Definition of the Prevention Area
Transactional sex is defined as an exchange of money, favors, or gifts in exchange for sexual relations. The term is used to distinguish the informal or less formal exchanges for sex that happen within relationships from the formal, immediate sex for money, which is referred to as “sex work” or “prostitution."
Transactional sex is widely practiced in sub-Saharan Africa. It is closely linked to sociocultural expectations of gender whereby men are expected to act as a provider to their partners, and women expect compensation for having sex. Young women may engage in transactional sex with older men to support their basic needs (e.g., food, clothing, school fees, and desire for love), or to obtain desirable consumer goods (e.g., cell phones, fashionable clothing, jewelry, and meals at expensive restaurants) and the status that goes with them. Gifts for sex may be seen as symbolizing the love and respect a man feels for his partner and the importance he places on the relationship. In contrast, “giving away” sex for free can stigmatize young women in society as “loose” and lacking self-respect.
An age-disparate relationship is defined as one where there is an age difference of five or more years between partners, with the man being older than the woman in the relationship. Often, transactional sex occurs in age-disparate relationships between young women and older men because older men are more likely than boys to have the means to offer gifts for sex. An “intergenerational/cross-generational” relationship is a specific type of age-disparate relationship, in which the man is 10 or more years older than the woman. While these relationships take different forms, this document largely focuses on age-disparate transactional sexual relationships.
Epidemiological Justification for the Prevention Area
Young women and girls are especially vulnerable to HIV due to biological and social factors. For example, unequal access to economic opportunity often compels them to trade their sexuality. The epidemiological record shows that young women in sub-Saharan Africa are two- to four-and-a-half times more likely to be living with HIV than their male counterparts. There is compelling evidence that these gender disparities stem in part from the frequency of age-disparate and transactional sexual networking.
Transactional sex often coexists with other risky sexual behaviors such as early sexual debut, and inconsistent condom use. As a result, there is considerable evidence linking transactional sex to undesirable sexual and reproductive health outcomes including sexually transmitted infections, unintended pregnancies, unsafe abortions, and gender-based violence.
Core Programmatic Components
Interventions addressing age-disparate transactional sexual relationships explicitly or as a secondary outcome have focused on the economic and social drivers of young people’s risk. Thus, focus areas have included changing gender norms, improving school attendance, improving young women's economic situation through microfinance and microcredit, creating safe spaces, engaging in healthy sexual behavior, and strengthening the parenting of young people. Increasing men's involvement in prevention programs that challenge gender and other social norms is another important programmatic component.
These components have often been combined—for example, joining an educational intervention with microcredit and community mobilization, or gender empowerment training with life skills and financial literacy. Some interventions have addressed gender inequality and livelihood insecurity by supporting educational attendance for girls.
Current Status of Implementation Experience
Some interventions to reduce young people's vulnerability to HIV have demonstrated a positive effect on outcomes such as condom use, number of partners, gender-based violence, transactional sex, and ultimately, HIV incidence. However, few interventions have explicitly tried to address age-disparate transactional sex and few have been rigorously evaluated.
One intervention, Stepping Stones, documented a 35 percent reduction in the incidence of HSV-2 (but not HIV) among participants; a reduction in the proportion of men reporting that they committed intimate partner violence; and the proportion of men reporting transactional sex. The Girls’ Power Initiative reported that its behavior change and communication model reduced the likelihood that young women would engage in transactional sex.
Moving forward, programmers must identify and account for possible variations in the populations engaged in transactional sexual relationships where age disparities are not involved, and how different forms of sexual partnering affect HIV vulnerability in different settings. Successful programs will also be based on an understanding of specific social norms that influence transactional and age-disparate sexual relationships. It will then be critical to integrate such knowledge into combination prevention programs addressing the biomedical, cultural, behavioral, and structural factors that contribute to sex-related HIV risk and vulnerability. All programs need to implement a rigorous evaluation strategy to assess whether and how they work to reduce young women’s vulnerability to HIV.
Updated July 2015