prevention efforts targeting older men can capitalize on this information about how younger women ridicule them. Furthermore, providing young women with alternative means of financial support may reduce their willingness to enter into IG relationships.
“I Just Need to be Flashy on Campus”: Female Students and Transactional Sex at a University in Zimbabwe
This ethnographic study among young college women in Zimbabwe challenges the common assumptions that 1) young women engage in age-disparate transactional relationships in order to provide for their basic needs and 2) that these relationships are always sexual. While they pursued higher education, the basic living needs of the 10 young women interviewed were supported by their middle-class parents. These women sought out relationships with older off-campus men in order to obtain access to consumer goods and other resources necessary to be recognized among their peers as fashionable and of a higher status. While sex is often desired or requested by their older suitors, these young women deploy a range of strategies to avoid sexual contact and are generally (if not always) successful.
Transactional Sex Amongst Young People in Rural Northern Tanzania: An Ethnography of Young Women’s Motivations and Negotiation
Conducted among youth ages 14 to 25 in nine rural villages in Tanzania, this ethnographic study examined young women’s motivations to exchange sex for gifts or money. Study participants generally were unmarried with only primary schooling. Transactional sex (TS) was common and not considered immoral; participants saw the exchange as both parties gaining what they wanted. Furthermore, participants alluded to family member complicity in certain TS situations. Most relationships were formed on the basis of financial gain: romantic love or finding a marriage partner were rarely factors. Although macro-level factors influencing TS primarily benefit men, micro-level factors benefit both men and women. The authors further identified four ways that TS likely increases risk of HIV infection in this setting. Because TS is so strongly embedded in this culture, any attempts at harm reduction among this population must be carefully designed and piloted.
“Women’s Bodies are Shops”: Beliefs about Transactional Sex and Implications for Understanding Gender Power and HIV Prevention in Tanzania
This ethnographic research studies TS in rural Tanzania within the context of family relationships. Young people aged 14 to 24 years and their parents were observed and interviewed; follow-up interviews provided clarification on important themes emerging from the first set of interviews. Generally, everyone—parents and youth alike—was in favor of TS. A woman’s body was seen as a commodity. Participants explained that only women who did not value their self-worth would have sex without any exchange. Such women were looked down on by others, seen as stupid or easily cheated, worth nothing, and thus equated with prostitutes. Furthermore, the exchange of goods or money was symbolic, signifying seriousness or love. Women often felt that they were exploiting men, and thus TS was a way for women to exert power. Despite knowing about the risks to sexual and reproductive health, women generally did not use contraception. Because TS appears to be a social norm, risk reduction programs may focus on encouraging women to include safer sex in their negotiation for gifts and money.
Beyond Sugar Daddies: Intergenerational Sex and AIDS in Urban Zimbabwe
While attention and research have focused on "sugar daddies" posing an increased risk of HIV to young women in sub-Saharan Africa, few studies have gathered epidemiologic HIV data within age-disparate relationships. This study examined the relationships and sexual behavior of 1,313 men in beer halls in Zimbabwe at the peak of the HIV epidemic (2002–2003). Nearly half of the interviewees reported having more than one sexual partner in the six months prior to the interview. Furthermore, nearly two-thirds reported at least one partner five or more years younger, many of whom were their wives. Only 2.5% of the relationships met the "sugar daddy" criteria. Unexpectedly, the study found that the younger the female partner was, the greater the likelihood of condom use. There was no association between a man’s positive HIV status and his engaging in intergenerational (IG) sex. The men reported lowest levels of condom use with their wives and steady partners. This suggests that while age-disparate relationships are a concern for a sustained HIV epidemic, conventional IG relationships—that is, married and long-term couples—pose a greater risk of HIV infection than “sugar daddy” relationships. Publicizing the dangers of age-disparate relationships may be one way to address this issue, as would changes in social norms that would enable women to negotiate safe sex, regardless of their age. Weaknesses of the study include not interviewing the female partners and that the men may not be representative of the broader population, as alcohol use is a known risk factor for HIV infection.
Cultural Scripts for Multiple and Concurrent Partnerships in Southern Africa: Why HIV Prevention Needs Anthropology
This qualitative study explores the underlying cultural contexts in which sexualities are formed and sexual practices performed in southern Africa. The author argues that practices of multiple, concurrent, and transactional relationships are “interlinked and should be considered together as key cultural scripts that prescribe for the practice of normative transactional sex.” One such cultural script suggests that giving gifts commensurate with their wealth is one way men in the region demonstrate “love, commitment, or affection” to their sexual partners. Men here feel compelled to share their wealth with sexual partners as a way of showing respect, and expressed the belief that only morally “loose” women would ever give sex for free.
Transactional Sex with Casual and Main Partners among Young South African Men in the Rural Eastern Cape: Prevalence, Predictors, and Associations with Gender-based Violence
Secondary analysis of data collected for an HIV behavioral prevention study informs this research on men’s views of TS from 70 villages in the rural Eastern Cape Province of South Africa. Researchers assessed TS practices with primary girlfriends and casual partners, including whether men received resources from female partners. Nearly 20 percent of the men interviewed gave material resources to casual partners, but only 7 percent received from casual partners. Among main girlfriends, giving and getting resources were nearly equal (15 percent versus 14 percent, respectively). Interestingly, men who gave and received resources were equally likely to report controlling and violent behaviors, including perpetrating interpersonal violence. Furthermore, TS was correlated to sexually assaulting women. The authors concluded that, “TS should be viewed as a part of a cluster of sexually violent and controlling practices.” This research suggests that interventions must focus on changing the idea that masculinity means success with and control over women, rather than work to reduce individual HIV risk behaviors.
Skinning the Goat and Pulling the Load: Transactional Sex among Youth in Dar es Salaam, Tanzania
In-depth interviews and focus group discussions took place among men and women ages 16 to 24 years in Dar es Salaam to identify their HIV risk factors. The researchers found TS emerging as a major theme in every discussion. Interviewees identified two types of partners: 1) regular, “true love” partnerships and 2) casual partners. The connection between sex and money was explicit in casual relationships. While such an exchange was also expected in the committed relationships, it was not the primary motivation for the relationship. Men generally engaged in partnerships for sex, while women entered them for social status, the eventuality of marriage, and money. Some women reported engaging in TS as a survival strategy. Men also reported forcing women to have sex after paying for drinks or entrance into a disco, and feeling justified in doing so. Women in committed partnerships, however, could express their sexual desires, refuse sex, and negotiate condom use with their partners. The authors conclude that TS has implications for HIV prevention programming and should be a part of comprehensive youth HIV prevention efforts.
Sex, Money, and Premarital Partnerships in Southern Malawi
In-depth interviews among youth in the Balaka district of Malawi dispel traditional “sugar daddy” myths and indicate that money and gifts are a part of traditional courting traditions. In these rural areas, premarital partnerships are the norm, as is providing the female partner with money and/or gifts to show love and affection. Often, this relationship is the precursor to marriage. For men, it is a point of masculinity to be able to provide a partner with money that women can use for luxury items. Among couples who may be together without claiming “true love,” there are some TS aspects to the relationship. Contrary to prevailing beliefs about women being disempowered, the interviews found that the woman decides whether she wants to enter into a relationship. Furthermore, she is free to end the relationship any time she wishes. Girls often informally ask about potential partners’ sexual behavior as a strategy to minimize HIV risk, but condom use is generally not very high among these partnerships.
Saying No to Intergenerational Sex: The Experience of Schoolgirls in Botswana
This qualitative study explored the factors that help school girls in Botswana avoid IG relationships. The girls who were able to resist relationships with older partners had a number of attributes and beliefs such as having a strong sense of self-worth, accepting their economic circumstances, and wanting to maintain power in decision making. Themes relating to social and cultural factors also played a role. For example, the girls had respect for marriage and believed that older people should be regarded as parents. They also reported religious beliefs and school connectedness. The authors recommended adapting these practices and program approaches into their HIV and AIDS prevention programs to empower girls to resist IG relationships.
Ties of Dependence: AIDS and Transactional Sex in Rural Malawi
Using qualitative evidence from rural Malawi, this anthropological analysis concludes that patron–client ties and a moral obligation to support the needy, fundamental to African social life, are central elements of TS. The study finds that men’s relative wealth may compel them to take sexual partners; that, for women, TS may be a pathway to social mobility and economic independence; and that the ties that derive from the exchange of sex for money are one form of patron–client interactions that are part of many African societies.
“Milking the Cow”: Young Women’s Constructions of Identity, Gender, Power and Risk in Transactional and Cross-generational Sexual Relationships: Maputo, Mozambique
Nearly 200 women aged 16 to 25 years from Central Maputo, Mozambique, participated in ethnographic research to understand their sexual behavior. The women classified sexual relationships into groups: 1) the namorados (same-age boyfriends with whom there is a perception of trust); 2) pitos (partners for sexual pleasure and no economic exchange); 3) sengue (older married men); and 4) amante (lovers). They consider sengue and amante to be transactional relationships. Women saw such relationships as a way to empower themselves socially and economically. They did not view TS as sex work because it takes place within a relationship. Because these women generally lack educational and occupational opportunities and can only earn low wages, TS offers them a way to advance. While having a sengue is seen as a source of status and pride among their peer group, these women keep such a relationship secret to avoid being labeled a whore—and to avoid losing access to an economic resource. Knowledge of HIV is high among these women, but they do not attempt to negotiate condom use because they do not want to risk losing their relationship and resources that come with it. Because TS is seen as a way to advance among these women, any behavior change interventions must address the loss of power and status that comes with such relationships. Furthermore, interventions must also target the men in these relationships.
Transactional Sex and the Pursuit of Modernity
This paper explores meanings of sexual exchange for material gain in an urban township of Durban, South Africa. Finding that sexual transactions are not always an outcome of wealthier men exploiting women’s need for subsistence support, TS can also be a product of a burgeoning globalized consumer culture. This culture is producing “wants” that may be felt keenly by some women as “needs,” with TS “perceived as ‘normal,’ leading many women to accept men’s multiple partners and to put themselves as risk of contracting HIV/AIDS—despite having knowledge of the pandemic.” The paper also highlights the role of women’s power and agency, arguing that women see their sexuality as the only means at their disposal to obtain what they perceive essential “commodities of modernity.” Recommendations include ensuring women’s access to and control over economic assets.
The Materiality of Everyday Sex: Thinking Beyond “Prostitution”
This article is based on ethnographic research conducted in the South African township of Mandeni. The article compares different forms of TS in two different areas—one a very poor informal settlement and the other an established township—and finds that sex linked to subsistence is more prominent in the informal settlement while sex linked to consumption is more prominent in the township. It argues that this distinction—although not clear-cut—can be attributed to both the different structural positions of women and the contrasting economic stability and historical backgrounds of the two areas. Three factors, the author argues, lead to TS. First is the privileged economic position of men, which provides a material basis for TS. Second are social norms that encourage men to have many sexual partners. Third is the role of women’s active agency in TS arrangements: “women approach transactional relations not as passive victims, but in order to access power and resources in ways that can both challenge and reproduce patriarchal structures."
The Negotiation of Sexual Relationships among School Pupils in South-western Uganda
Questionnaires, in-depth interviews, focus group discussions, and role plays among 110 secondary school students ages 14 to 20 years old informed the findings on youth sexual relationships in rural Uganda. Money played an important role in negotiation of sex: the more money a boy had, the greater his bargaining power. While gifts could be exchanged in a platonic relationship as well as a sexual one, money entering the negotiation explicitly equaled sex for these youth. Older partners were coveted by virtue of their ability to give their partners more money. Sex was often seen as girls’ “solution to their problem” of a lack of spending money, with money earned through TS spent on necessities as well as luxuries. Interestingly, virtually all boys and girls agreed that even if a girl possessed unlimited monies, sex should never be given away for free. While some students experimented with condom use, most did not use them regularly. Furthermore, the girls said it was the boy’s responsibility to procure condoms and discuss their use. The authors state this research indicates that HIV interventions focusing on delaying sex or reducing partners did not have an effect on this study group.