Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature

Abstract

In sub-Saharan Africa, young women ages 15-24 have more than twice the risk of acquiring HIV as their male counterparts. A growing body of epidemiological evidence suggests that the practice of "transactional sex" may contribute to this disparity. Over the last 15 years, the social sciences have contributed significantly to understanding the meaning of and motivations for this practice. The findings from these studies are rich, but varied, rendering lessons difficult to navigate for intervention and further research. We therefore contribute a historically-grounded, comprehensive literature review on the nature and motivations for women's participation in transactional sex in sub-Saharan Africa. Drawing from over 300 studies (through 2014), we distill three prominent paradigms observed in the literature that we review toward presenting a unified conceptualization of the practice. "Sex for basic needs," the first paradigm, positions women as victims in transactional sexual relationships, with implications for interventions that protect girls from exploitation. In contrast, the "sex for improved social status" paradigm positions women as sexual agents who engage in transactional sex toward attaining a middle-class status and lifestyle. Finally, a third paradigm, "sex and material expressions of love," draws attention to the connections between love and money, and the central role of men as providers in relationships. We find important commonalities in the structural factors that shape the three paradigms of transactional sex including gender inequality and processes of economic change. We suggest that there are three continua stretching across these paradigms: deprivation, agency, and instrumentality. This review proposes a definition of transactional sex and discusses implications for research and interventions aiming to reduce young women's risk of HIV through such relationships. We consider the consequences of drawing from too narrow an understanding of the practice, and highlight the benefits of a broader conceptualization.

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

“…This systematic review of the relationship between transactional sex and HIV is a part of a larger comprehensive review assessing the state of knowledge on transactional sex in sub-Saharan Africa including its conceptualization, definition and measurement as well as its association with HIV and related risk behaviours [11]. The comprehensive search strategy was broad to accommodate these multiple aims and includes studies conducted through 2014.…”

“…Numerous in-depth studies conducted across the region confirm [11] first that transactional sex relationships are non-commercial ; participants describe themselves as boyfriends and girlfriends, or lovers, not as clients and sex workers. Second, the exchange embedded in these relationships is implicit ; it is not formally negotiated and may not immediately follow a sexual act.…”

“…A growing body of literature speculates that transactional sex—defined here as non-marital, noncommercial sexual relationships motivated by the implicit assumption that sex will be exchanged for material benefit or status [11]—may play a role in young women's disproportionate risk and explain the feminization of the epidemic [2,12]. …”

Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review

“…This definition excludes transactional sex, which is the exchange of favours, gifts or money for sexual activity. Those who engage in transactional sex do not necessarily self-identify as sex workers or clients (Stoebenau, Heise, Wamoyi, & Bobrova, 2016) while sex workers clearly identify what they do as work or "business" which is distinct from their non-work lives (Chatterji, Murray, London, & Angelwicz, 2005;WHO, 2011b).…”

The Neglect of Buying Power in Traditional Economic Theory, and its Practical Implications

“…In low-income countries, and possibly elsewhere too, the prevalence of transactional sex is related to the degree of inequality but not to the degree of overall poverty [1,2]. The women have low incomes in both situations, but the difference is the buying power of men -relatively high with inequality, but low with overall poverty.…”