University of California San Francisco, San Francisco, California.
University of California San Francisco, San Francisco, California; School of Public Health, University of California Berkeley, Berkeley, California.
J Adolesc Health. 2021 May;68(5):930-936. doi: 10.1016/j.jadohealth.2020.09.027. Epub 2020 Nov 18.
Intergenerational transactional sex (ITS) occurs in Sub-Saharan Africa within the context of widespread poverty and limited employment opportunities. We examined how adolescents describe these relationships, why their peers engage in ITS, and what repercussions adolescents shoulder as a result.
We conducted 14 focus group discussions with boys and girls (N = 120) aged 15-19 years in informal settlement communities in Kisumu, Kenya. We used a framework approach to guide data analysis.
Adolescents referred to a relatively well-off older partner in ITS relationships as a "sponsor." Poverty proved the main driver of ITS. Boys and girls noted family and peer pressure to have a "better life" via sponsors who provided for three levels of need: urgent (e.g., food), critical (e.g., school fees), and material (e.g., clothes). Adolescents described multiple risks, including "no power" to negotiate condom use. Repercussions included dropping out of school because of community stigma, "abandonment" in the event of pregnancy, and unsafe abortions.
Adolescents face the difficult choice between the need for money to contribute to their families' income and the discomfort and health risks of a sponsor relationship. The pressure to have a sponsor was higher among out-of-school adolescents and adolescent mothers because of heightened poverty and vulnerability. Structural interventions, such as eliminating school fees, could help reduce adolescents' perceived need to acquire sponsors. Our findings suggest a need to update guidelines for sexual and reproductive health counseling in schools and community settings to openly discuss why ITS is so commonplace and engage in risk reduction conversations with adolescents.
代际交易性性行为（ITS）发生在撒哈拉以南非洲，其背景是普遍存在的贫困和有限的就业机会。我们研究了青少年如何描述这些关系，为什么他们的同龄人会从事 ITS，以及青少年因此承担了什么后果。
我们在肯尼亚基苏木的非正规住区对 15 至 19 岁的男孩和女孩进行了 14 次焦点小组讨论（N=120）。我们使用框架方法指导数据分析。
青少年将 ITS 关系中相对富裕的年长伴侣称为“赞助人”。贫困是 ITS 的主要驱动因素。男孩和女孩都提到了家庭和同伴的压力，希望通过赞助人过上“更好的生活”，赞助人满足了三个层次的需求：紧急需求（如食物）、关键需求（如学费）和物质需求（如衣服）。青少年描述了多种风险，包括无法协商使用避孕套。后果包括因社区耻辱感而辍学、怀孕时被“抛弃”以及不安全堕胎。
青少年面临着为家庭收入做出贡献的需要和赞助人关系带来的不适和健康风险之间的艰难选择。由于贫困加剧和脆弱性增加，失学青少年和青少年母亲面临更大的寻找赞助人的压力。结构性干预措施，如取消学费，可以帮助减少青少年对获得赞助人的需求。我们的研究结果表明，需要更新学校和社区性与生殖健康咨询的指南，公开讨论为什么 ITS 如此普遍，并与青少年进行风险降低对话。
