Ranganathan Meghna, Heise Lori, Pettifor Audrey, Silverwood Richard J, Selin Amanda, MacPhail Catherine, Delany-Moretlwe Sinead, Kahn Kathleen, Gómez-Olivé F Xavier, Hughes James P, Piwowar-Manning Estelle, Laeyendecker Oliver, Watts Charlotte
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa;
J Int AIDS Soc. 2016 Jul 27;19(1):20749. doi: 10.7448/IAS.19.1.20749. eCollection 2016.
Young adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours.
We analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13-20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI.
Overall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19-5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship.
This study provides quantitative support demonstrating that transactional sex is associated with HIV infection in young women. Even though the specific variables tested do not mediate the relationship, a potential explanation for this association may be that the men with whom young women are having sex belong to networks of sexually connected individuals who are at a "high risk" for HIV infection. The results highlight the importance of structural intervention approaches that can alter the context of young women's HIV risk.
撒哈拉以南非洲地区的年轻青春期女性感染艾滋病毒的可能性是男孩或男性的三到四倍。性交易是一种可能与年轻女性感染艾滋病毒风险增加相关的关系动态。存在一系列与艾滋病毒相关的风险行为，可能导致这种易感性。然而，迄今为止，关于性交易在增加艾滋病毒感染方面的作用，尤其是在撒哈拉以南非洲地区年轻女性中的作用，流行病学数据有限。我们的论文展示了自我报告的性交易参与率数据，并探讨了性交易是否与一组年轻、农村、有性行为的南非女性感染艾滋病毒的风险增加有关。我们还探讨了这种关系是否通过某些与艾滋病毒相关的风险行为介导。
我们分析了一项关于有条件现金转移预防艾滋病毒的三期试验的基线数据，该试验涉及南非农村地区693名年龄在13 - 20岁、有性行为且上学的年轻女性。我们研究了年轻女性参与性交易与艾滋病毒感染之间的关联。性交易被定义为一种非商业、非婚姻的性关系，其中性行为以金钱和/或礼物作为交换。我们探讨了这种关系是否由某些与艾滋病毒相关的风险行为介导。我们使用逻辑回归和多项回归，并报告未调整和调整后的比值比及95%置信区间。
总体而言，14%（n = 97）有性行为的年轻女性报告参与了性交易。参与性交易与艾滋病毒阳性风险增加相关（调整后的比值比：2.5，置信区间：95% 1.19 - 5.25，p = 0.01）。当对可能有助于解释这种关系潜在途径的某些其他艾滋病毒风险维度进行调整后，这种关联的效应大小几乎保持不变。
本研究提供了定量支持，表明性交易与年轻女性的艾滋病毒感染有关。尽管所测试的特定变量并未介导这种关系，但这种关联的一个潜在解释可能是，与年轻女性发生性行为的男性属于性关联个体网络，这些个体感染艾滋病毒的“风险很高”。结果凸显了结构性干预方法的重要性，这些方法可以改变年轻女性感染艾滋病毒风险的背景。
