Men's understanding of three different measures of transactional sex: A cognitive interviewing study among men in Rakai, Uganda.

Lack of valid and reliable measures and inconsistent transactional sex (TS) measurement has resulted in poor understanding of the practice, particularly among men. To improve TS measurement and facilitate comparison across studies, we examined how men comprehend and respond to three common TS measures. We conducted cognitive interviews with 25 sexually active adult men in Rakai, Uganda from November 2021-February 2022 and thematically analysed the data. Most men responded affirmatively to the three TS measures, but there was variation in responses across measures. The two measures that assessed relationship motivation and gendered norms of material provision for sex showed better comprehension and consistency than the measure without these components. For these two measures, a substantial proportion of men responded affirmatively but provided explanations related to gendered expectations of material provision rather than describing provision in a specific relationship which was not the intent of the measures. The measure developed by Wamoyi and colleagues appeared to most accurately measure TS. Our findings support TS measures that include a clear statement of motivation and account for gendered norms of giving and receiving. Given heterogeneity in TS measurement, this study enhances our understanding of common TS measures.