London School of Hygiene and Tropical Medicine, London, UK.
Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA.
J Int AIDS Soc. 2022 Dec;25(12):e26038. doi: 10.1002/jia2.26038.
Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub-Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use.
We use data from a mixed-method, cluster randomised controlled trial of the Ujana Salama cash "plus" intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017-2019). The impact evaluation consisted of a parallel mixed-methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the "plus" intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts.
The prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905).
The mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.
在撒哈拉以南非洲，与青少年女孩和年轻妇女艾滋病毒感染相关的是交易性行为或性换取物质。进行交易性行为的动机因满足基本需求、提高社会地位或出于浪漫原因（期望男性提供）而异。交易性行为也与艾滋病毒风险行为有关，例如多个性伴侣以及其他艾滋病毒风险决定因素，包括伴侣暴力和虐待、饮酒和不坚持使用安全套。
我们使用了坦桑尼亚农村乌贾纳萨拉马现金“加”干预混合方法、集群随机对照试验的第一和第三轮数据（2017-2019 年）。影响评估包括同时进行定量和定性数据收集的平行混合方法设计，以及在讨论过程中整合研究结果。我们首先使用多变量逻辑回归模型检查与交易性行为相关的背景因素，然后使用协方差分析估计“加”干预是否减少了青少年女孩和年轻妇女的交易性行为。我们使用主题内容分析对定性转录本进行分析。
在第 3 轮，未婚青少年女孩和年轻妇女的交易性行为发生率为 26%。研究结果表明，年龄增长是交易性行为的一个风险因素（OR = 1.80；95% CI：[1.50, 2.17]），留在学校与参与交易性行为呈负相关（OR = 0.24；95% CI：[0.14, 0.40]）。现金加干预对减少交易性行为没有影响（β=0.003，p=0.905）。
现金加干预对交易性行为的影响机制很复杂；经济不安全是交易性行为和艾滋病毒感染的一个重要驱动因素，但需要考虑心理社会因素和性别社会规范在干预措施制定中的作用。我们的研究结果表明，针对艾滋病毒感染结构性驱动因素的组合预防干预措施应侧重于努力增加入学率和完成率。
