ArticleJournal of the International AIDS Society2016
Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection.
Article in Journal of the International AIDS Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it, 115 citations in OpenAlex.
- Transactional sex among women in Sub-Saharan Africa: A systematic review and meta-analysis.PloS one · 2023Pooled it
- Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2016Pooled it
- Developmental Trajectories of Transactional Sex and Age-Disparate Relationships During Adolescence: An HPTN 068 Analysis.AIDS and behavior · 2024Trial
- Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed-methods study.Journal of the International AIDS Society · 2022Trial
- 'It's because I like things… it's a status and he buys me airtime': exploring the role of transactional sex in young women's consumption patterns in rural South Africa (secondary findings from HPTN 068).Reproductive health · 2018Trial
- HIV pre-exposure prophylaxis service delivery among young women at increased risk for HIV acquisition in South Africa: a time-and-motion study.BMC health services research · 2026Article
- Associations Between Extreme Weather Events, Resource Insecurities, and HIV Vulnerabilities Among Adolescent Girls and Young Women in Kenya: Latent Profile Analysis Findings.AIDS and behavior · 2026Article
- Identifying sexual behavioural choices when commencing pre-exposure prophylaxis: Findings from a public health facility in eThekwini, KwaZulu-Natal, South Africa.Southern African journal of HIV medicine · 2026Article
- Article
- Does the Risk Premium Differ Between Women Engaging in Commercial and Transactional Sex? Evidence From Urban Cameroon.Health economics · 2025Article
- Finding knowledge: how youth identify their candidacy and sources of information regarding sexual and reproductive health in rural KwaZulu-Natal. South Africa.BMC public health · 2025Article
- Barriers to PrEP use and adherence among adolescent girls and young women in Eastern, Southern, and Western Africa: a scoping review.BMC women's health · 2024Article
- Uptake and Persistence of Safer Conception Strategies Among South African Women Planning for Pregnancy.AIDS and behavior · 2024Article
- 'You are looked upon as a luxury tool': Young Tanzanian women's perception of community norms supporting partner violence during transactional sex (Culture, health & sexuality · 2024Article
- Adolescents' risky sexual behaviours and practices: Implications for sexuality education implementation in Zambia.African journal of primary health care & family medicine · 2024Article
- Economic vulnerabilities, mental health, and coping strategies among Tanzanian youth during COVID-19.BMC public health · 2024Article
- Food Insecurity and Engagement in Transactional Sex Among Female Secondary Students in Rwanda.AIDS and behavior · 2024Article
- Article
- The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study.Sexual and reproductive health matters · 2023Article
- Understanding sexual behaviors of youth from the lens of caregivers, teachers, local leaders and youth in Homabay County, Kenya.Reproductive health · 2023Article
Corrections and comments
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Authors and funding
13 authors at 9 institutions in 6 countries.
Funding
Abstract
introductionYoung adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours.
methodsWe analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13-20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI.
resultsOverall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19-5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship.
conclusionsThis study provides quantitative support demonstrating that transactional sex is associated with HIV infection in young women. Even though the specific variables tested do not mediate the relationship, a potential explanation for this association may be that the men with whom young women are having sex belong to networks of sexually connected individuals who are at a "high risk" for HIV infection. The results highlight the importance of structural intervention approaches that can alter the context of young women's HIV risk.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.