School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Genesis Analytics, Johannesburg, South Africa.
AIDS Care. 2024 Jul;36(sup1):179-186. doi: 10.1080/09540121.2024.2307385. Epub 2024 Feb 9.
Transactional sex increases sub-Saharan African women's risk of HIV acquisition. We quantitatively explored the pathways contributing towards women's future engagement in transactional sex with casual partners and khwapheni (secret concurrent sex partners). We conducted secondary data analysis from a cluster randomised controlled trial in urban informal settlements in eThekwini Municipality., South Africa. Data were collected at enrolment (t0) and 24 months' later (t2) using self-completed questionnaires. Structural equation modelling (SEM) assessed pathways leading to transactional sex over two years. 677 women 18-35 years were enrolled and 80.5% ( = 545) were followed up. At t2, 44.6% of respondents reported transactional sex with a casual partner or khwapheni. The SEM demonstrated a small effect (d = 0.23) between transactional sex at t0 and at t2. Controlling for past transactional sex, main partner relationship control had a large effect size on future transactional sex (d = 0.60). Hazardous drinking had a medium effect size (d = 0.45) and food insecurity a small effect (d = 0.24), (RMSEA 0.03, 90%CI 0.02-0.04; CFI 0.97; TLI 0.96). HIV prevention programming should highlight current transactional sex but also address structural issues predicting future transactional sex, including food insecurity and alcohol misuse. Gender transformative interventions to reduce controlling behaviours in main relationships are worth investigating.
性交易增加撒哈拉以南非洲妇女感染艾滋病毒的风险。我们定量探讨了导致女性未来与偶然伴侣和 khwapheni（秘密同时性伴侣）从事性交易的途径。我们对南非埃滕哈赫温市城市非正规住区的一项集群随机对照试验进行了二次数据分析。数据是在注册时（t0）和 24 个月后（t2）使用自我完成的问卷收集的。结构方程模型（SEM）评估了在两年内导致性交易的途径。共有 677 名 18-35 岁的妇女参加了研究，其中 80.5%（=545 人）得到了随访。在 t2 时，44.6%的受访者报告与偶然伴侣或 khwapheni 发生了性交易。SEM 显示，t0 和 t2 之间的性交易存在较小的影响（d=0.23）。控制过去的性交易，主要伴侣关系控制对未来的性交易有较大的影响（d=0.60）。危险饮酒有中等影响（d=0.45），粮食不安全有较小影响（d=0.24），（RMSEA 0.03，90%CI 0.02-0.04；CFI 0.97；TLI 0.96）。艾滋病毒预防规划应重点关注当前的性交易，但也应解决预测未来性交易的结构性问题，包括粮食不安全和酒精滥用。值得研究减少主要关系中控制行为的性别转换干预措施。
