Regional heterogeneity in violence and individual characteristics associated with recent transactional sex among Ugandan girls and young women: A national and regional analysis of data from the Violence Against Children and Youth Survey

Abstract

Objectives This study assessed associations between recent transactional sex (TS) and potential determinants and variations in patterns across two geographic regions with high HIV burden compared to the rest of Uganda, among adolescent girls and young women (AGYW). Methods In 2015, a nationally representative cross-sectional household survey was conducted in Uganda. A stratified multi-stage cluster sample design produced nationally representative estimates and sub-national estimates for AGYW in two high HIV burden regions, DREAMS Central 1 (Bukomansimbi, Ssembabule, and Rakai districts) and DREAMS Central 2 (Mubende, Mityana, Gomba, and Mukono districts), and the rest of Uganda. To identify associations between recent TS (defined as sex in the past 12 months in exchange for material support or help) and risk factors, multivariable logistic regressions were conducted. Interaction terms assessed the associations between violence and recent TS across geographic regions. Results Nationally, 14.2% of sexually active AGYW engaged in recent TS. Region-specific significant associations emerged between recent TS and marriage, family wealth, friendship, orphanhood, and sexual debut. In DREAMS Central 1 and 2, AGYW who witnessed violence in the home or community, or experienced sexual, physical, or emotional violence had higher odds of recent TS than AGYW who did not experience that form of violence (adjusted odds ratio ranged between 2.10 (95% CI, 1.07, 4.13) and 8.25 (95% CI, 3.40, 20.06)). The magnitude of association between recent TS and types of violence varied by region. Conclusions Violence is strongly and consistently associated with recent TS, and patterns in prevalence and risk factors vary across regions in Uganda. Given the high risk of HIV association with recent TS, HIV epidemic control efforts may benefit from focus on comprehensive violence prevention and target persons who engage in TS. Comprehensive HIV prevention programming aimed at keeping AGYW HIV-negative should incorporate prevention of violence and TS as key components to facilitate HIV epidemic control in this vulnerable population.

Transactional sex among women in Sub-Saharan Africa: A systematic review and meta-analysis

“…Early sexual debut was significantly associated with TS [ 36 , 39 ]. Participants who had had their first sexual intercourse before or at the age of 16 years were 2.58 times (OR = 2.58, 95% CI, 1.56, 4.27) more likely to have TS as compared to participants who had first sexual intercourse after 16 or later years.…”

“…04 . Women who had a history of physical violence were 6 times (OR = 6.70, 95% CI, 3.22, 13.53) [ 36 , 37 ] more liked to practice transactional sex than women who did not have physical violence. The heterogeneity test showed an I 2 value of 0.00%, P = 0 .…”

“…83 . Sexual violence were a determinant factor for transactional sex (OR = 3.76, 95% CI, 1.08, 13.05) [ 36 , 39 ]. The heterogeneity test was I 2 , 64.31%, and p = 0.04 [ 36 , 39 ] ( Fig 9 ).…”

“…The sample size ranges from 204 in Nigeria [32] to 8984 in Malawi [33]. Based on the geographical location, three studies were from Ethiopia [10,34,35], three studies were from Uganda [36][37][38], one was from Liberia [39], three were from South Africa [40][41][42], four were from Nigeria [32,[43][44][45], one was from Cameron [46], two were from Malawi [33,44], two studies were from Kenya [44,47] and one study was from each country (Zambia, Zimbabwe, Benin, Burkina Faso, Central Africa Republic(CAR), Chad, Guinea, Niger, and Togo) [44]. The included studies dealt with practises of transactional sex among women and associated factors in sub-Saharan African Countries [10,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (Table 2).…”

Unhealthy alcohol use and intimate partner violence among men and women living with HIV in Uganda

“…Unequal relationship power dynamics, prevailing social norms around gender and traditional constructs of masculinity that emphasize male exertion of power (at time through force) over females place women at greater risk of experiencing IPV [ 14 , 15 ]. Unequal power dynamics and gendered economic systems may exacerbate vulnerability in relationships where younger women are reliant on older male partners for monetary support [ 16 ]. For these reasons, the majority of IPV research to date in sub-Saharan Africa has focused on perpetration among men and victimization among women.…”