Predictors and Patterns of Transactional Sex with Casual Partners Among Adult Men Living in an Informal Urban Area, South Africa.

Few studies have explored the relationship between transactional sex and HIV in adult men, with even fewer exploring the predictors of providing money or goods in exchange for sex. This study aimed to characterise the predictors and patterns of transactional sex in adult men in an urban informal area in South Africa. We used baseline, cross-sectional data from a study of 2406 men aged 18-40 years from an urban informal area. Past year transactional sex was assessed through questions adapted from those used previously. Controlling behaviour was measured using an adapted Sexual Relationship Power Scale. Multivariable logistic regression was used to determine associations between transactional sex and other potential explanatory variables. Nearly half (47%) of respondents who had ever had sex reported at least one type of transactional sex with a casual partner in the past year. A third of men provided support or money for a sex partner's family, 30% provided cash and 28% provided somewhere to stay. Controlling for other factors, men with higher levels of controlling behaviour had nearly double the odds of engaging in transactional sex. Men reporting three or more sexual partners had significantly higher odds of engaging in transactional sex. Hazardous drinkers had 33% higher odds of engaging in transactional sex. Men's provision of money or goods in exchange for sex with women is related to other high-risk behaviours, such as multiple sexual partners, hazardous drinking and controlling behaviour. To address transactional sex-related HIV risks, programming should address harmful masculinities, including relationship control.