Transactional sex and HIV risk among young women in rural South Africa

Young women aged 15-24 in sub-Saharan Africa are 3-4 times more likely to be HIV-infected than boys or men of the same age. Transactional sex - sex exchanged for material possessions or favours - is a significant source of HIV risk in young women.

This Learning Lab describes analysis, key findings and implications from the HPTN 068 Swa Koteka Conditional Cash Transfer trial. 

Despite the potential for transactional sex to increase HIV risk among young women, there is limited epidemiological data demonstrating an association. An analysis of baseline data from the HPTN 068 Swa Koteka Conditional Cash Transfer trial in rural north east South Africa showed that transactional sex was associated with an almost three-fold increased risk of being HIV positive in young women, after controlling for other risk factors. Surprisingly however, the association between transactional sex and HIV was not mediated by any of the sexual risk behaviours that might help to explain the underlying pathways of HIV risk:

  • sexual relations between a younger woman and an older man
  • sex under the influence of alcohol or drugs
  • having multiple sexual partners

Dr Meghna Ranganathan is a post-doctoral Research Fellow at the London School of Hygiene and Tropical Medicine . She earned a PhD at the LSHTM with a thesis examining the relationship between household poverty, transactional sex and HIV infection in adolescent girls in rural South Africa. She has a keen interest in inter-disciplinary research at the intersection of poverty, gender and health and currently works on the evaluation of an economic empowerment intervention in Sub-Saharan Africa.


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