Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex

Kyegombe, Nambusi; Meiksin, Rebecca; Wamoyi, Joyce; Heise, Lori; Stoebenau, Kirsten; Buller, Ana Maria

doi:10.1080/26410397.2019.1700770

Cited by 29 publications

(26 citation statements)

References 38 publications

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“…It needs to be interpreted against a backdrop of social norms and structural realities which shape the experience of those involved and how they experience their situation [27,[56][57][58]. The findings on community perceptions of exploitative, wrong, or unfair aspects of transactional sex described in this paper concord with those of previous studies including the condemnation of adolescent girls' and young women's participation in transactional sex relationship out of coercion or force [59], a view that was reflected across all participant groups. Other studies also recognise that for some adolescent girls and young women, participation in transactional sex relationships is driven by vulnerability arising from poverty and absolute deprivation [12,18,55].…”

Section: Discussionsupporting

confidence: 65%

Community perspectives on the extent to which transactional sex is viewed as sexual exploitation in Central Uganda

Kyegombe

Meiksin

Namakula³

et al. 2020

BMC Int Health Hum Rights

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Background: Definitions of child sexual exploitation vary. Sexual exploitation violates children's rights and exposes them to mental and physical harm. There exist differences in views of behaviour that is considered exploitative, including transactional sex. This paper explores community perspectives on the extent to which transactional sex is considered exploitative. Methods: In 2014, we conducted 19 focus group discussions and 44 in-depth interviews with young people and adults in two communities in Uganda. Participants were presented with vignettes describing sexual encounters between adolescent girls and young women and men to explore under what conditions participants considered the scenario to be exploitative and why. Interviews were conducted in Luganda using a semi-structured tool, audio recorded and transcribed verbatim. Analysis was thematic and complemented by constant comparison and deviant case analysis techniques. Results: Definitions by multilateral, bilateral, and non-governmental organisations of the sexual exploitation of children shared similarities with community conceptualisations of wrong or unfair sex. Although in community conceptualisations there was no consensus on what constituted sexual exploitation, transactional sex was condemned to the extent to which it involved sex with a minor or misled a naïve or immature girl; involved lack of consent, particularly in relationships characterised by power differentials; or worsened the pre-existing status of the girl. Also relevant was the extent to which a man's intentions were considered inappropriate; the adolescent girl or young woman was considered vulnerable; and the adolescent girl or young woman was considered responsible for 'her situation'. Conclusions: Existing social norms that condemn sex with a minor or sex that involves deception, sexual coercion or misleading an immature girl, present opportunities to mobilise communities to protect adolescent girls and young women at risk. Any intervention must, however, be designed with full cognisance of the social and structural drivers that underlie transactional sex and limit adolescent girls' and young women's opportunities to provide for themselves without recourse to sexual relationships with men. Interventions must also be designed to recognise that girls in transactional sex relationships may not consider themselves as exploited, thus requiring engagement with them based on their own concerns, aspirations, and expectations.

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Section: Discussionsupporting

confidence: 65%

Community perspectives on the extent to which transactional sex is viewed as sexual exploitation in Central Uganda

Kyegombe

Meiksin

Namakula³

et al. 2020

BMC Int Health Hum Rights

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“…These were also the situations where schooling was not guaranteed for the girl child [ 28 , 43 ] including low continuation following pregnancy [ 31 , 44 ] - as was found in our study. Our finding of poverty as central to the first birth and subsequently repeat adolescent birth agrees with the previous research findings that, early adolescent birth was driven by sexual exploitation of the girls in return for material incentives – transactional relationships [ 45 – 49 ]. Families see girls, as a source of revenue (=bride-price) and therefore marry them off at the earliest excuse irrespective of the legislation against early marriage [ 12 , 43 ].…”

Section: Discussionsupporting

confidence: 92%

“… I would have left that man long time ago but, …” exploring circumstances of and motivators for repeat adolescent birth in Eastern Uganda

et al. 2021

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Background First birth before 18 years has declined in Uganda unlike repeat adolescent birth (=second or more births before age 20 years). We explored the circumstances of and motivators for repeat adolescent birth in Eastern Uganda. Methods Between January and March 2020, we conducted a qualitative study involving 70 individual in-depth interviews with purposively selected respondents - 20-25-year-old women with and without repeat adolescent birth, their partners, and parents, in the communities of Teso sub-region. We conducted latent content analysis. Results Four major themes emerged: poverty, vulnerability, domestic violence, and demotivators. Sub-themes identified under poverty were: “limited provisions”, “peasantry”, “large families”, “dropping out of school”, “alcohol abuse”, and “broken family structure”. Vulnerability included “marital entrapment” and “partner coercion”. Demotivators included: “abandonment”, “stern warning”, “objection to marriage”, and “empowerment”. Extreme poverty resulted in inadequate provision of basic needs leading to unprotected sexual activity in a bid to secure financial support. Following the first birth, more than three quarters of the women with repeat adolescent birth reported increased economic distress that forced them to remain in unwanted marriage/union, often characterized by partner coercion, despite wanting to delay that repeat birth. Women without repeat adolescent birth avoided a second birth by empowerment through: an economic activity, contraception use, and resumption of schooling. Conclusion Repeat adolescent birth in Uganda is premised around attempts to address the economic distress precipitated by first birth. Many women want to delay that repeat birth but the challenges robbed them of their reproductive autonomy. Beyond efforts to prevent first birth, programs need to address economic empowerment, ensure contraceptive access, and school re-integration for adolescent mothers in order to prevent shortly-spaced repeat births.

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“…TS is associated with a 50% increased risk of HIV among AGYW, making it a top-priority issue in HIV epidemic control [ 10 ]. TS prevention efforts have focused largely on relieving economic pressure and changing harmful gender norms [ 41 ]. The present findings indicate that factors associated with TS differ by context, suggesting interventions should be tailored to meet the needs of AGYW in their unique social environments.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex

Cited by 29 publications

References 38 publications

Community perspectives on the extent to which transactional sex is viewed as sexual exploitation in Central Uganda

Community perspectives on the extent to which transactional sex is viewed as sexual exploitation in Central Uganda

“… I would have left that man long time ago but, …” exploring circumstances of and motivators for repeat adolescent birth in Eastern Uganda

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

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