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Introduction: Ulcerative STIs, including syphilis, increase the risk for HIV acquisition and transmission due to the presence of ulcers/chancres that serve as a point-of-entry and exit for HIV. In Zimbabwe, diagnosis of syphilis often occurs in pregnant women who seek ANC services where syphilis testing is offered, and among men and women who seek health care for STIs. Zimbabwe's national syphilis estimates are based on these diagnosed cases, with little information available about the prevalence of untreated syphilis among the general population. This analysis uses data from ZIMPHIA (2015–2016) to describe factors associated with active syphilis among men and women ages 15 years and older. Methods: ZIMPHIA collected blood specimens for HIV and syphilis testing from 22,501 consenting individuals (ages 15 years and older). Household HIV testing used the national HIV rapid-testing algorithm with HIV-positive results confirmed at satellite laboratories using Geenius HIV-1/2 rapid test (Bio-rad, Hercules, California, USA). Point-of-care non-Treponemal and Treponemal syphilis testing was performed using Chembio's Dual-Path Platform Syphilis Screen & Confirm Assay. Factors associated with active syphilis were explored using multiple variable, weighted logistic regression and were stratified by gender. Results: The likelihood of active syphilis in HIV-positive females was 3.7 times greater in HIV-positive females than HIV-negative females (aOR: 3.7, 95% CI 2.3–5.9). Among males odds of having active syphilis was 5 times higher among those that engaged in transactional sex than those who did not have sex or transactional sex (aOR: 5.3, 95% CI 1.9–14.7), and 6 times higher if HIV positive versus negative (aOR: 5.9, 95% CI 3.0–12.0). Urban residence, province, education (highest attended), marital status, number of sex partners, consistency of condom use, pregnancy status (females), and circumcision status (males) were not significant in the adjusted model for either females or males. Conculsion: HIV status was found to be the only factor associated with active syphilis in both females and males. Given the persistent link between HIV and active syphilis, it is prudent to link individuals' diagnoses and treatments, as recommended by the WHO. Enhanced integration of STI and HIV services in health delivery points such as ANC, reproductive services, or male circumcision clinics, combined with consistent, targeted outreach to high-risk populations and their partners, may assist the MOHCC to eliminate active syphilis in Zimbabwe. [ABSTRACT FROM AUTHOR]

Background: Adolescent motherhood is common in South Africa and occurs against a backdrop of high HIV risk. While childbearing during adolescence may result in social and economic strain that may negatively impact health, there has been limited study of whether adolescent motherhood increases the risk of HIV or herpes simplex virus type 2 (HSV-2) acquisition or engagement in high-risk sexual partnerships. Setting: Data are from HIV Prevention Trials Network 068, a longitudinal conditional cash transfer study of adolescent girls and young women (age, 13-23) in rural South Africa. Methods: We used survival analysis to estimate hazard ratios to determine if adolescent motherhood (live birth before 20 years) predicted incident HIV and incident HSV-2 and generalized estimating equations for behavioral risk ratios to determine if adolescent motherhood was associated with transactional sex and age-disparate partnerships. Results: Of 2452 adolescent girls and young women who were HIV negative at baseline, 5% were adolescent mothers; 16% were adolescent mothers by the end of the study period. After controlling for covariates, adolescent motherhood predicted incident HSV-2 acquisition [ adjusted hazard ratios, 1.30; 95% confidence interval (CI): 1.01 to 1.95] but not HIV acquisition (adjusted hazard ratios, 1.19; 95% CI, 0.76 to 1.86). Adolescent motherhood was also associated with being in an age-disparate partnership (adjusted risk ratio, 1.30; 95% CI: 1.07 to 1.58) but not transactional sex. Conclusion: Adolescent motherhood increased the risk of HSV-2 and engagement in age-disparate partnerships, both known risk factors for HIV infection. Sexually transmitted infection screening and/or tailored combination HIV prevention interventions that account for the context of adolescent motherhood are critical to maximize adolescent mothers' long-term health and to meet UNAIDS 95-95-95 targets by 2030. [ABSTRACT FROM AUTHOR]

Introduction: This article explores explanations for attitudes towards the acceptability of transactional sex. The sparse research investigating attitudes towards transactional sex uncovers a link between gender equality, or feminism, and a lack of support for the trade in sex. However, there are no research agendas that attempt to explain variance in attitudes towards transactional sex where support for gender equality is widespread throughout a population. Methods: We estimate regression models utilizing the 2017 Danish Values Survey (Den Danske Værdiundersøgelse) in order to predict views on the acceptability of transactional sex. Results: While the trade in sex is legal in Denmark, we find that a majority of respondents hold negative attitudes towards transactional sex, which conveys a lack of congruence between public opinion and policy. Further, gender is a powerful predictor of attitudes towards transactional sex, with women finding it less acceptable. In addition, the analysis uncovers that general attitudes towards sexual behaviour are the largest predictor of views on the acceptability of transactional sex. That being said, we find that men's views on the acceptability of transactional sex are more of a function of their general attitudes towards sexual behaviour than they are for women. Conclusions: The findings indicate that, unlike men, women appear to differentiate between their attitudes towards general sexual behaviour and their views on sexual behaviour that they may associate with negative societal implications. [ABSTRACT FROM AUTHOR]

Background: Armed conflict and the HIV pandemic are significant global health issues. Evidence of the association between armed conflict and HIV infection has been conflicting. Our objective was to examine the role of mediating risk factors, such as engagement in transactional sex work, to elucidate the relation between armed conflict and HIV infection. Methods: We used multistage sampling across three Northeastern Ugandan districts to randomly select 605 women aged 13 to 49 to answer cross-sectional surveys from January to May of 2016. We used multivariate logistic regression model with R 4.0.3 to examine if exposure to armed conflict has an indirect effect on reporting having an HIV-positive serostatus through engagement in transactional sex work. Age and district residence were included as covariates. Results: Exposure to armed conflict β =.16, SE =.04, p <.05, OR = 1.17, 95% [CI.08,.23] was significantly associated with reporting a HIV-positive serostatus. For each 1-unit increase in exposure to armed conflict (i.e., additional type of armed conflict exposure), there was a 17% increase in the odds of reporting a HIV-positive serostatus. Engagement in transactional sex work was not associated with reporting a HIV-positive serostatus β =.04, SE =.05, p =.37, 95% [CI −.051,.138]. We found district of residence, age, and interaction effects. Conclusions: Although exposure to armed was associated with reporting an HIV-positive serostatus, this relationship was not mediated by engagement in transactional sex. Further research is needed on risk factors that mediate this relationship. The likelihood of reporting a HIV-positive serostatus increased with each additional type of exposure to armed conflict. Thus, screening for exposure to multiple traumatic stressors should occur in HIV prevention settings. Healthcare services that are trauma-informed and consider mental distress would likely improve HIV outcomes. [ABSTRACT FROM AUTHOR]

Although sugaring has become a popular practice in the United States in recent years, there is very little research on the reasons individuals enter into these relationships. The few studies that address what motivates women to begin sugar arrangements primarily focus on transactional sex (TS) in Africa and compensated dating (CD) in Asia. Researchers draw from three main perspectives to understand the reasons females participate in TS and CD which include the "sex for basic needs" paradigm, the "sex for improved social status" paradigm, and the "sex and expressions of love" paradigm. Drawing from 48 in-depth, semi-structured interviews, I explore the motivations that lead women in the United States to begin a sugar arrangement. In so doing, I found that, while these paradigms speak to some of the factors that motivate women in the United States to sugar, the reasons they do so are more varied than these three perspectives suggest. Instead, women participate in sugar relationships for a multitude of reasons which included the hope of obtaining money, material items, sex, companionship, love, mentorship, to relieve boredom, to have fun, and to satisfy their curiosity. [ABSTRACT FROM AUTHOR]

Men's role in transactional sex is relatively unexplored, limiting initiatives to prevent exploitative transactional sex and its negative health implications for girls and women. We addressed this literature gap by conducting eight focus group discussions and twenty in-depth-interviews with boys and men aged 14 − 49 years in 2015 in Tanzania. We employed a novel combination of theoretical perspectives – gender and masculinities, and social norms – to understand how transactional sex participation contributes to perpetuating gendered hierarchies, and how reference groups influence men's behaviour. Findings signal two gender norms that men display within transactional sex: the expectation of men's provision in sexual relationships, and the expectation that men should exhibit heightened sexuality and sexual prowess. Adherence to these expectations in transactional sex relationships varied between older and younger men and created hierarchies among men and between men and women and girls. We found that approval of transactional sex was contested. Although young men were likely to object to transactional sex, they occupied a structurally weaker position than older men. Findings suggest that interventions should employ gender synchronised and gender transformative approaches and should prioritise the promotion of alternative positive norms over preventing the exchange of gifts or money in relationships. [ABSTRACT FROM AUTHOR]

We sought to explore characteristics and risk factors associated with transactional sex in a sample of young black and Latinx sexual minority cisgender men and transgender women of age 15 to 24 years who were living with or at high risk for HIV infection and whether these associations vary by gender identity and HIV status. A total of 454 black and Latinx sexual minority cisgender men and transgender women from Baltimore, MD; Philadelphia, PA; Washington, DC; and St. Petersburg/Tampa, Fl, were recruited to participate in a multisite study that included a 45-minute baseline Web-based survey and HIV-1 rapid testing. Bivariate analysis was used to explore factors associated with transactional sex. Factors significant at p -value <.20 in bivariate analysis were entered into a final logistic regression models; and models were further stratified by gender identity and HIV status. The mean age was 21.3 (standard deviation = 2.5), with 14.7% (n = 65) identifying as transgender, and 103 youth (22.7%) reporting lifetime transactional sex. Transactional sex was associated with transgender identity, recent unstable housing in the last 12 months, poorer perceived financial well-being, coerced sex, and marijuana use. Differences were noted by gender identity and HIV status, with marijuana use associated with transactional sex in cisgender men and unstable housing and sexual coercion in youth living with HIV. Young black and Latinx cisgender men and transgender women are at a high risk for engaging in transactional sex. Transactional sex may create a syndemic for HIV risk exposure through co-occurring and reinforcing conditions of unstable housing, violence, and substance use. [ABSTRACT FROM AUTHOR]

Introduction: The rate of infectious syphilis continues to increase among females in British Columbia (BC) and Canada, raising concerns of increased incidence of congenital syphilis. We characterized syphilis cases among females in BC to identify opportunities to prevent syphilis and optimize its care.Methods: All cases of infectious syphilis diagnosed in BC between March 13, 2018 and December 31, 2020 and reported as female gender were reviewed. Demographics, risk factors and concurrent conditions were collected from a provincial surveillance system. Subgroup analyses comparing cases with and without housing instability, substance use, mental illness and a recent sexually transmitted infection (STI) were conducted to understand differences between these subgroups. Statistical associations were calculated using chi-square or t-tests.Results: There were 226 reported cases of female infectious syphilis in BC during this period: 38 (16.8%) in 2018; 74 (32.7%) in 2019; and 114 (50.4%) in 2020. Mean age was 32 years (range 15-75 years). Of those who reported concurrent conditions, most cases had experiences with housing instability (71.1%), substance use (68.2%) and mental illness (83.9%), while 42.9% had a recent STI. Cases who reported housing instability or substance use were significantly more likely to have experiences with a recent STI, street involvement, transactional sex, mental illness and income assistance (all p<0.01).Conclusion: Our findings highlight the importance of fostering an enabling environment for syphilis care. Concurrent services to support individuals with syphilis as well as housing instability, substance use and mental illness, may help prevent syphilis and improve wellbeing. [ABSTRACT FROM AUTHOR]

Gender-based power imbalances place women at significant risk for sexual violence, however, little research has examined this association among women living with HIV/AIDS. We performed a cross-sectional analysis of relationship power and sexual violence among HIV-positive women on anti-retroviral therapy in rural Uganda. Relationship power was measured using the Sexual Relationship Power Scale (SRPS), a validated measure consisting of two subscales: relationship control (RC) and decision-making dominance. We used multivariable logistic regression to test for associations between the SRPS and two dependent variables: recent forced sex and transactional sex. Higher relationship power (full SRPS) was associated with reduced odds of forced sex (AOR = 0.24; 95 % CI 0.07-0.80; p = 0.020). The association between higher relationship power and transactional sex was strong and in the expected direction, but not statistically significant (AOR = 0.47; 95 % CI 0.18-1.22; p = 0.119). Higher RC was associated with reduced odds of both forced sex (AOR = 0.18; 95 % CI 0.06-0.59; p

Background and Aim: For over 40 years of the HIV/AIDS global epidemic, no effective cure nor vaccine is yet available, making the current control strategies focused on curbing new infections through risk reduction. The study aimed to determine the prevalence of HIV risk factors and their associated socio-demographics among women of reproductive age in Sierra Leone.Methods: We used weighted data from the Sierra Leone Demographic and Health Survey (SLDHS) of 2019 for 12,005 women aged 15-49 years. Multistage sampling was used to select study participants. Exposure to HIV risk factors was considered if a woman reported at least one of the following; having multiple sexual partners, transactional sex, non-condom use for the unmarried, and having other sexually transmitted infections (STIs). We, then, conducted multivariable logistic regression to explore the associated socio-demographics. All the analyses were done using SPSS (version 25).Results: Of the 12,005 women, 38.1% (4577/12005) (95% confidence interval (CI) 37.3-39.0) had at least one of the four risk factors. Women of 15 to 19 years (adjusted odds ratio (AOR) = 1.34, 95% CI 1.00-1.80) and 20 to 34 years (AOR = 1.25, 95% CI 1.05-1.49) had more odds of having HIV risk factors compared to those of 35 to 49 years. Urban residents (AOR = 1.49, 95% CI 1.17-1.89) and those from the Northwestern region (AOR = 1.81, 95% CI 1.26-2.60) were also more likely to encounter HIV risk factors compared to their respective counterparts. Moreover, unmarried women (AOR = 111.17, 95% CI 87.55-141.18) and those working (AOR = 1.38, 95% CI 1.14-1.67) also had higher odds of having HIV risk factors, compared to their respective counterparts. Sex of household head and parity were also significant associates.Conclusions: More than a third of women in Sierra Leone had encountered at least one HIV risk factor, and this was associated with age, place of residence, region, marital status, working status, household head and parity. There is a need for strengthening HIV/AIDS education programs, laws and policies targeting the young, working, unmarried and urban-resident women. [ABSTRACT FROM AUTHOR]

Homelessness is widely recognized as a pervasive issue. Despite increasing research on factors affecting the health and well-being of people who are homeless, one that remains relatively understudied is the role of romantic and sexual relationships. Given that this population has the same needs for intimacy and closeness as anyone else, it is important to understand how these relationships occur, what barriers exist in developing and maintaining them, and what is their impact. This scoping review aimed to (a) characterize the nature of research that has examined sexual and romantic relationships among people who are homeless and (b) identify and synthesize the findings of studies that examined romantic and sexual relationships among people who are homeless. Of 539 studies that examined sexual or romantic relationships among people who are homeless, 88.87% examined sexual health risk, 11.13% examined sexual victimization, 5.57% examined survival sex, and 2.41% examined consensual sexual or romantic relationships. Of the studies that examined consensual sexual or romantic relationships substantially (n = 13) all used qualitative methods and identified common themes such as love, romance, and emotional support; partner relationships as transactional; barriers to partner relationships; and casual sex and pleasure. Despite the possible benefits of sexual and romantic relationships in the context of homelessness, researchers instead have primarily focused on possible risks associated with sex. We introduce how sexual citizenship can be applied to understand how current practices and policies limit people's civic participation when homeless. Public Policy Relevance Statement: Despite the possible benefits of sexual and romantic relationships for people who are homelessness, this review found that researchers instead have overwhelmingly focused on possible risks associated with sex in this population. The few studies that examined consensual sexual or romantic relationships among people experiencing homelessness found that these relationships can be an important source of support through the difficult conditions associated with homelessness. Policymakers and practitioners should consider how their policies and practices may undermine the ability of people experiencing homelessness to develop and maintain consensual, healthy, and supportive, sexual and romantic relationships. [ABSTRACT FROM AUTHOR]

In some Ugandan fishing communities, almost half the population lives with HIV. Researchers designate these communities "HIV hotspots" and attribute disproportionate disease burdens to "sex-for-fish" relationships endemic to the lakeshores. In this article, we trace the emergence of Uganda's HIV hotspots to structural adjustment. We show how global economic policies negotiated in the 1990s precipitated the collapse of Uganda's coffee sector, causing mass economic dislocation among women workers, who migrated to the lake. There, they entered overt forms of sex work or marriages they may have otherwise avoided, intimate economic arrangements that helped to "engineer the spread of HIV," as one respondent recounted. [ABSTRACT FROM AUTHOR]

Cash transfers are theorised to reduce adolescent girls and young women's economic vulnerability and engagement in transactional sex; however, the processes involved remain unclear. We conducted longitudinal cross-sectional, and narrative timeline in-depth interviews with young women aged 15–23 years in northern Tanzania enrolled in a cash transfer intervention. We analysed data using a thematic approach guided by the transactional sex framework. We summarised data and compared findings to the domains of the framework. Participants reported relationships in the 'sex and material expression of love' domain characterised by emotional intimacy and loose ties between material support and sex, and the 'sex for basic needs' domain characterised by limited emotional intimacy, economic vulnerability, and a clear exchange between material support and sex. Some participants expressed that cash transfers provided business capital and savings which enabled them to decrease 'sex for basic needs'. Cash transfers influenced transactional sex engagement by altering partner selection criteria such as from an emphasis on what men could provide to a focus on relationship stability. Findings suggest that cash transfers have the potential to reduce young women's transactional relationships motivated by economic vulnerability. [ABSTRACT FROM AUTHOR]

Sugar dating is a by and large new and growing phenomenon within the sex and intimacy industry, centred on web sites tailored to facilitating the practice. The phenomenon overlaps significantly with prostitution but is marketed as something else. In this article, based on interviews with 15 "sugar babies" and 9 "sugar daddies" with experience of heterosexual sugar dating, we investigate the strategies that sugar daters use to demarcate their experiences from prostitution. We show that both the women and the men carry out a linguistic and practical "relational work" serving to dissociate sugar dating either from prostitution as such or from what the interview participants regarded as real prostitution. The relational work pivots around five central themes: how the compensation is labelled, how the compensation is carried out, the woman's sexual voluntariness, mutual pleasure, and dating similarity. We contend that the interview participants' distancing from prostitution may be interpreted not only as a way of fending off associations with a stigmatized practice, but also as an expression of the fact that the interview persons have charged conceptions of prostitution that they have difficulties aligning with their own experiences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the factors that managers in independent hotels can influence to improve organisational citizenship behaviour (OCB) by examining the relationship between leadership style and OCB through newly developed balanced organisational culture and trust variables. Unlike most studies, which have been on chain hotels, this study investigates these relationships in independent hotels in Iran. Additionally, organisational size was also included in the study. Design/methodology/approach: Using information from Ministry of Cultural Heritage, Handicrafts and Tourism, 160 independent hotels were identified and approached. A survey was assembled using well-known instruments. In total, 392 usable questionnaires out of 1,150 distributed were collected from employees and analysed using structural equation modelling. Findings: Contrary to previous studies, it was found that in this context, neither transformational nor transactional leadership affects trust directly but only through balanced organisational culture, and only transactional leadership had a direct relationship with OCB. Also, organisational size had a moderating effect on the relationship between trust and OCB. Originality/value: The authors add to the theoretical literature dealing with the different behaviour of constructs developed in a Western context in other contexts and suggests that hotel managers in a collectivist culture, like Iran, who want to build OCB can do so by creating organisational culture conditions (Balanced Organisational Culture) that foster trust between managers and their subordinates. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, the number of homeless girls and women is increasing, and the government has yet to devise a strategy to address the issue of teenage homelessness. They are influenced by numerous dimensions of health, including physical health, mental health, and social isolation. At all stages of homelessness, the stakeholders and homeless people must work together to address the issue. As a result, this study will be helpful to generate relevant data that may guide policymakers in designing solutions for this underserved group of people. Objectives: To explore coping mechanisms and suggestions to stakeholders among women experiencing homelessness in Dire Dawa city, eastern Ethiopia, 2021. Design: A community-based phenomenological qualitative study was conducted at Dire Dawa city. Methods: Data were collected from women experiencing homelessness and key informants through focus group discussion and in-depth interviews using a semi-structured tool. A total of 31 women experiencing homelessness (13 in-depth interviews and 3 focus group discussion with 6 participants in each) and 2 key informants participated in this study. Data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti 7. The thematic analysis follows six steps: familiarization, coding, generating themes, reviewing themes, naming themes, and writing up. Results: Two major themes were driven: coping mechanisms and suggestions to stakeholders. There are three subthemes under the coping mechanism (begging, survival sex, and child prostitution) while there are a total of seven subthemes under suggestions to stakeholders (integration and collaboration, special attention to children, family education, shelter and job, schooling, sexual education, and addiction rehabilitation). Conclusion: Child prostitution and survival sex are a very common coping mechanism which is practiced by women experiencing homelessness. Changing society’s mindset and paying special attention to children is critical. Furthermore, the government and various stakeholders should work together to develop a rehabilitation program for street children who have been exposed to substance use. [ABSTRACT FROM AUTHOR]

In understanding conflict-related sexual violence (CRSV), the notion of how sexuality and sex are naturally linked to power is gaining traction in IR discourses. There is, however, little contextual or empirical evidence that accounts for the various forms of CRSV against men, or how offenders exploit power dynamics in conflict and post-conflict settings to achieve their sexual desires. As a result, we rely on ethnographic accounts from survivors/victims, NGO workers, and security personnel on the front lines of the counter-terrorism campaign in the Lake Chad basin, particularly in North-eastern Nigeria. Long-term terrorist violence, we argue, creates material imbalances in men and boys and increases their vulnerabilities, providing platforms for individual perpetrators to exploit their vulnerable status or engage in sex-trafficking rings to satisfy their sexual urges. Therefore, this article adds conceptually and empirically to the nature and motivations of wartime sexual violence, as well as the gendered dynamics of armed conflict. It challenges the popular masculinist notion that men are immune to sex trafficking and sexual violence. The study emphasises the importance of effective IDP camp management and prosecution in preventing would-be offenders. [ABSTRACT FROM AUTHOR]

Background: Adolescent girls and young women across sub-Saharan Africa are at disproportionate risk of HIV infection compared to their male counterparts. Transactional sex has been identified as an important proximate risk for infection in this population. Definitions and measures of transactional sex vary, necessitating improved measures to better estimate prevalence across settings, over time, and to understand the mechanisms through which transactional sex increases HIV risk. This article describes the results of cognitive interviews in rural KwaZulu-Natal in South Africa to evaluate the performance of an improved measure of transactional sex. Methods: Data were collected between May and June 2017 with sexually active adolescent girls and young women (n = 10) and men (n = 10) drawn from a general population sample. Two questions were tested. Audio-recorded interviews were conducted in isiZulu using a structured tool. Matrices were used to summarise the data across participants which were then compared using constant comparative techniques. Results: Participants captured the instrumental nature of transactional sex relationships clearly and understood that the questions were about relationships that were primarily motivated by benefit. However, despite prior qualitative research in this setting describing transactional sex as widely practised, only one male participant answered either question in the affirmative in this face-to-face interview. This implies a judgement placed on relationships that are deemed as having been motivated mainly by exchange, perhaps compelling people to under-report such relationships. Conclusion: Participants' unwillingness to answer in the affirmative highlights the importance of understanding the research context and the possible social and historical influences which may influence how survey questions are answered. This has implications for measurement development, and highlights the need for measures that can be responsive to contextual differences. Further research is needed for refinements to measurement approaches in this and other settings. [ABSTRACT FROM AUTHOR]

Background: The United Nations Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) has been marred by widespread allegations of sexual exploitation and abuse (SEA) of women and girls by UN peacekeepers. There is minimal research conducted on the perceptions of communities most affected by the SEA themselves, and even less about those below the age of 18. Methods: Using mixed-methods data, we examined the perceptions of adolescents aged 13–17 on how the lives of women and girls have been affected by the presence of UN peacekeepers within the DRC. SenseMaker, a mixed-methods narrative capture tool, was used to survey participants around six United Nations bases across eastern DRC. Each participant shared a story about the experiences of Congolese women and girls in relation to MONUSCO personnel and interpreted their own stories by answering a series of questions. Patterns of adolescent perspectives (aged 13–17) were analyzed in comparison to all other age groups and emerging qualitative themes were mapped onto quantitative variables. Results: Quantitative data showed that adolescents were more likely, in comparison to all other age groups, to perceive interactions between peacekeepers and women/girls as being initiated by the woman/girl, that the MONUSCO personnel was perceived to be able to offer protection, and that the interactions between local women/girls and peacekeepers were sexual in nature. Three qualitative themes emerged: poverty bringing peacekeepers and women/girls together, material/financial gain through transactional sex and sex work, and support-seeking actions of affected women/girls. Conclusions: Our mixed methods data illustrate the problematic finding that adolescents facing poverty may perceive SEA as protective through the monetary and material support gained. These findings contribute to the growing body of literature on peacekeeping economies and have implications for the prevention of, and response to, peacekeeper-perpetrated SEA. [ABSTRACT FROM AUTHOR]

Background The aim of this research was to determine the prevalence and characteristics of youths having ever exchanged sex and to assess if there were differences depending on whether they had done it once or several times. We also investigated what they exchanged sex for and their relationship with the last person they did it with. Methods A cross-sectional national survey was carried out in Switzerland in 2017 among young adults. The 5175 participants (51% males, mean age 26.3years) who answered the question 'Have you ever received something or obtained an advantage in exchange for a sexual act?' were divided into three groups: Never (96.8%), Once (1.5%) and Several (1.7%). Results In the multivariate analysis, compared to the Never group, those in the Once group were significantly more likely to be males, to have a poor mental health, to be non-exclusively heterosexual and to have had 10+ lifetime sexual partners. Those in the Several group reported the same characteristics, but were also more likely to be younger at first sexual contact, to have their parents not living together, to report a lower socioeconomic status and a history of sexual abuse, and to have ever sent sexual images/videos of themselves. They were also less satisfied with their financial situation. Conclusions Results indicate that transactional sex is a reality for some youths in Switzerland, and health professionals dealing with them should include this question in their sexual anamnesis. From a public health perspective, sexual education and prevention campaigns should include this phenomenon. [ABSTRACT FROM AUTHOR]

Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6months until July2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex. Conclusions More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men. [ABSTRACT FROM AUTHOR]

Abstract Background Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited. Methods In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex. Results Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P

Abstract Background There are limited data globally on HIV in men who engage in casual and transactional sex with female tourists. Methods In 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey. Results We recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women. Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists. The prevalent infections were: HIV, 0.3% (95% CI 0.0–0.4%); syphilis, 0.5% (0.0–1.2%); herpes virus type-2, 5.0% (2.5–7.5%). Conclusions There are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual female population in Sri Lanka. More research is needed in South-East Asia on men who trade sexual services to female and male tourists.

Background: Sexual relationship between young women and older men is a major contributor to women’s risk of HIV/AIDS and other sexually transmitted infections (STIs). This study assessed the knowledge, attitude, and behavioural intentions for intergenerational sexual relationships (IGS) among young female students in Nigeria. Methods: We conducted study between July and August 2018 using a descriptive cross-sectional design. Using convenience sampling method, we selected 160 young female students enrolled in a Joint Universities Pre-Degree Educational Programme in a Nigeria university. For data collection, we employed a self-report questionnaire. Data were analysed by use of a Chi-square test. Alpha was set at 5%. Results: The study revealed that 60% of the respondents had a moderate level of knowledge regarding IGS. More than half (56.3%) of the respondents had indifferent attitudes towards IGS. About two-thirds (62.5%) of the respondents had a moderate level of behavioural intentions. The main motive of young girls for IGS was to get money and gifts (83.8%). There was a significant association between monthly stipend (P≤0.0001), level of knowledge (P≤0.0001), attitude (P≤0.0001), and overall behavioural intentions to practice IGS among the students. Conclusion: The study concluded that female students had a moderate level of behavioural intentions to practice intergenerational sexual relationships. There is a need for appropriate health interventions that will address both present and future engagement in intergenerational sexual relationships among young women and prevent negative health outcomes from unsafe sex among this age group.

Abstract Background Definitions of child sexual exploitation vary. Sexual exploitation violates children’s rights and exposes them to mental and physical harm. There exist differences in views of behaviour that is considered exploitative, including transactional sex. This paper explores community perspectives on the extent to which transactional sex is considered exploitative. Methods In 2014, we conducted 19 focus group discussions and 44 in-depth interviews with young people and adults in two communities in Uganda. Participants were presented with vignettes describing sexual encounters between adolescent girls and young women and men to explore under what conditions participants considered the scenario to be exploitative and why. Interviews were conducted in Luganda using a semi-structured tool, audio recorded and transcribed verbatim. Analysis was thematic and complemented by constant comparison and deviant case analysis techniques. Results Definitions by multilateral, bilateral, and non-governmental organisations of the sexual exploitation of children shared similarities with community conceptualisations of wrong or unfair sex. Although in community conceptualisations there was no consensus on what constituted sexual exploitation, transactional sex was condemned to the extent to which it involved sex with a minor or misled a naïve or immature girl; involved lack of consent, particularly in relationships characterised by power differentials; or worsened the pre-existing status of the girl. Also relevant was the extent to which a man’s intentions were considered inappropriate; the adolescent girl or young woman was considered vulnerable; and the adolescent girl or young woman was considered responsible for ‘her situation’. Conclusions Existing social norms that condemn sex with a minor or sex that involves deception, sexual coercion or misleading an immature girl, present opportunities to mobilise communities to protect adolescent girls and young women at risk. Any intervention must, however, be designed with full cognisance of the social and structural drivers that underlie transactional sex and limit adolescent girls’ and young women’s opportunities to provide for themselves without recourse to sexual relationships with men. Interventions must also be designed to recognise that girls in transactional sex relationships may not consider themselves as exploited, thus requiring engagement with them based on their own concerns, aspirations, and expectations.

Abstract Background Adolescent pregnancy has been a persistent area of interest and concern in the field of public health. The debate about adolescents’ sexual risk behaviour has also gained prominence due to findings that have demonstrated that adolescent girls between 15 and 19 years of age give birth to 16 million infants and account for 62% of new HIV infections in the Caribbean and African regions. Health compromising behaviours often develop in adolescence, yet the sexual and reproductive health of adolescent mothers is often marginalised in the healthcare field. The aim of this study was to explore adolescent mothers’ understanding of sexual risk behaviour. Methods The study employed a descriptive qualitative design. To collect the data, four focus group discussions were conducted with adolescent mothers aged 16–19 years. The eighteen adolescent mothers were recruited using purposive sampling technique from a hospital in the Ugu district in KwaZulu-Natal, South Africa. Data were analysed using thematic analysis. Results The study revealed that decisions to engage in risky sexual behaviour is influenced by peer pressure, drugs and alcohol, sexual experimentation, myths about contraception, the media, poor parental supervision and power gender dynamics, poverty leading to transactional sex, the vulnerability of young girls, and the fear of partner rejection. Conclusion The findings of this study will contribute to a better understanding of adolescent mothers’ perspectives of sexual risk behaviour. In the subject matter of sexual and reproductive health, adolescents’ autonomy with respect to cultural and social recommendations should not be sidelined. Due to their vulnerability, adolescent women are exposed to transactional sex, and it is particularly due to poverty that adolescent women are driven into sexual relations with older men as a means of survival. Moreover, interventions to curb postpartum sexual risk behaviour are important to protect adolescent women and mothers against HIV/AIDS. The sexual and reproductive education of adolescent women should focus on resilience, negotiating skills, and protective decision making. Collaborative efforts to curb sexual risk taking by young women should be encouraged and should involve relevant agents from the educational, social and clinical fields.

Abstract Background Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60.0% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices. Method A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18–49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson’s chi square test and logistic regression. Results Out of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7–38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n = 187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p

Background: Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China., Objective: This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China., Methods: We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence., Results: A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95% CI 1.22-9.64) in the past 6 months., Conclusions: This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS., (©Hang Hong, Xiaojun Shi, Yuhui Liu, Wei Feng, Ting Fang, Chunlan Tang, Guozhang Xu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection., Objective: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients., Methods: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted., Results: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam., Conclusions: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention., (©Tiffany R Phillips, Christopher K Fairley, Kate Maddaford, Anna McNulty, Basil Donovan, Rebecca Guy, Ruthy McIver, Rebecca Wigan, Rick Varma, Jason J Ong, Denton Callander, Gabrielle Skelsey, Mish Pony, Dylan O'Hara, Jade E Bilardi, Eric PF Chow. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 20.05.2024.)

And, for those whom Koch features in the book, their path into and through sex work is done with considerable agency, sometimes aspiration, and often pride - in the "healing" work they are doing for the needy men they serve. Certainly, the gendering of the economy skews toward men and continues to disadvantage women: what, according to Koch's analysis, is the primary motivation for sex workers to enter what they perceive as just a temporary, ordinary, job to make better money?. [Extracted from the article]

Researchers have been moving toward understanding sex workers as agentic and career-based social actors for some time. However, while these modern sex work lenses are readily applied to a variety of high-end and emerging forms of sex work, the field has often been reluctant to frame impoverished and potentially exploitative sex work in the same manner. Here, I ask whether and how the frameworks of "agency" and "career" can be applied to a population of poor male-identified survival sex workers. I use data from an innovative mixed-methods community-based approach that yields a broad sample of majority African American male survival sex workers from a large US city. I argue that by privileging respondents' own interpretation of their lives, it is possible to construct a nuanced understanding of sex work as a "career" and to conceive of their work as both a profession and a source of disadvantage. I conclude that we should continue to focus on the voices of sex workers themselves in defining what sex work means and how it affects their lives. [ABSTRACT FROM AUTHOR]

This article examines the blesser phenomenon in South Africa, which gained rapid popularity in 2016. A large body of research exists that reveals that transactional sex is a significant theme within the phenomenon of blesser and blessee relationships. Scholarship has demonstrated that transactional sex has contributed to an increase in human immunodeficiency virus infection rates, especially amongst women aged 15-24 years, as well as a concerning increase in teenage pregnancy. Whilst these are dire realities of blesser--blessee relationships, the one that is most concerning in the current climate in South Africa is the increase in gender-based violence (GBV), intimate partner violence (IPV) and femicide. Therefore, this article concerns itself primarily with this epidemic as it seeks to demonstrate how the blesser phenomenon contributes to GBV and IPV. Blessees are the young women in the blesser--blessee relationships who experience trauma and shame because of the violence and abuse inflicted on them by the older male blessers. The article argues that the church should be seen to be taking decisive action in addressing the scourge of GBV and IPV. The narrative approach is used to give the blessees the opportunity to share their stories. By applying the techniques of narrative therapy, positive deconstruction and the art of holy listening, the study reaches its key outcome: to offer to the church a framework for a pastoral care and healing methodology to help our sisters in Christ to experience healing and to move from shame to self-worth. [ABSTRACT FROM AUTHOR]

Purpose: Drawing on the self-determination and conservation of resources theories, as well as the transactional theory of stress, this paper aims to develop and empirically test a research model depicting the interrelationships of sense of calling, emotional exhaustion (EXH), intent to remain with the organization (IRO), task-related pro-environmental behavior (PEB) and non-green behavior (NGB). Design/methodology/approach: Data came from hotel employees with three waves of one-week time lag and their direct supervisors in China. The authors assessed these linkages through structural equation modeling. Findings: Sense of calling mitigates EXH and NBGs, while it fosters IRO and task-related PEBs. EXH partly mediates the influence of sense of calling on NGBs. Practical implications: It is important to maintain a workplace in which employees foster their work competence, possess a more positive interpretation of work meaning and accomplish their career goals. Management should organize environmental training programs that would compel employees to pay attention to the protection of nature and scarce resources and enable them to be involved in the environmental sustainability process. Originality/value: A search made in the hospitality and tourism literature shows that few studies have investigated the consequences of employees' sense of calling. The authors' search also highlights the void that little is known about the mechanism linking sense of calling to green and non-green outcomes. [ABSTRACT FROM AUTHOR]

We explored transactional sex and relationships (TSR) among South African adolescent girls and young women (AGYW) using (1) survey data from 4,399 AGYW aged 15–24 years, and (2) qualitative data from 237 AGYW and 38 male peers. Ten percent of sexually active AGYW reported having ever had transactional sex; 14% reported having stayed in a relationship for money or material items. Factors associated with higher reporting of TSR included HIV positivity, higher food insecurity, and alcohol use. Those AGYW who were between the ages of 20–24 years (OR: 1.0; 95% CI: 0.81–1.24), had a sexual partner older than her by 5 years or more (OR: 1.89; 95% CI: 1.58–2.26), and had a transactional relationship in the past (OR: 61.1; 95% CI: 47.37–78.76) were more likely to report having transactional sex. AGYW qualitative narratives included both assertions of agency in choosing to engage in TSR, and power inequities resulting in condomless sex. Our findings can inform interventions to addressing transactional sex and relationships, critical to South Africa's HIV response. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed associations between recent transactional sex (TS) and potential determinants and variations in patterns across two geographic regions with high HIV burden compared to the rest of Uganda, among adolescent girls and young women (AGYW). Methods: In 2015, a nationally representative cross-sectional household survey was conducted in Uganda. A stratified multi-stage cluster sample design produced nationally representative estimates and sub-national estimates for AGYW in two high HIV burden regions, DREAMS Central 1 (Bukomansimbi, Ssembabule, and Rakai districts) and DREAMS Central 2 (Mubende, Mityana, Gomba, and Mukono districts), and the rest of Uganda. To identify associations between recent TS (defined as sex in the past 12 months in exchange for material support or help) and risk factors, multivariable logistic regressions were conducted. Interaction terms assessed the associations between violence and recent TS across geographic regions. Results: Nationally, 14.2% of sexually active AGYW engaged in recent TS. Region-specific significant associations emerged between recent TS and marriage, family wealth, friendship, orphanhood, and sexual debut. In DREAMS Central 1 and 2, AGYW who witnessed violence in the home or community, or experienced sexual, physical, or emotional violence had higher odds of recent TS than AGYW who did not experience that form of violence (adjusted odds ratio ranged between 2.10 (95% CI, 1.07, 4.13) and 8.25 (95% CI, 3.40, 20.06)). The magnitude of association between recent TS and types of violence varied by region. Conclusions: Violence is strongly and consistently associated with recent TS, and patterns in prevalence and risk factors vary across regions in Uganda. Given the high risk of HIV association with recent TS, HIV epidemic control efforts may benefit from focus on comprehensive violence prevention and target persons who engage in TS. Comprehensive HIV prevention programming aimed at keeping AGYW HIV-negative should incorporate prevention of violence and TS as key components to facilitate HIV epidemic control in this vulnerable population. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the various topics within the issue, including gender inequality, gender-based violence, and transactional sex.

Current estimates suggest there are between 800,000 and 2 million-plus individuals in Thailand that are currently selling sex and/or sexual services. Previous literature has shown that attitudes held towards individuals who sell sex (ISS) can have a significant impact on their day-to-day lives. Further, foreigners in Thailand are exhibiting increasing financial and social power in the country. Given this impact, it stands to reason that greater understanding of attitudes held by the growing population of foreigners in Thailand may have important implications worthy of further focus in both research and clinical settings. The current study examined the attitudes of 224 self-identified foreigners currently residing in Thailand towards ISS in the country. Results indicate significant differences in attitudes based on the gender of the participant, the gender of the individual selling sex, and whether participants had previously purchased sex in the country. Overall, men who have previously purchased sex reported a significantly more positive attitude towards ISS in Thailand when compared to women and men who had not previously purchased sex. Further, attitudes differed based on the gender of the individual selling sex. For instance, transgender individuals who sell sex were significantly more likely to be perceived as enjoying their work when compared to women and men who sell sex in Thailand. Ultimately, these results can help inform future awareness and educational interventions targeted at foreigners in Thailand to reduce violence and abuse of ISS in the country. [ABSTRACT FROM AUTHOR]

This article describes a novel virtual participatory action research (VPAR) approach to engaging youth who trade sex in Minnesota. The Minnesota Youth Sex Trading (MYST) Project switched to an entirely virtual format due to the COVID-19 pandemic. As part of an intergenerational team, Millennial and Generation Z researchers created a research-brand using technical marketing skills and knowledge of online youth culture to engage youth and other stakeholders in the project. This approach centered trust-building, accountability, transparency, and authenticity to build an online community and increase connection with marginalized young people via Instagram. Responding to COVID-19 and social uprisings, we have adapted our engagement strategies in ways that contain valuable insights into young people's engagement in research. This article illuminates promising VPAR principles to engage youth online as experts in prevention, intervention, and wellness promotion, yielding important new insights about the future of engaged research. [ABSTRACT FROM AUTHOR]

A sugar relationship is a monetary-based liaison between a wealthier older and an attractive younger person, the latter receiving expensive gifts or financial compensation in exchange for her or his sexual companionship. Attachment, motivation, and self-esteem are all integrative parts of adult romantic and sexual relationships. There is relatively little empirical research on the psychological correlates of accepting attitudes toward sugar relationships. The research aimed to explore the relationship among the acceptance of sugar relationship, attachment (avoidance and anxiety), motivation (extrinsic and intrinsic), and self-esteem. A total of 2,409 Hungarian adults including 1,980 younger participants (1,804 women, 175 men, mean age = 21.17) and 429 older participants (290 men, 138 women, mean age = 48.86) completed an online test battery comprising four self-report measures. In the younger subsample, the only significant association obtained for the acceptance of sugar relationships was its positive correlation with extrinsic motivation. In the older subsample, the acceptance of sugar relationships was positively correlated with all tested variables except self-esteem. Subsequent analysis revealed that attachment avoidance but not anxiety moderated the associations between the variables. Among younger participants, the negative effect of self-esteem and intrinsic motivation on accepting sugar relationships decreased with increasing attachment avoidance. Among older participants, the positive effect of extrinsic motivation on accepting sugar relationships decreased with increasing attachment avoidance. The results are discussed with regard to relational and sexual goals associated with adult attachment orientations. [ABSTRACT FROM AUTHOR]

The gay-for-pay genre of gay pornography often utilizes inauthentic narratives, situations, or settings to indicate its male performers are heterosexual and partaking in on-camera gay sex strictly for remuneration. Poverty gay-for pay, a lesser-known gay pornographic subgenre, is devoid of the contrivances and modelesque men who populate mainstream gay-for-pay porn. Instead, it fetishizes elements of the tangible destitution experienced by the ordinary Joe male performers, such as homelessness and past incarceration, used to leverage gay sex acts from typically heterosexual men. The following paper is a reading of the visual and textual content of the poverty gay-for-pay pornographic websites Gemini Men and Workin' Men XXX. Informed by previous literature, the current article discusses the unique multimodal messages employed by each studio to suggest the male performers are authentically heterosexual. Studio history, online media content (text, photos, video, audio), and featured performers are reviewed. Based on this examination, three distinctive methods used by the poverty gay-for-pay subgenre to code the male performers as genuinely heterosexual are discussed: (1) survival sex; (2) the father figure; and (3) reversal of power dynamics. The implications for the existence of this subgenre of gay pornography are examined. [ABSTRACT FROM AUTHOR]

A sugar relationship is a monetary-based liaison between a wealthier older and an attractive younger person, the latter receiving expensive gifts or financial compensation in exchange for her or his sexual companionship. Attachment, motivation, and self-esteem are all integrative parts of adult romantic and sexual relationships. There is relatively little empirical research on the psychological correlates of accepting attitudes toward sugar relationships. The research aimed to explore the relationship among the acceptance of sugar relationship, attachment (avoidance and anxiety), motivation (extrinsic and intrinsic), and self-esteem. A total of 2,409 Hungarian adults including 1,980 younger participants (1,804 women, 175 men, mean age = 21.17) and 429 older participants (290 men, 138 women, mean age = 48.86) completed an online test battery comprising four self-report measures. In the younger subsample, the only significant association obtained for the acceptance of sugar relationships was its positive correlation with extrinsic motivation. In the older subsample, the acceptance of sugar relationships was positively correlated with all tested variables except self-esteem. Subsequent analysis revealed that attachment avoidance but not anxiety moderated the associations between the variables. Among younger participants, the negative effect of self-esteem and intrinsic motivation on accepting sugar relationships decreased with increasing attachment avoidance. Among older participants, the positive effect of extrinsic motivation on accepting sugar relationships decreased with increasing attachment avoidance. The results are discussed with regard to relational and sexual goals associated with adult attachment orientations.

Since 2015, young urban black women in South Africa have been posting images of luxury items on social media platforms such as Instagram. These women claim that their luxury items are gifts from their ‘blessers’/wealthy men in exchange for sex and companionship. This has led to the rise of the ‘blesser culture’ on social media and the prevalence of transactional sex for upward mobility and status. This article provides a post-colonial feminist evaluation of 10 young black women from northern Johannesburg. It examines their motivations for engaging in these relationships. It draws from Stoebenau et al.’s (2016) theoretical framework that describes the three paradigms of transactional sex, ‘sex for basic needs,’ ‘sex for upward mobility and status’ and ‘sex and material expressions of love’ as a continuum of deprivation, agency, and instrumentality. This analysis challenges research frameworks that limit transactional sex to matters of HIV/AIDS transmission, and the framing of women as powerless victims of men. The article reveals these women seek blessers based on relative deprivation, to access a more high-status lifestyle and upward social mobility and from a position of agency. They view blesser relationships as a mutually beneficial exchange that allows them to give sex to access the commodities of modernity.

Gay and bisexual men (GBM) who report engagement in transactional sex are at increased risk for HIV acquisition. The current study aimed to assess the prevalence of transactional sex and its association with demographic characteristics, social marginalization, HIV sexual risk behaviors, psychosocial health problems, and access to healthcare services among a multi-site sample of GBM in Nigeria. Bivariate and multivariable logistic regression were used to examine factors associated with engagement in transactional sex in the previous 3 months. More than a third (39.6%) of the participants reported engagement in transactional sex in the previous 3 months. In the multivariable model, factors associated with engagement in transactional sex included: reporting a monthly income of 30,000 Naira [adjusted odds ratio (aOR) 1.98; 95% CI: 1.12 to 3.35], compared to 30,000 or more Naira monthly income, reporting 4 or more receptive anal sex acts in the previous 30 days (aOR 2.45; 95% CI: 1.31 to 4.57) compared to reporting none, and having depressive symptoms (aOR 1.82; 95% CI: 1.06 to 3.14). There is an urgent need for interventions that address the economic disenfranchisement and psychosocial problems experienced by GBM in Nigeria, which has implications for sexual health. [ABSTRACT FROM AUTHOR]

The article presents the findings of the SEXHUM project studying the impact of the different policies targeting migrant sex workers in Australia, France, New Zealand, and the United States. It draws on the concept of sexual humanitarianism, referring to how neoliberal constructions of vulnerability associated with sexual behaviour are implicated in humanitarian forms of support and control of migrant populations. Based on over three years of fieldwork we examine the differential ways in which Asian cis women and Latina trans women are constructed and targeted as vulnerable to exploitation, violence and abuse, or not, in relation to racialized and cis-centric sexual humanitarian canons of victimhood. Through our comparative analysis we expose how the implication of sexual humanitarian rhetoric in increasingly extreme bordering policies and interventions on migrant sex workers impacts on their lives and rights, arguing for the urgent need for social reform informed by the experiences of these groups. [ABSTRACT FROM AUTHOR]

Objectives: We sought to review the literature on the access experiences and attitudes toward abortion among youth experiencing homelessness in the United States. Methods: We conducted a systematic review of peer‐reviewed literature published from 2001 to 2019. We included qualitative studies involving US participants that focused on access experiences, views, or accounts of unintended pregnancy and/or abortion among youth experiencing homelessness. We excluded studies published before 2001 as that was the year mifepristone medication abortion was made available in the US and we aimed to investigate experiences of access to both medical and surgical abortion options. Results: Our thematic analysis of the data resulted in five key themes that characterize the abortion attitudes and access experiences of youth experiencing homelessness: (1) engaging in survival sex and forced sex, (2) balancing relationships and autonomy, (3) availability does not equal access, (4) attempting self-induced abortions using harmful methods, and (5) feeling resilient despite traumatic unplanned pregnancy experiences. Conclusions: Youth experiencing homelessness experience barriers to abortion access across the US, including in states with a supportive policy context and publicly funded abortion services. In the absence of accessible services, youth may consider harmful methods of self-induced abortion. Improved services should be designed to offer low-barrier abortion care with the qualities that youth identified as important to them, including privacy and autonomy. [ABSTRACT FROM AUTHOR]

Mozambique has one of the highest burdens of HIV in the world, where the prevalence is estimated at 13.2% among adults aged 15–49 years. Men who pay for sex (MPS) are considered a bridging population for HIV infection. However, the characteristics of MPS in Mozambique are poorly understood. The objective of this study was to estimate the prevalence of paid sex among men 15–49 years and investigate risk factors associated with paid sex. We analyzed data collected from 4724 men, aged 15–49 years, as part of the 2015 Mozambique AIDS Indicator Survey. Chi-squared tests and logistic regression models accounting for survey design were used to assess the associations between paying for sex and demographic characteristics and the number of lifetime and recent sex partners, condom use at last sex, and self-reported sexually transmitted infection symptoms. The prevalence of paid sex in the last 12 months was 10.4% (95% CI 9.0–12.1), with Cabo Delgado province having the highest prevalence (38.8%). MPS in the last 12 months were most frequently between the ages of 20–24 years (13.5%), not in a relationship (17.8%), had a primary education (11.9%), from poor households (14.0%), had more than three sexual partners excluding their spouse in the last 12 months (44.7%), and self-reported a STI in the past 12 months (44.2%). HIV prevalence was higher among men who ever paid for sex compared with men who did not (13.1% vs. 9.4%, p =.02). Men who reported 10+ lifetime partner (aOR 7.7; 95% CI 4.5–13.0; p <.001), from Cabo Delgado (aOR 4.0; 95% CI 2.2–7.4; p <.001), who reported STI symptoms in the past 12 months (aOR 2.7; 95% CI 1.7–4.2; p <.001), and HIV positive (aOR 1.6; 95% CI 1.0–3.7; p =.05) were more likely to have paid for sex in the last 12 months. These findings present the HIV prevalence among Mozambican MPS and highlight the need for a comprehensive behavioral, structural, and biomedical approach to interventions to reduce the risks of commercial and transactional sex. [ABSTRACT FROM AUTHOR]

HIV prevention needs among urban refugee and displaced youth engaged in transactional sex are understudied. We examined associations between transactional sex and the HIV prevention cascade among urban refugee/displaced youth in Kampala, Uganda. We conducted a cross-sectional survey with a peer-driven sample of refugee/displaced adolescent girls and young women (n = 324) and adolescent boys and young men (n = 88) aged 16–24 living in Kampala's informal settlements. We conducted gender-disaggregated multivariable linear and logistic regressions to examine associations between past 12-month transactional sex and: lifetime HIV testing, condom self-efficacy, and recent [past 3-month] consistent condom use. Among the 27% of young women reporting transactional sex, 63% reported HIV testing. In multivariable analyses with young women, transactional sex was associated with higher condom self-efficacy, increased consistent condom use, but not HIV testing. Among the 48% of young men reporting transactional sex, 50% reported HIV testing. In multivariable analyses with young men, transactional sex was associated with lower HIV testing but not with condom self-efficacy or consistent condom use. Young men were 68% less likely to report HIV testing if transactional sex engaged. Findings point to urgent HIV testing gaps among transactional sex engaged urban refugee/displaced youth and a need for gender-tailored HIV prevention strategies. [ABSTRACT FROM AUTHOR]