ArticleJournal of acquired immune deficiency syndromes (1999)2020
The Mediating Role of Partner Selection in the Association Between Transactional Sex and HIV Incidence Among Young Women.
Article in Journal of acquired immune deficiency syndromes (1999), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis.The Lancet. Global health · 2024Pooled it
- Developmental Trajectories of Transactional Sex and Age-Disparate Relationships During Adolescence: An HPTN 068 Analysis.AIDS and behavior · 2024Trial
- Loss to Follow-Up and Visit Nonadherence in an HIV Incidence Cohort in Kisumu, Kenya.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Prevalence and factors associated with modern and dual contraceptive use among women living with HIV in Cross River State, Nigeria: a cross-sectional study.Contraception and reproductive medicine · 2026Article
- Prevalence and factors associated with sexual violence against adolescent girls in Brazil: results of the 2019 National Survey of School Health.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2026Article
- Prevalence and knowledge about cross-generational sexual relationships among undergraduates in a Nigerian tertiary institution.BMC public health · 2025Article
- Does the Risk Premium Differ Between Women Engaging in Commercial and Transactional Sex? Evidence From Urban Cameroon.Health economics · 2025Article
- Profiles of Sexual Economic Exchanges among Women in Kisumu, Kenya: A Latent Class Analysis.Archives of sexual behavior · 2025Article
- Protocol: the American Women: Assessing Risk Epidemiologically (AWARE) cohort study.BMC public health · 2024Article
- Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania.Frontiers in reproductive health · 2024Article
- The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study.Sexual and reproductive health matters · 2023Article
- HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis.medRxiv : the preprint server for health sciences · 2023Article
- Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial.JMIR research protocols · 2023Article
- From a drought to HIV: An analysis of the effect of droughts on transactional sex and sexually transmitted infections in Malawi.SSM - population health · 2022Article
- From Survival to Glamour: Motivations for Engaging in Transactional Sex and Relationships Among Adolescent Girls and Young Women in South Africa.AIDS and behavior · 2021Article
- To educate a woman and to educate a man: Gender-specific sexual behavior and human immunodeficiency virus responses to an education reform in Botswana.Health economics · 2021Article
- Article
- Associations between extreme weather events, resource insecurities, and HIV vulnerabilities with self-reported urinary tract infection symptoms among adolescent girls and young women in Kenya.The journal of climate change and healthArticle
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
objectiveIn sub-Saharan Africa, transactional sex is associated with an increased risk of HIV infection in adolescent girls and young women, but the mechanisms for this relationship remain unclear. We hypothesize that young women who report transactional sex may have multiple partners and older partners, thereby increasing their HIV risk.
settingWe used longitudinal data from the HPTN 068 trial in rural South Africa where young women aged 13-20 who were HIV-negative at enrolment (n = 2362) were followed approximately annually for up to 6 years.
methodsWe used the parametric g-formula to estimate the total effect of time-varying, frequent transactional sex (receipt of gifts/money at least weekly versus monthly or less) on HIV incidence and the controlled direct effect for mediation in a simulated cohort using 20,000 bootstrapped observations. We calculated rates and hazard ratios (HRs) over the entire study period.
resultsThe HR for the total effect of frequent transactional sex on HIV incidence was 1.56 (95% confidence interval: 1.28 to 1.85). However, this effect was mediated by partner age (>5+) and number of partners (>1) and the HR was attenuated to 1.09 (95% confidence interval: 0.90 to 1.28) when setting both partner age and partner number constant.
conclusionBoth partner age difference and partner number mediate the relationship between transactional sex and incident HIV infection. Through this mediation analysis, we provide important longitudinal evidence to suggest that young women who engage in frequent transactional sex select multiple partners, often older male partners that may be part of higher risk sexual networks.
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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.