Cultural consensus modeling to measure transactional sex in Swaziland: Scale building and validation

Abstract

Transactional sex is associated with increased risk of HIV and gender based violence in southern Africa and around the world. However the typical quantitative operationalization, “the exchange of gifts or money for sex,” can be at odds with a wide array of relationship types and motivations described in qualitative explorations. To build on the strengths of both qualitative and quantitative research streams, we used cultural consensus models to identify distinct models of transactional sex in Swaziland. The process allowed us to build and validate emic scales of transactional sex, while identifying key informants for qualitative interviews within each model to contextualize women’s experiences and risk perceptions. We used logistic and multinomial logistic regression models to measure associations with condom use and social status outcomes. Fieldwork was conducted between November 2013 and December 2014 in the Hhohho and Manzini regions. We identified three distinct models of transactional sex in Swaziland based on 124 Swazi women’s emic valuation of what they hoped to receive in exchange for sex with their partners. In a clinic-based survey (n=406), consensus model scales were more sensitive to condom use than the etic definition. Model consonance had distinct effects on social status for the three different models. Transactional sex is better measured as an emic spectrum of expectations within a relationship, rather than an etic binary relationship type. Cultural consensus models allowed us to blend qualitative and quantitative approaches to create an emicly valid quantitative scale grounded in qualitative context.

Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland

“…While there is plenty of anecdotal evidence suggesting a link between poverty and HIV in Swaziland, empirical evidence from studies with methodological rigor are limited [10,77] prior to our study. Though Miller and colleagues identified models of transactional sex in Swaziland indicating possible mechanisms through which low income might lead to HIV risk, the research is not an epidemiological study [78]. In our study, we found a clear dose-dependent relationship between lower economic status and HIV infection with both current cash income and childhood household wealth index.…”

The feminine ideal and transactional sex: Navigating respectability and risk in Swaziland

“…This study was part of a larger mixed method project that utilized cultural consensus, qualitative, and quantitative methods to identify and understand distinct emic models of transactional sex in Swaziland (Fielding-Miller et al, 2016). Data presented in this manuscript is primarily based on in-depth interviews (IDIs) and focus group discussions (FGDs).…”

“…Scores can range from 0–1.00 with 1.00 reflecting perfect knowledge about a cultural model. We present full details on our methodology elsewhere (Fielding-Miller et al, 2016). …”

Cultural Consensus Modeling to Understand the Reproductive Health Needs of South African Adolescent Girls

“…contraceptive use, dual protection use) shared by a group within a culture using an ethnographic approach. [16][17][18] A particular strength of CCM is that it starts by allowing respondents to specify factors based on the experiences which they believe are important. Thus, CCM is locally appropriate, so enlisting the strengths of an ethnographic approach.…”

“…Free listing is a simple technique that asks a respondent to list as many items as they can think of within a given domain; this allows participants to draw upon a shared cultural knowledge when responding to free listing prompts. [17] Participants and procedures A convenience sample of 50 participants (mean age 15.7 years) was recruited. The sample size was determined based on previous studies suggesting that 50 participants would result in data saturation using free listing.…”