AEGiS-14IAC: Prevalence of transactional sex in an antenatal clinic population in South Africa.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Prevalence of transactional sex in an antenatal clinic population in South Africa.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrE1203)

Dunkle KL, Jewkes RK, Brown HC, McIntyre JA, Gray GE
Gender and Health Group, Medical Research Council, Pretoria, South Africa

INTRODUCTION: Self-identified sex workers have long been recognized as a risk group for HIV, but sex work represents only one end of a broad spectrum of transactional sexual behaviour. Little research to date has explored the prevalence of transactional sexual exchanges in a general population sample.

METHODS: We interviewed key informants to develop a list of commodities for which sex is commonly exchanged and types of partners with whom these exchanges occur. We then developed and tested a set of detailed questions regarding history of transactional sex with casual partners (transactional sex with main partners was excluded). These questions were incorporated into an on-going epidemiological study of gender inequalities and HIV infection among women seeking care at antenatal clinics in Soweto.

RESULTS: Transactional sex takes place with two types of casual partner: once-offs and 'roll-ons' (secret relationships concurrent with a main partnership). In the first 340 of 1400 planned interviews, 26.2% of pregnant women reported engaging in any transactional sex with casual partners. Among these women, commodities exchanged included cash (95.4%), food (35.9%), items for the woman's children (34.8%), clothes (34.8%), cosmetics (30.3%), transport (29.2%), space to sleep (11.2%), and school fees (6.7%). Transactional sex was associated with elevated risk of prevalent HIV infection (OR=1.59; 95% CI 0.96-2.64). Among the 64.1% of women who reported ever taking casual partners (N=218), those who reported hunger in their households were more likely to report transactional encounters (OR=2.17; 95% CI 1.22-3.87) as were women with substance use problems (OR=11.33; 95% CI 2.49-51.6).

CONCLUSIONS: Transactional sex with casual partners is highly prevalent among women of reproductive age in Soweto, is associated with social vulnerability and may be associated with elevated HIV risk. Prevention strategies for women should explicitly address transactional sexual exchanges.

Keywords: AEGIS, Prevalence, Coitus, Sex Behavior, HIV Infections, Population, Interviews, Socioeconomic Factors, Prostitution, South Africa, Epidemiologic Studies, Human, Female, Child, Pregnancy, epidemiology

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TuOrE1203