Stephenson, R., Winter, A., and Elfstrom, M. AIDS Care (2013), Vol. 25 No. 6, pp. 784-792.
The authors analyzed Demographic and Health Surveys to examine how individual- and community-level factors affect reported risky transactional sex among men. The analysis included 2,893 men in Malawi, 2,110 in Tanzania, and 1,799 in Nigeria. While several community characteristics are linked to higher reported engagement in risky transactional sex, community-level variations remained in all countries. Reports of risky transactional sex were 12.4 percent, 9.8 percent and 6.7 percent in Malawi, Nigeria, and Tanzania, respectively. Tanzanian men with any education, and Nigerian men with primary education, were more likely to engage in risky transactional sex. In Nigeria, fewer never-married men reported risky transactional sex than married, cohabitating, or divorced men; and more men in lower wealth quintiles reported the behavior. Gender equity appeared to affect risky transactional sex: where a greater proportion of women had at least some education (and, in Nigeria, where more women were employed), men were less likely to report risky transactional sex. The average number of sexual partners in the past 12 months was associated with more risky transactional sex. Factors associated with reduced reporting of the behavior include condom use at last intercourse (Malawi), greater knowledge among men and women of three HIV prevention measures (Nigeria and Tanzania), and women's older average age at first birth (Malawi and Tanzania). The authors advocated for incorporating gender issues and community-level factors into HIV interventions.