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Background: Transactional sexual behavior has been demonstrated as an important factor underlying the HIV epidemic in sub-Saharan Africa. The aim of this study was to evaluate the relationship between having a history of transactional sexual relationships with condom use and STI risk., Methods: Participants completed a behavioral questionnaire in isiXhosa and provided self-collected vaginal swabs which were tested for Chlamydia trachomatis, Neisseria gonorrhea, and Trichomonas vaginalis. Multinomial logistic regression was used to compare condom use rates and sexually transmitted infection (STI) risk among women with a history of transactional sexual relationships to women with a history of casual sexual relationships and those with no history of casual sexual relationships., Results: Of the 446 respondents, 223 (50%) reported no history of casual sexual relationships, 94 (23.32%) indicated a history of casual sexual relationships, and among these 119 (26.68%) reported a history of transactional sexual relationships with casual partners. Participants with a history of transactional sexual relationships had a higher rate of condom use with a main partner and a lower prevalence of Chlamydia infection than participants with a history of casual relationships. Participants with a history of transactional sexual relationships were also less likely to have had a STI in the past compared with those who indicated no history of casual relationships., Conclusion: These results highlight attempts by women who report participation in transactional sex to use condoms. The results also point to possibly concealed risk to STI and HIV among women who indicate no history of transactional sex., (Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Although new HIV treatments continue to offer hope for individuals living with HIV, behavioural interventions shown to reduce HIV risk behaviour remain one of the most powerful tools in curbing the HIV epidemic. Unfortunately, the development of evidence based HIV interventions is a resource-intensive process that has not progressed as quickly as the epidemiology of the disease. As the epidemic continues to evolve, there is a need to expedite the development of evidence-based HIV interventions for populations that are often disproportionately impacted by HIV/AIDS. One mechanism of accelerating the development process is to adapt evidence-based HIV interventions for vulnerable populations. The aim of this paper was to describe the adaptation process of a HIV intervention for African-American women for black South African Xhosa women. For African-American women the intervention was effective in increasing consistent condom use, sexual self-control, sexual communication, sexual assertiveness and partner adoption of norms supporting consistent condom use.