Mechanisms leading to transactional sex - understanding pathways for women and men in urban informal settlements

Abstract

Background Transactional sex is a risk factor for HIV acquisition in sub-Saharan Africa. There are several gaps in the knowledge base including inconsistent measurement of transactional sex , especially for men; and less precision around motivations for or pathways underpinning transactional sex. Few studies of the patterns and predictors of engaging in transactional sex in men exist, nor is it known whether men who engage in particular clusters of behaviour are more inclined to engage in transactional sex. The overall aim of this study is to explore mechanisms and patterns of transactional sex among women and men living in urban informal settings in South Africa. Methods This PhD made use of data from two different quantitative studies: the Stepping Stones Creating Futures Trial (SS-CF) and the Sonke CHANGE Trial. Both studies were conducted in urban informal settlements outside of major metropolitan cities in Gauteng and in KwaZulu-Natal. I conducted secondary analysis of longitudinal data from 545 women 18-30 years retained at endline in the SS-CF study. I conducted structural equation modelling, multivariable analysis and latent class analysis using two cross-sectional waves of data from the Sonke CHANGE trial of men aged 18-40 years. Results Prevalence of transactional sex was high in both women and men in informal urban settlements. Women reported engaging in transactional sex for cash, while men speculated that casual sexual partners exchanged sex to support their children or families. Women with main partners who exhibited high levels of control were more likely to have transactional sex with a casual partner in the future and men exhibiting high levels of relationship control were more likely to engage in transactional sex. Classes of men displaying more aggressive behaviour were the most likely to engage in transactional sex. Conclusions This study is the first to my knowledge to make use of a new measure of transactional sex in men. It is also the first to explain men’s motivations for transactional sex and to report that they are embedded in masculinities. To understand women’s motivations for engaging in transactional sex, it is important to consider the role of controlling behaviour by their main partners. Due to these varied drivers of transactional sex, interventions addressing transactional sex for both women and men should operate at the individual, interpersonal, and societal levels. Specifically, interventions for men vi should integrate gender transformation efforts, including critical reflections on relationship control in all relationships, alongside economic empowerment initiatives.