Roach Mary Anne E, Loeb Talia, Willis Kalai, Sing'oei Valentine, Owuoth John, Crowell Trevor A, Polyak Christina S, Rao Amrita, Baral Stefan, Rucinski Katherine B
Program for Implementation and Equity Research, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA.
HJF Medical Research International, Kisumu, Kenya.
Arch Sex Behav. 2025 Feb;54(2):495-506. doi: 10.1007/s10508-024-03020-2. Epub 2024 Oct 29.
Sexual economic exchanges, including sex work and transactional sex, have been consistently associated with HIV acquisition among young women in sub-Saharan Africa. Heterogeneity in HIV vulnerability across overlapping types of sexual economic exchange has not been sufficiently explored, limiting appropriate and effective linkage to prevention interventions. From January 2017 to May 2018, cross-sectional data were captured at screening for entry into an HIV incidence cohort in Kisumu, Kenya. Men and women aged 18-35 years completed a socio-behavioral questionnaire. Latent class analysis was used to classify sexually active women into discrete groups based on self-identification of occupational sex and other sexual exchanges, including exchange for money, gifts, food, school fees, substances, shelter/rent, and/or clothing. Profiles examined characteristics within and across typologies. Mixed logistic regression models assessed demographic and socio-behavioral characteristics associated with probabilistic class membership. A total of 1063 participants were screened, of whom 536 (50.4%) were sexually active women (median age: 27 years [interquartile range 23-30]). Sexual economic exchange was reported by 403 (77.2%) sexually active women, who most commonly reported recent exchange of sex for money (73.9%), gifts (19.6%), food (25.9%), and substances (17.7%); 44.6% reported selling sex as a primary or secondary occupation. Three profiles of sexual economic exchange were identified, each with distinct demographic, behavioral, and occupational characteristics: exchange for money and other necessities (23.3% prevalence), exchange for primarily money (38.2% prevalence), and sex comprising limited or no exchange (38.4% prevalence). In mixture modeling, as compared to limited or no exchange, exchange for money and other necessities, and exchange for primarily money were both associated with increased age, higher number of partners, and partners at least 10 years older. Heterogeneous patterns of sexual economic exchange were observed among women in Kenya reflect the different motivations and pathways by which women exchange sex. Female sex workers are often considered a homogeneous group, but these data highlight the need for differentiated services based on the diverse needs of women who engage in sexual economic exchange.
性经济交易，包括性工作和交易性行为，一直与撒哈拉以南非洲年轻女性感染艾滋病毒有关。不同类型的性经济交易中艾滋病毒易感性的异质性尚未得到充分探索，这限制了与预防干预措施的适当有效联系。2017年1月至2018年5月，在肯尼亚基苏木对进入艾滋病毒发病率队列的筛查中收集了横断面数据。18至35岁的男性和女性完成了一份社会行为问卷。潜在类别分析用于根据职业性行为和其他性交易的自我认定，将性活跃女性分为不同的组，包括以性交易换取金钱、礼物、食物、学费、毒品、住所/租金和/或衣物。概况分析考察了不同类型内部和之间的特征。混合逻辑回归模型评估了与概率类别成员相关的人口统计学和社会行为特征。总共筛查了1063名参与者，其中536名（50.4%）为性活跃女性（中位年龄：27岁[四分位间距23 - 30]）。403名（77.2%）性活跃女性报告了性经济交易，她们最常报告最近以性交易换取金钱（73.9%）、礼物（19.6%）、食物（25.9%）和毒品（17.7%）；44.6%报告将卖淫作为主要或次要职业。确定了三种性经济交易概况，每种都有不同的人口统计学、行为和职业特征：以性交易换取金钱和其他必需品（患病率23.3%）、主要以性交易换取金钱（患病率38.2%）以及性交易包含有限或无交易（患病率38.4%）。在混合模型中，与有限或无交易相比，以性交易换取金钱和其他必需品以及主要以性交易换取金钱都与年龄增加、性伴侣数量增加以及性伴侣年龄至少大10岁有关。在肯尼亚女性中观察到的性经济交易的异质模式反映了女性进行性交易的不同动机和途径。女性性工作者通常被视为一个同质群体，但这些数据凸显了根据参与性经济交易的女性的不同需求提供差异化服务的必要性。
