Transactional Sex As A Response To Risk In Western Kenya

Robinson, Jonathan; Yeh, Ethan

doi:10.1596/1813-9450-4857

Cited by 19 publications

(30 citation statements)

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“…In assessing the operationalization of transactional sex in the literature, we found studies used a range of measures [11] and transactional sex was too often conflated with “sex work” or “prostitution” in meaning and measurement [39–41]. We acknowledge that transactional sex and sex work exist along a continuum; therefore, we should not expect to be able to clearly distinguish the practices in every case.…”

Section: Discussionmentioning

confidence: 99%

Transactional sex and risk for HIV infection in sub‐Saharan Africa: a systematic review and meta‐analysis

Wamoyi

Stobeanau

Bobrova

et al. 2016

Journal of the International AIDS Society

175

142

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IntroductionYoung women aged 15 to 24 years in sub-Saharan Africa continue to be disproportionately affected by HIV. A growing number of studies have suggested that the practice of transactional sex may in part explain women's heightened risk, but evidence on the association between transactional sex and HIV has not yet been synthesized. We set out to systematically review studies that assess the relationship between transactional sex and HIV among men and women in sub-Saharan Africa and to summarize the findings through a meta-analysis.MethodsThe search strategy included 8 databases, hand searches in 10 journals, and searches across 17 websites and portals for organizations as informed by expert colleagues. A systematic review of cross-sectional and longitudinal studies was carried out for studies on women and men who engage in transactional sex published up through 2014. Random effects meta-analysis was used to further examine the relationship between transactional sex and prevalent HIV infection across a subset of studies with the same exposure period. Analyses were conducted separately for men and women.ResultsNineteen papers from 16 studies met our inclusion criteria. Of these 16 studies, 14 provided data on women and 10 on men. We find a significant, positive, unadjusted or adjusted association between transactional sex and HIV in 10 of 14 studies for women, one of which used a longitudinal design (relative risk (RR)=2.06, 95% confidence interval (CI): 1.22 –3.48). Out of 10 studies involving men, only 2 indicate a positive association between HIV and transactional sex in unadjusted or adjusted models. The meta-analysis confirmed general findings from the systematic review (unadjusted meta-analysis findings are significant for women (n=4; pooled odds ratio (OR)=1.54, 95% CI: 1.04–2.28; I2=42.5%, p=0.156), but not for men (n=4; pooled OR=1.47, 95% CI: 0.85–2.56; I2=50.8%, p=0.107).ConclusionsTransactional sex is associated with HIV among women, whereas findings for men were inconclusive. Given that only two studies used a longitudinal approach, there remains a need for better measurement of the practice of transactional sex and additional longitudinal studies to establish the causal pathways between transactional sex and HIV.

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Section: Discussionmentioning

confidence: 99%

Transactional sex and risk for HIV infection in sub‐Saharan Africa: a systematic review and meta‐analysis

Wamoyi

Stobeanau

Bobrova

et al. 2016

Journal of the International AIDS Society

175

142

View full text Add to dashboard Cite

show abstract

“…Some people engage in high-risk sexual behaviors as a means of coping with food insecurity, which contributes to enhanced HIV transmission risk (84,85). In a large population-based crosssectional study in Botswana and Swaziland, food insufficiency (not enough food to eat, per self-report) was independently associated with inconsistent condom use with a nonprimary partner, sex exchange, intergenerational sexual relationships, and lack of control in sexual relationships among women (13).…”

Section: Behavioral Pathwaysmentioning

confidence: 99%

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Weiser

Young

Cohen

et al. 2011

The American Journal of Clinical Nutrition

386

427

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Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.

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“…Transactional sex, or offering sex in exchange for receiving money or goods, has been reported by sub-Saharan women in the general population who do not identify as sex workers [23, 24]. Transactional sex has been shown to be associated with increased risk of partner violence [25, 26] and HIV infection [26].…”

Section: Introductionmentioning

confidence: 99%

“…Transactional sex has been shown to be associated with increased risk of partner violence [25, 26] and HIV infection [26]. In western Kenya, Robinson and Yeh found that women engaged in transactional sex to compensate for financial losses during times of household illness [24]. Similarly, in our pilot study in western Kenya, several HIV-infected women drinkers reported engaging in transactional sex as a method to pay for college, school fees or rent [27], with reported drinking at times to facilitate transactional sex.…”

Section: Introductionmentioning

confidence: 99%

Rates and Covariates of Recent Sexual and Physical Violence Against HIV-Infected Outpatient Drinkers in Western Kenya

et al. 2017

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Victimization from physical and sexual violence presents global health challenges. Partner violence is higher in Kenya than Africa. Violence against drinkers and HIV-infected individuals is typically elevated, so dual vulnerabilities may further augment risk. Understanding violence risks can improve interventions. Participants were 614 HIV-infected outpatient drinkers in western Kenya enrolled in a randomized trial to reduce alcohol use. At baseline, past 90-day partner physical and sexual violence were examined descriptively and in gender-stratified regression models. We hypothesized higher reported violence against women than men, and positive violence association with HIV stigma and alcohol use across gender. Women reported significantly more current sexual (26.3% versus 5.7%) and physical (38.9% versus 24.8%) victimization than men. Rates were generally higher than Kenyan lifetime national averages. In both regression models, HIV stigma and alcohol-related sexual expectations were significantly associated with violence while alcohol use was not. For women, higher violence risk was also conferred by childhood violence, past-year transactional sex, and younger age. HIV-infected Kenyan drinkers, particularly women, endorse high current violence due to multiple risk factors. Findings have implications for HIV interventions. Longitudinal research is needed to understand development of risk.

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Transactional Sex As A Response To Risk In Western Kenya

Cited by 19 publications

References 0 publications

Transactional sex and risk for HIV infection in sub‐Saharan Africa: a systematic review and meta‐analysis

Transactional sex and risk for HIV infection in sub‐Saharan Africa: a systematic review and meta‐analysis

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Rates and Covariates of Recent Sexual and Physical Violence Against HIV-Infected Outpatient Drinkers in Western Kenya

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