Trial reportJournal of the International AIDS Society2022
Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed-methods study.
Trial report in Journal of the International AIDS Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Systematic review of cash plus or bundled interventions targeting adolescents in Africa to reduce HIV risk.BMC public health · 2024Pooled it
- Transactional sex and intersecting vulnerabilities: a multicountry cross-sectional study of pregnant and parenting adolescents in sub-Saharan Africa.BMJ public health · 2026Article
- Social Protection and HIV risk Factors among Youth in Southern Africa: An Analysis of Cross-sectional Population-based HIV Impact Assessment Surveys.AIDS and behavior · 2025Article
- Differentiated HIV service delivery model for female sex workers in sub-Saharan Africa: A systematic review.Southern African journal of HIV medicine · 2025Article
- Adolescents' risky sexual behaviours and practices: Implications for sexuality education implementation in Zambia.African journal of primary health care & family medicine · 2024Article
- Qualitative evaluation of an edutainment intervention to prevent age-disparate transactional sex in Tanzania: Changes in educational aspirations and gender equitable attitudes towards work.PLOS global public 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
- The relationship between cash-based interventions and violence: A systematic review and evidence map.Aggression and violent behaviorArticle
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTransactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub-Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use.
methodsWe use data from a mixed-method, cluster randomised controlled trial of the Ujana Salama cash "plus" intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017-2019). The impact evaluation consisted of a parallel mixed-methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the "plus" intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts.
resultsThe prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905).
conclusionsThe mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.
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