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The relationship between food insecurity and transactional sex is well recognized, but less is known about this relationship among adolescents. We analyzed cross-sectional baseline data from 3,130 female secondary students aged 12-19 enrolled in a three-arm, cluster randomized controlled trial to examine the association between food insecurity and transactional sex. The explanatory variable was food security and the outcome was ever engaging in transactional sex. Over one quarter (28.7%) reported any food insecurity and 1.9% of all participants (9.6% of sexually active participants) reported ever engaging in transactional sex. In adjusted models, ever experiencing any food insecurity was associated with a higher prevalence of ever transactional sex (PR: 1.60; 95% CI: 1.02, 2.49) compared to little to no food insecurity. These results provide insight into potential predictors of higher-risk sexual behavior in Rwanda; they also provide policy-makers with populations with whom to intervene on upstream determinants of transactional sex, notably poverty and food insecurity.

Background: Promising evidence supports the effectiveness of edutainment interventions in shifting norms to prevent violence against women and girls and other harmful practices, yet further research into mechanisms and pathways of impact is needed to inform intervention development, delivery and scale-up. This exploratory qualitative evaluation examined the feasibility and indications of change in attitudes, beliefs, norms and behaviours following the broadcast of a radio drama aired to prevent age-disparate transactional sex in Kigoma, Tanzania. Methods: Over seven weeks, six episodes were broadcast on local radio weekly, between November and December 2021 in Kigoma, targeting adolescent girls (aged 13–15 years) and their caregivers. Reflection sessions were conducted twice a week with 70 girls across seven schools, supplemented by after-school Girls' Club listening sessions for a subgroup of 30 girls. We conducted seven before and after focus group discussions, five with girls (n = 50), one with men caregivers (n = 9) and one with women caregivers (n = 9) and analysed them using thematic and framework analysis approaches. Results: Overall, we found that while girls exhibited significant engagement with the drama, caregiver participation, particularly among men, was low. Thus, no clear changes were detected in men. We did not find any differences in impact based on listening sessions' attendance vs. home listening. We detected positive changes among girls and women in four thematic areas after listening to the drama: (1) participant's increasingly challenged perceptions about what kinds of girls and men take part in age-disparate transactional sex, what can be exchanged, and men's motivations for engaging; (2) there was a shift from attributing blame for age-disparate transactional sex relationships from girls to men; (3) girl's reported increased agency and confidence to avoid age-disparate transactional sex relationships; and (4) we found a heightened sense of responsibility and recognition for the role of parents, peers and community members in preventing age-disparate transactional sex. Conclusions: These findings highlight the need for further implementation research to explore ways to effectively engage men. They also underscore the potential of engaging, evidence-based edutainment interventions in fostering spontaneous critical reflection about complex behaviours such as age-disparate transactional sex, and diffusing key messages among target populations without the use of organised diffusion activities. [ABSTRACT FROM AUTHOR]

Background: Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence. Method and findings: We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects. Conclusion: The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV. Trial registration: The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021. In a randomised control trial, Aurélia Lépine and team assess the impact of health insurance as a means of protecting women who engage in commercial sex or transactional sex from economic shocks to prevent HIV infection in Yaoundé, Cameroon. Author summary: Why was this study done?: Women in Africa, especially adolescent girls and young women, suffer a greater burden of new HIV infections than men. Evidence suggests that women may engage in risky sexual behaviours, including unprotected sex, to earn extra money when faced with high expenses or income loss, also known as economic shocks. One of the most common economic shock in Africa is medical out of pocket payments, which can be dramatically reduced with health insurance. What did the researchers do and find?: We conducted a randomised control trial assessing the impact of health insurance as a way of protecting women engaging in commercial sex or transactional sex from economic shocks to prevent HIV infection. We recruited 1,508 female participants, stratified depending on whether the participant is a female sex worker (n = 755) or engage in transactional sex (n = 753). Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579) from November 2021 or at the end of the study 12 months later (control; n = 568). We found that health insurance almost fully eliminated out-of-pocket medical spending and led to a small increase in health care use. Among women who received the intervention, we found large reductions in HIV infection and reductions in risky sexual behaviours for women and girls engaging in transactional sex, but there was no effect in women and girls engaging in commercial sex. What do these findings mean?: These findings showed that preventing economic shocks among women engaging in transactional sex in Africa is an effective HIV prevention strategy. The results also highlighted that women in transactional sex were more affected by HIV than female sex workers in our study, a finding that warrants attention from policy makers. The main limitation of this study was the poor sensitivity and specificity of sexually transmitted infection tests. [ABSTRACT FROM AUTHOR]

This study investigates the sexual and reproductive health (SRH) challenges and access to SRH services among internally displaced persons (IDPs) in two Nigerian states: Benue (North-central) and Kaduna (Northwest). The research focuses on understanding how different contexts and variation in the management of displacement in these contexts influence SRH outcomes for IDPs and use of SRH services within and outside camp settings. We conducted face-to-face survey interviews with 581 sexually active IDPs residing in camps for at least 6 months. The questionnaire covered contraception, gender-based violence, sexually transmitted infection (STI) services, and SRH service utilization. Our findings reveal significant contextual differences between the two states. Benue reported higher rates of transactional sex, while Kaduna had higher rates of intimate partner violence and contraceptive use. SRH service use was generally higher in Benue than in Kaduna. We found statistically higher odds of SRH service use one camp in Benue (β = 2.7; p < 0.001) and significantly lower odds in a camp in Kaduna ((β = 0.1; p < 0.001) in comparison with a camp in Benue. By showing how different approaches may shape displaced persons' access to SRH services within and outside camps, our study highlights the importance of understanding the nuances in humanitarian contexts in designing responses. This study provides valuable insights into the SRH needs and experiences of IDPs in different Nigerian contexts, informing targeted interventions and policies to improve service provision for displaced populations. [ABSTRACT FROM AUTHOR]

Background: Understanding the impact of natural disasters on the HIV epidemic in populations with high HIV burden is critical for the effective delivery of HIV control efforts. We assessed HIV risk behaviors, seroprevalence, and viral suppression in a high HIV prevalence Lake Victoria fishing community before and after COVID-19 emergence and lockdown and a severe lake flooding event, both of which occurred in 2020. Methods: We used data from the largest Lake Victoria fishing community in the Rakai Community Cohort Study, an open population-based HIV surveillance cohort in south-central Uganda. The data were collected both prior to (September-December 2018) and after (October-December 2021) COVID-19 emergence and a severe flooding event. Households impacted by flooding were identified via drone data and through consulting village community health workers. The entire study population was subject to extensive COVID-19-related lockdowns in the first half of 2020. Differences in HIV-related outcomes before and after COVID, and between residents of flooded and non-flooded households, were assessed using a difference-in-differences statistical modeling approach. Findings: A total of 1,226 people participated in the pre- and post-COVID surveys, of whom 506 (41%) were affected by flooding. HIV seroprevalence in the initial period was 37% in flooded and 36.8% in non-flooded households. After the COVID-19 pandemic and lockdown, we observed a decline in HIV-associated risk behaviors: transactional sex declined from 29.4% to 24.8% (p = 0.011), and inconsistent condom use with non-marital partners declined from 41.6% to 37% (p = 0.021). ART coverage increased from 91.6% to 97.2% (p<0.001). There was 17% decline in transactional sex (aPR = 0.83, 95% CI: 0.75–0.92) and 28% decline in the overall HIV risk score (aPR = 0.83, 95% CI: 0.75–0.92) among HIV-seronegative participants. We observed no statistically significant differences in changes of HIV risk behavior, seroprevalence, or viral suppression outcomes when comparing those affected by floods to those not affected by floods, in the periods before and after COVID-19, based on difference-in-differences analyses. Interpretation: Despite a high background burden of HIV, the COVID-19 pandemic, and severe flooding, we observed no adverse impact on HIV risk behaviors, seroprevalence, or virologic outcomes. This may be attributed to innovative HIV programming during the period and/or population resilience. Understanding exactly what HIV programs and personal or community-level strategies worked to maintain good public health outcomes despite extreme environmental and pandemic conditions may help improve HIV epidemic control during future natural disaster events. [ABSTRACT FROM AUTHOR]

Background: For a variety of reasons related to biology, behaviour, and environment, a subset of a population known as female sex workers (FSWs) or female transactional sex workers is at increased risk of health, depression, social stigma and access to timely and quality healthcare when needed. In low- and middle-income countries (LMICs), there was lack of understanding regarding the experiences and healthcare utilisation and behaviours, the health burden among them, their experiences, and how they access health care. Using Anderson's behavioural model of health service utilisation as a framework, this review aimed to explore the experiences of, and healthcare seeking behaviours of female sex workers in low-and middle-income countries. Methods: Six relevant databases such as PubMed, Embase, Global Health, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed research articles published between January 1990 and December 2023 that discussed female transactional sex work in low- and middle-income countries. Subject terms such as: low-and middle- incomes, sex workers (female and male), sexually transmitted infections (STIs) in the sex work industry, prostitution, commercial sex, and health-seeking behaviour were used for the databases search. Out of 6,135 articles that were retrieved for the study, 26 met the inclusion criteria. Of the total number of studies, four were reviews, eight were quantitative studies, six were qualitative studies, and two utilised mixed methods. Findings: Results from a thematic analysis of studies that combined quantitative and qualitative methods yielded six overarching themes.The study found that women engaged in sex work for different reasons – to fend for themselves (i.e., livelihood), self-employment and others do it for pleasure. However, force sex or unprotected which can lead to sexually transmitted infections, sexual abuse, job insecurity, were critical risks factors in engaging in sex work. These factors make them vulnerable to predators and health risks. It was found that sex workers were aware of the importance of seeking healthcare, and do make the efforts, however, crucial factors such as difficulty accessing healthcare and maltreatment by healthcare providers and social stigma disincentivises FSW health-seeking behaviours. Sexual workers reported discomfort disclosing their occupations because of the stigma and discrimination which further affects their regular health examinations and obtaining medically approved condoms from healthcare facilities. Conclusion: Complex challenges rooted in economic vulnerability, social marginalisation, and limited access to healthcare afflict female sex workers in LMICs. The maltreatment and stigma can potentially affect LMICs from achieving using health facility care, with potential implications on achieving the universal health coverage goals. Comprehensive, rights-based strategies that address structural injustices and empower these women to live healthier, more secure lives are necessary to address their special needs. [ABSTRACT FROM AUTHOR]

The life‐history tradeoff between reproduction and survival often results in a discordant timing of peak mortality risk for males and females in seasonally reproducing species. Understanding how this seasonal association between reproductive investment and survival is impacted by individual age, demography, and climate is increasingly important as anthropogenic influence is driving rapid global climate and population structure changes. We investigate how tradeoffs between seasonal reproductive investment and survival have fluctuated in response to observed changes in demography and climate using 60 years of demographic records collected from a free‐ranging population of rhesus macaques Macaca mulatta (n = 1919 males, 1609 females). Seasonal mortality rates fluctuated significantly over the 60‐year period for both males and females. In males, but not females, age‐specific survival was different during periods of low and high reproductive investment, indicating that tradeoffs between reproduction and survival are particularly age‐dependent in males. There was no little to no evidence for an effect of sex ratio on survival in either sex. In both sexes, higher population density was associated with lower survival, and this negative effect of density was particularly strong during each sex's period of low reproductive investment. While there was no evidence for an effect of temperature on female survival during periods of low reproductive investment, during periods of high reproductive investment there was a positive association between average daily temperature maximum and female survival. Female survival was higher overall when rainfall was greater, and this positive effect of rainfall on survival was particularly strong for females during periods of low reproductive investment. Conversely, there were no effects of temperature or rainfall on male survival. The results of this study illustrate the considerable ways that climatic and demographic factors can influence sex‐specific mortality during each sex's distinct periods of reproductive investment. [ABSTRACT FROM AUTHOR]

Women engaged in sex work (WESW) are at increased risk for exposure to work setting violence. This phenomenological study examines the experience of work setting violence and strategies utilized to maintain safety for WESW in Republic of Barbados in the Caribbean. In-depth, semi-structured interviews were conducted with 30 cis-gender WESW in Barbados. This study found participants experienced work-related violence that includes physical assault, rape, robbery, kidnapping, and attempted murder. Participants were actively engaged in strategies for maintaining safety that were central to their business practices. Moreover, local HIV prevention intervention efforts including condom assertiveness training, free condom distribution, and rapid, accessible STI testing further enabled participants to assert and enforce safe business practices. Unfortunately, poor economic conditions at the time of the study, which reduced the market of available customers who were willing to pay full price while increasing the number of WESW, diminished the participants' power to insist on safe business practices. This has implications for interventions to prevent and counteract gender-based violence, as well as gender-based social and economic development efforts. [ABSTRACT FROM AUTHOR]

Sugar dating arrangements involve an older partner ("sugar daddy/mommy") who provides financial support to a younger partner ("sugar baby") in exchange for intimacy. The current study recruited a U.S. and Canadian sample of sugar babies (n = 45) and sugar benefactors (n = 32) through social media sources to survey them about perceived power in their sugar arrangement, gender roles, and stigma. Sugar benefactors did not differ in perceived power from sugar babies, nor in endorsement of traditional gender roles or stigma. Directed content analysis analyzing open-ended responses about associated outcomes indicated that both partners placed strong emphasis on companionship despite the importance of sex within arrangements. Sugar babies reported that money drives participation, although arrangements fulfill other needs, such as pleasure. Other benefits include having an arrangement with clear boundaries and expectations. Disadvantages include concerns for safety, that being physical safety for babies, and reputation and being used for money for daddies. Notably, both groups perceived sugar babies as having equal or more power than sugar benefactors, although this was often attributed to sugar babies' attractiveness and youth. Findings include insights from both babies and benefactors, and support perspectives that sugar dating is distinct from traditional sex work. [ABSTRACT FROM AUTHOR]

The current study provides initial validity evidence for a measure of Transactional Sex (TS). Participants (N = 269) were recruited from a Northeastern University in the United States and consisted of undergraduate and graduate students. Participants completed an online survey through QuestionPro that contained the Transactional Sex Measure (TSM) as well as measures of depression, anxiety, and stress, condom use negotiation self-efficacy and sexual risk, alcohol and drug use, and materialism. Construct and criterion validity were examined. Findings revealed that the TSM provided good criterion validity evidence but the construct validity evidence was minimal. Further studies on the conceptualization of TS and distribution of the TSM across a variety of diverse samples can provide more validity evidence. [ABSTRACT FROM AUTHOR]

This study examined the internal moral debate that takes place among Israeli men who pay for sex (MWPS) while traveling abroad. We explored how they construct their sense of moral worth and present themselves as moral subjects in light of the intensified stigmatization of their actions. Using the theoretical frameworks of pragmatic morality and boundary work, we conceptualize four main moral justification regimes that MWPS use to construct themselves as moral subjects: Cultural normalization; Conditional freedom of choice; The altruistic act of charity; and Unpacking the Stigma Discourse. The findings highlight how these justification regimes are anchored in three intersecting fields – cultural, spatial, and power relations – which produce various matrices of conflict, compromise, or collaboration in different situations. Thus, the flexible switching between various justification regimes reveals how MWPS define themselves and their activities and negotiate various moral dispositions – akin to various cultural logics – in the context of moral taint and stigma. [ABSTRACT FROM AUTHOR]

Abstract Background Promising evidence supports the effectiveness of edutainment interventions in shifting norms to prevent violence against women and girls and other harmful practices, yet further research into mechanisms and pathways of impact is needed to inform intervention development, delivery and scale-up. This exploratory qualitative evaluation examined the feasibility and indications of change in attitudes, beliefs, norms and behaviours following the broadcast of a radio drama aired to prevent age-disparate transactional sex in Kigoma, Tanzania. Methods Over seven weeks, six episodes were broadcast on local radio weekly, between November and December 2021 in Kigoma, targeting adolescent girls (aged 13–15 years) and their caregivers. Reflection sessions were conducted twice a week with 70 girls across seven schools, supplemented by after-school Girls’ Club listening sessions for a subgroup of 30 girls. We conducted seven before and after focus group discussions, five with girls (n = 50), one with men caregivers (n = 9) and one with women caregivers (n = 9) and analysed them using thematic and framework analysis approaches. Results Overall, we found that while girls exhibited significant engagement with the drama, caregiver participation, particularly among men, was low. Thus, no clear changes were detected in men. We did not find any differences in impact based on listening sessions’ attendance vs. home listening. We detected positive changes among girls and women in four thematic areas after listening to the drama: (1) participant’s increasingly challenged perceptions about what kinds of girls and men take part in age-disparate transactional sex, what can be exchanged, and men’s motivations for engaging; (2) there was a shift from attributing blame for age-disparate transactional sex relationships from girls to men; (3) girl’s reported increased agency and confidence to avoid age-disparate transactional sex relationships; and (4) we found a heightened sense of responsibility and recognition for the role of parents, peers and community members in preventing age-disparate transactional sex. Conclusions These findings highlight the need for further implementation research to explore ways to effectively engage men. They also underscore the potential of engaging, evidence-based edutainment interventions in fostering spontaneous critical reflection about complex behaviours such as age-disparate transactional sex, and diffusing key messages among target populations without the use of organised diffusion activities.

Abstract Background For a variety of reasons related to biology, behaviour, and environment, a subset of a population known as female sex workers (FSWs) or female transactional sex workers is at increased risk of health, depression, social stigma and access to timely and quality healthcare when needed. In low- and middle-income countries (LMICs), there was lack of understanding regarding the experiences and healthcare utilisation and behaviours, the health burden among them, their experiences, and how they access health care. Using Anderson’s behavioural model of health service utilisation as a framework, this review aimed to explore the experiences of, and healthcare seeking behaviours of female sex workers in low-and middle-income countries. Methods Six relevant databases such as PubMed, Embase, Global Health, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed research articles published between January 1990 and December 2023 that discussed female transactional sex work in low- and middle-income countries. Subject terms such as: low-and middle- incomes, sex workers (female and male), sexually transmitted infections (STIs) in the sex work industry, prostitution, commercial sex, and health-seeking behaviour were used for the databases search. Out of 6,135 articles that were retrieved for the study, 26 met the inclusion criteria. Of the total number of studies, four were reviews, eight were quantitative studies, six were qualitative studies, and two utilised mixed methods. Findings Results from a thematic analysis of studies that combined quantitative and qualitative methods yielded six overarching themes.The study found that women engaged in sex work for different reasons – to fend for themselves (i.e., livelihood), self-employment and others do it for pleasure. However, force sex or unprotected which can lead to sexually transmitted infections, sexual abuse, job insecurity, were critical risks factors in engaging in sex work. These factors make them vulnerable to predators and health risks. It was found that sex workers were aware of the importance of seeking healthcare, and do make the efforts, however, crucial factors such as difficulty accessing healthcare and maltreatment by healthcare providers and social stigma disincentivises FSW health-seeking behaviours. Sexual workers reported discomfort disclosing their occupations because of the stigma and discrimination which further affects their regular health examinations and obtaining medically approved condoms from healthcare facilities. Conclusion Complex challenges rooted in economic vulnerability, social marginalisation, and limited access to healthcare afflict female sex workers in LMICs. The maltreatment and stigma can potentially affect LMICs from achieving using health facility care, with potential implications on achieving the universal health coverage goals. Comprehensive, rights-based strategies that address structural injustices and empower these women to live healthier, more secure lives are necessary to address their special needs.

While universities have been lauded as sanctuaries of peace where students and staff pursue educational goals, there has been a marked increase in the victimisation of students by staff members who have been known to hound students for sexual favours. This increase in unethical conduct continues regardless of "sound" policies regulating university student and staff relationships. Against this background, this study sought to explore the factors shaping the pervasive practice of transactional sex between staff and students at a university in rural South Africa. Underpinned by the sexual exchange theory, the study utilised an exploratory sequential mixed-methods design. The findings categorised into four key themes—academic reasons, impunity and power dynamics, financial constraints, and peer pressure and influence—highlight the entrenched nature of this practice within the university setting. The study recommended implementing and enforcing strict policies with clear consequences for perpetrators and establishing confidential reporting systems and dedicated support units for victims.

Introduction: People who inject drugs (PWID) and people who use drugs (PWUD) are an important population group that remain under-served in Ghana. Though PWID and PWUD are among the key populations most-at-risk to acquire sexually transmitted or blood-borne diseases, they are among those with the least access to human immunodeficiency (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses' prevention, care and treatment services in Ghana due to lack of data on them. We provide a rapid assessment of the PWUD and PWID situation in Ghana. Methods: This rapid cross-sectional design undertook consultative meetings between the study team and relevant stakeholders, including Civil Society Organizations (CSO) working with PWUD/PWID. The assessment considered a representative sample of PWID and PWUD. It was conducted in four (4) selected regions of Ghana (Greater Accra, Ashanti, Western, and Northern). Overall, 323 participants were interviewed using respondent-driven sampling (RDS) approach. Information obtained from participants were demographics, HIV risk behaviors, human immunodeficiency (HIV) and sexually transmitted infections (STI)-related knowledge HIV/HCV/HBV screening, attitude, and practices among others. Analyses were conducted using Stata version 17 and RDSAT version 7.1.46 software. Findings: Drug use was found to be more prevalent among the youth with a median age of 37 years. Majority of the respondents were males (86%). About 28% of the female respondents identified themselves as sex workers, while about 74% have been involved in transactional sex. The median age at which respondents started using and injecting drugs was 20 and 22 years respectively. Majority (68%) of the respondents consume drugs through smoking, with 20% through snorting, inhaling or swallowing and 12% through injection. The drug mostly used among the respondents was heroin (52%). The most commonly injected drug was cocaine (55%). About 64.7% of respondents reported mixing two or more drugs. HIV prevalence among respondents was 2.5%, 12.3% among women and 17.7% among women engaged in sex work, highlighting the overlap vulnerability. The prevalence of hepatitis C was 6.0%, and Hepatitis B was 4.5%. Access to care is limited, with 63% of the respondents never been tested for HIV. Conclusion: These rapid assessment findings reveal the challenging conditions for people who use and inject drugs coupled with a relatively high prevalence of HIV and Hepatitis C compared to the general population. However, it also reveals that Ghana has a window of opportunity to prevent an exponential spread of HIV and Hepatitis in this population. Therefore, there is the need to implement prevention and treatment programs for HIV and hepatitis among people who use and inject drugs including essential strategies for an enabling environment in Ghana. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We build on growing evidence to show that substance use and watching pornographic material are key factors that influence transactional sex. We draw on a sample of 532 young women (10-24 years) enrolled in the Uganda Youth Development Link Programme from Central Uganda. The odds of watching pornographic material (aOR=3.77; 95%CI=1.76-8.09) and substance use (aOR=3.28; 95%CI=1.96-5.48) were higher for facilitating transactional sex among young women – reaffirming that substance use and watching pornographic material are risk factors for transactional sex in low-resource settings. Efforts to address the sexual and reproductive health needs of young people in Uganda, should consider this unique risk factor profile. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Adolescent girls and young women (AGYW) continue to experience a high incidence of HIV in southern and eastern Africa, even in the context of large-scale HIV prevention interventions. In Tanzania, AGYW account for the largest proportion of new infections and have a higher risk of HIV acquisition than males of comparable age. Methods: We used routinely collected data from the PEPFAR/USAID-funded Sauti Project, a large combination HIV prevention program, to examine the relationship between transactional sex and sex with older partners among AGYW in Tanzania (2015–2020). Out-of-school AGYW 15–24 years completed a vulnerability index and were tested for HIV. We estimated weighted prevalence ratios (PR) and 95% confidence intervals (CI) for the associations of transactional sex (sex exchanged for money/services/gifts outside of sex work) and sex with older partners (≥5-years older, ≥10-years older) with prevalent HIV. Age cutoffs of 5 and 10 years were used to align partner age differences with age-disparate and intergenerational sex, respectively. We assessed potential synergism between exposures, and subgroup analyses explored associations among girls 15–19. Results: Sixty seven thousand three hundred fifty seven AGYW completed the vulnerability index and 14,873 had captured HIV testing records. Median age was 20 years (IQR 18–22). Transactional sex and age-disparate sex were common (35% and 28%, respectively); 13% of AGYW reported both behaviors. HIV prevalence was associated with both transactional sex (PR: 1.28; 95% CI 1.00–1.63) and age-disparate sex (PR:1.26, 95% CI 0.99–1.60). In common referent analysis, transactional sex remained strongly associated with HIV, even in the absence of age-disparate sex (PR 1.41; 95% CI 1.02–1.94). Discussion: Evidence of statistical synergism was not present, suggesting both transactional sex and age-disparate sex operate through similar pathways to increase HIV risk. Increased specificity within HIV prevention programs is needed to better meet the sexual and reproductive health needs of AGYW at high risk of HIV in Tanzania, including investment in tailored youth-friendly strategies for AGYW who have been marginalized from the current HIV response. [ABSTRACT FROM AUTHOR]

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% (n = 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. [ABSTRACT FROM AUTHOR]

This study examined the prevalence and correlates of intimate partner violence (IPV) among a cohort of racial/ethnically diverse men who have sex with men (MSM) in Los Angeles. An ongoing longitudinal cohort study of MSM in Los Angeles, constructed by design so half of the participants use substances (SU) and half are persons living with HIV, provided data. Data collection occured between 2014 and 2020. At semiannual study visits, participants completed a computer-assisted self-interview which included questions on substance use (past 6 months) and experiences of IPV (past 12 months). The criterion variable was reported physical and sexual IPV. Multivariable models generalized estimating equations (GEE) estimated associations between reported SU and physical and sexual IPV, adjusting for repeated measurement and confounders. In total, 557 persons (2,962 visits) contributed to the analysis; the median baseline age was 30 years (interquartile range: 28.0–39.0). The prevalence of IPV in the past 12 months was 22.3%, with 18.3% reporting physical and 10.2% reporting sexual IPV across study visits. Stimulant use prevalence was higher among those who reported IPV compared to those who did not (68% vs. 42.1%; p <.001); cannabis use prevalence was lower among those reporting IPV (42.3% vs. 49% respectively; p <.001). Adjusted analysis showed reported stimulant use associated with greater odds of physical IPV (adjusted odds ratio [aOR] = 2.0; 95% confidence interval [CI] [1.4, 2.8], p <.001) but not sexual IPV (aOR = 1.3; 95% CI [0.8, 2.0], p =.332). Models stratified by HIV status yielded similar results. Findings showed a high prevalence of past-year IPV experiences among MSM in Los Angeles. Findings highlight links between SU and IPV and underscore a significantly increased likelihood of IPV for MSM in Los Angeles who report current methamphetamine use. This study provides evidence to support universal IPV screening and to make available safety resources at all points where MSM seek healthcare. [ABSTRACT FROM AUTHOR]

Mitochondria perform an array of functions, many of which involve interactions with gene products encoded by the nucleus. These mitochondrial functions, particularly those involving energy production, can be expected to differ between sexes and across ages. Here, we measured mitochondrial effects on sex-and age-specific gene expression in parental and reciprocal F1 hybrids between allopatric populations of Tigriopus californicus with over 20% mitochondrial DNA divergence. Because the species lacks sex chromosomes, sex-biased mitochondrial effects are not confounded by the effects of sex chromosomes. Results revealed pervasive sex differences in mitochondrial effects, including effects on energetics and aging involving nuclear interactions throughout the genome. Using single-individual RNA sequencing, sex differences were found to explain more than 80% of the variance in gene expression. Males had higher expression of mitochondrial genes and mitochondrially targeted proteins (MTPs) involved in oxidative phosphorylation (OXPHOS), while females had elevated expression of non-OXPHOS MTPs, indicating strongly sex-dimorphic energy metabolism at the whole organism level. Comparison of reciprocal F1 hybrids allowed insights into the nature of mito-nuclear interactions, showing both mitochondrial effects on nuclear expression, and nuclear effects on mitochondrial expression. While based on a small set of crosses, sex-specific increases in mitochondrial expression with age were associated with longer life. Network analyses identified nuclear components of strong mito-nuclear interactions and found them to be sexually dimorphic. These results highlight the profound impact of mitochondria and mito-nuclear interactions on sex-and age-specific gene expression. [ABSTRACT FROM AUTHOR]

Background: Lesotho's government has shown consistent efforts to implement social protection programmes. However, while recent evidence established a positive causal relationship between some of these programmes and food security there is little evidence on the extent to which these initiatives are associated with better educational and sexual and reproductive health outcomes among vulnerable adolescents in Lesotho. Methods and Findings: The study uses cross-sectional, nationally representative data from the 2018 Lesotho Violence Against Children and Youth Survey. Our research examined the association between social protection receipt and educational and sexual and reproductive health outcomes among adolescents and young people (13–24 years) living in poverty. We employed multivariate logistic regression controlling for age, orphanhood, HIV status and sex. Social protection receipt was defined as household receipt of financial support from a governmental, non-governmental, or community-based program that provides income. Additionally, we fitted a marginal effects model by sex. Among the 3,506 adolescent females and males living in the two lowest poverty quintiles, receipt of social protection was associated with improvements in multiple adolescent outcomes: higher odds of consistent condom use (aOR 1.64, 95% CI 1.17–2.29), educational attainment (aOR 1.79, 95% CI 1.36–2.36), and school enrolment (aOR 2.19, 95% CI 1.44–3.34). Stratified analyses by sex showed that social protection receipt was also associated with reduced likelihood of child marriage among females (aOR 0.59, 95% CI 0.42–0.83) and higher odds of educational attainment and school enrolment among males (aOR 2.53, 95% CI 1.59–4.03 and aOR 3.11, 95% CI 1.56–6.19, respectively). Conclusions: Our study provides evidence that social protection programs are associated with improved educational, sexual and reproductive health and child marriage prevention outcomes among adolescents living in poverty. Implementing and expanding such social protection initiatives could prove instrumental in improving the well-being of vulnerable adolescents. Contributions: Social protection programs have been increasing in sub-Saharan African countries, playing a pivotal role in poverty reduction, with Lesotho being no exception. Despite the optimistic outlook brought about by the implementation of the National Social Protection Strategy Lesotho I (2014-19) and II (2021–2031), the impact of these programs on some specific outcomes that concern the lives of the most vulnerable adolescents in Lesotho remains to some extent unexplored. Additionally, Lesotho grapples with high rates of HIV, adolescent pregnancy, child marriage and early school dropout, which can further contribute to poor long-term health and social outcomes among adolescents. In this study, we used data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS) to examine the association between receiving social protection and multiple adolescent outcomes: educational, sexual and reproductive. The findings revealed that social protection programs, particularly the existing government-provided cash transfers, are significantly associated with multiple better outcomes among adolescents living in the poorest households in Lesotho. Such cash transfer schemes in Lesotho are associated with improved sexual and reproductive health outcomes for adolescent females, including reduced child marriage rates, and improved educational outcomes for males. These findings indicate that government-led social protection programmes are positively associated with favourable outcomes that can improve the quality of life for adolescents in resource-limited settings. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: The design of HIV prevention programs for adolescent girls and young women (AGYW) are informed by data on who is at highest risk and where they can be reached. Places (hotspots) associated with selling sex are an established outreach strategy for sex work (SW) programs but could be used to reach other AGYW at high risk. Setting: This study took place in Mombasa, Kenya. Methods: We conducted a cross-sectional, bio-behavioural survey among (N = 1193) sexually active AGYW aged 14–24 years recruited at hotspots. We compared HIV prevalence by subgroup (SW; transactional sex, TS; and non-transactional sex), stratified by hotspot type (venues and nonvenues). We examined whether associations between HIV prevalence and hotspot/subgroup remained after adjustment for individual-level risk factors, and estimated HIV prevalence ratio with and without adjustment for these individual-level factors. Results: Overall HIV prevalence was 5.6%, 5.3% in venues and 7.3% in nonvenues. Overall SW HIV prevalence was 2-fold higher than among participants engaged in nontransactional sex. After adjusting for age and individual-level risk factors, HIV prevalence was 2.72 times higher among venue-based SWs (95% confidence interval: 1.56 to 4.85) and 2.11 times higher among nonvenue AGYW not engaged in SW (95% confidence interval: 0.97 to 4.30) compared with venue-based AGYW not engaged in SW. Conclusion: AGYW who sell sex remain at high risk of HIV across types of hotspots. The residual pattern of elevated HIV burden by AGWY subgroup and hotspot type suggests that unmeasured, network-level factors underscore differential risks. As such, hotspots constitute a "place" to reach AGYW at high risk of HIV. [ABSTRACT FROM AUTHOR]

Men who engage in transactional sex with men (MTSM) are a high-risk population for HIV and other sexually transmitted infections. Epidemiological data have so far included them in the broad category of men who have sex with men (MSM), while research on transactional sex typically focused on female sex workers. The internet has substantially changed sex work practices and earlier findings concerning the sexual health needs of MTSM may no longer be applicable. We analyzed quantitative data from MSM based in the UK (n = 11629) taking part in the European MSM Internet Survey (EMIS-2017). Compared to non-MTSM, MTSM (n = 230; 2%) were younger, more likely to self-identify as an ethnic minority, be single, have lower education levels, struggle financially, and—controlling for age—more likely to be living with diagnosed HIV. Commonly unmet needs among all MSM were a lack of confidence in accessing HIV post-exposure prophylaxis, uncertainty about HIV status, and ignorance of where to access hepatitis vaccinations. Compared with other MSM, MTSM were notably less satisfied with the safety of their sexual practices, less confident in their ability to maintain sexual boundaries, and more likely to engage in risk because of absent precautionary resources. Given their greater opportunity for sexual risk, as well as fewer resources for negotiating safety, our findings suggest that services should prioritize MTSM in HIV prevention and sexual health promotion, including assertiveness and social skills training, in addition to knowledge-based education. [ABSTRACT FROM AUTHOR]

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t -tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed. [ABSTRACT FROM AUTHOR]

The Comarca Ngäbe-Buglé (CNB), home to >200,000 Indigenous people, is one of the poorest regions in Panama. We describe transactional sex (TS) behaviours, normative beliefs and factors associated with TS among Indigenous adolescents(14-19years) in the CNB. We conducted a mixed-methods study in the CNB between January and November 2018, which included a qualitative study with participant observation and semi-structured interviews that focused on descriptive norms related to TS; and a cross-sectional study among public-school-going adolescents using self-administered questionnaire to report sexual behaviour and injunctive norms related to TS. Participants in the epidemiological study were also asked to submit samples for HIV, syphilis, chlamydia, and gonorrhoea testing. Qualitative thematic analysis was used to organise and analyse field notes and semi-structured interviews. Quantitative analysis included four models: TS experience and acceptance of a TS offer and the associations of these outcome variables with demographic and behavioural variables and HIV/STI infections. In the qualitative study among 20 adolescents, we found that people offering TS were reported to be from within and outside of the community, and included older men and women, and disturbingly, teachers. Participants reported feeling individual and collective agency in the decision to engage in TS and described little social sanctions for participation. In the quantitative study among 700 adolescents(309 girls[45.1%],379 boys[54.9%]), we found that girls(18.8%;58/309) and boys(15.5%;58/379) reported similar levels of having been offered TS, and of acceptance among those offered(girls 81.4% [35/43]; boys 77.8% [35/45]). TS was found to be associated with the reported forced sex and HIV/syphilis seropositivity. Due to widespread acceptance and feelings of agency, interventions would not be effective if they focused on eliminating the transactional component of sexual encounters. Instead, interventions should focus on individual and household economic stability, increasing violence reporting, bringing perpetrators to justice, and adopting condom use during all sexual encounters. [ABSTRACT FROM AUTHOR]

Intoduction: Transactional sex (TS) is common in areas of sub-Saharan Africa, motivated by reasons beyond financial support. Through this qualitative study we sought to understand the motivation driving TS among adolescent schoolgirls in rural western Kenya where rates are reportedly high. Identifying and understanding drivers within the local context is necessary for implementation of successful public health policy and programming to reduce the associated harms impacting health and wellbeing. Methods: To understand the drivers of sexual behaviors, individual views, and sociocultural norms, we spoke with schoolgirls, male peers, parents and teachers. The three latter groups may influence, encourage, and shape girls' views and behaviors and thus contribute to the perpetuation of cultural and societal norms. Results: One hundred and ninety-nine participants took part across 20 FGDs; 8 comprised of schoolgirl groups, and 4 each of schoolboy, parent or teacher groups. Through thematic analysis, poverty emerged as the key driver of TS and a normative behaviour amongst secondary school girls. Subthemes including parental influence, need for menstrual pads, pressure from boda boda drivers, peer pressure, and blame were part of a complex relationship linking poverty with TS. Discussion: We conclude that whilst TS is perceived as inevitable, normal and acceptable it is not really a choice for many girls. Exploring ways to encourage communication between families, including around menstruation, may help enable girls to ask for help in acquiring essential items. In addition, education at a community level may shift social norms over time and decrease the prevalence of age-disparate TS among schoolgirls and older, wealthier men in the community. [ABSTRACT FROM AUTHOR]

In Vanuatu, the use of the terms such as ʻmen who have sex with menʼ (MSM) and ʻtransgenderʼ has increased over the past decade. This paper draws on twenty months ethnographic research in Port Vila, the country's capital, to analyse what happens on the ground when MSM and transgender categories are taken up to identify people or to narrate the self. The focus is on who uses these terms, in what ways they are experienced, and what is rendered visible (or not) by their use. This research departs from approaches framing ʻnon-heteronormativeʼ categories as related solely to gender and sexuality. It argues that MSM and transgender categories are used in various ways to refer not only to sexual practices and/or gender identity, but also to health risk behaviours, transactional sex and LGBT rights advocacy. The analysis offered suggests we view MSM and transgender categories as technologies that, depending on the interactional context, contribute to bureaucratic tasks or to maintaining or, on the contrary, changing established socio-political relations. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and subsequent mitigation measures led to social disruption and negative economic shocks for a large proportion of Uganda's population. The social and economic consequences of COVID-19 on Ugandan men's sexual behaviours, including transactional sex relationships, are unclear. We conducted in-depth interviews between November 2021–February 2022 with 26 men in a high HIV prevalence region of Uganda. Data were analysed thematically to understand how sexual relationships, including transactional sex, were impacted by COVID-19. We found that COVID-19 mitigation measures had far-reaching social and economic impacts on most respondents, particularly those employed in the informal economy. Men described experiencing job loss, food insecurity and restricted mobility, which limited opportunities to provide for and meet with transactional sex partners. Inability to provide financial resources meant that men could not form new transactional sex relationships and men who could no longer provide for their existing transactional sex partners consistently reported relationship dissolution. Men who reported stable employment during the pandemic described few changes in transactional sex relationships. Similarly, men in non-transactional relationships did not report relationship dissolution despite decreased financial provision. Further research should assess the potential short- and long-term impacts of COVID-19 mitigation measures on transactional sex relationships. [ABSTRACT FROM AUTHOR]

Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) could help overcome multilevel challenges to HIV prevention for people who inject drugs (PWID), including those in the binational San Diego-Tijuana metroplex. Yet, general PrEP awareness and interest in LAI-PrEP remain underexplored among PWID. From 2020 to 2021, 562 HIV-negative PWID in San Diego and Tijuana completed surveys assessing general PrEP awareness and interest in oral and LAI-PrEP. Modified Poisson regression examined factors associated with general PrEP awareness. Multinomial logistic regression assessed factors associated with interest in both oral and LAI-PrEP, oral PrEP only, LAI-PrEP only, or neither. General PrEP awareness was low (18%) and associated with experiencing unsheltered homelessness (adjusted prevalence ratio [APR] = 1.50, 95% confidence interval [CI]: 0.96–2.33), past 6-month fentanyl injection (APR = 1.53, 95% CI: 1.04–2.25), and transactional sex (APR = 1.71, 95% CI: 1.06–2.76). Interest in oral PrEP only was most common (44%), followed by LAI-PrEP only (25%) and neither (16%). Compared to the odds of being interested in LAI-PrEP only, the odds of being interested in oral PrEP only were lower among those who were stopped by police (AOR = 0.38, 95% CI: 0.22–0.65), reported past 6-month fentanyl injection (AOR = 0.33, 95% CI: 0.20–0.56), polydrug use (AOR = 0.48, 95% CI: 0.27–0.86), injecting multiple times daily (AOR = 0.26, 95% CI: 0.14–0.46), receptive syringe use (AOR = 0.30, 95% CI: 0.19–0.49), and higher perceived HIV risk (AOR = 0.24, 95% CI: 0.15–0.39). Interest in LAI-PrEP was more common among PWID reporting social and structural factors that could interfere with oral PrEP adherence, suggesting LAI-PrEP implementation could increase PrEP coverage among those most vulnerable to HIV. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status. Methods: Data were from Nigeria's AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15–24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner's HIV status. Results: Our LCA model identified four distinct AYA subgroups termed 'low-risk perception' (n = 7,361; 39.5%), 'consent and proximity' (n = 5,163; 27.74%), 'testing site' (n = 4,996; 26.84%), and 'cost and logistics' (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02–1.35), transactional sex (aOR 1.50, 95% CI 1.23–1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39–2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63–0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04–1.39) and transactional sex (aOR 1.53, 95% CI 1.26–1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58–2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34–0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15–24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected. Conclusions: Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA. [ABSTRACT FROM AUTHOR]

Background: Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. Methods: Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. Findings: The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. Conclusions: This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Plain English summary: Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs. [ABSTRACT FROM AUTHOR]

AbstractThis paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls’ and young women’s vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga. [ABSTRACT FROM AUTHOR]

The U.S. Deep South bears a disproportionate burden of HIV and other STIs. Transactional sex may influence these epidemics, but few studies have estimated its prevalence or correlates in the Deep South. We estimated the history of transactional sex among adults accessing an Alabama AIDS Service Organization from 2008–2022, using chi-square tests to examine its sociodemographic and behavioral correlates. We used modified Poisson regression with cluster-robust standard errors to estimate adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI) for the associations between transactional sex and new HIV, hepatitis C (HCV), and STI diagnoses. Transactional sex was reported at 944/20,013 visits (4.7 %) and associated with older age, being a cisgender woman or gender minority, identifying as white, diverse drug use, and sharing of drug equipment. Compared to others, clients reporting transactional sex had increased prevalence of syphilis (apR 3.60, 95 % CI 1.16–11.19) and HCV (aPR 1.53, 95 % CI 1.24–1.88). Using 14 years of community-based data, this study is the first to estimate the relationship between transactional sex and HIV, HCV, and STIs in Alabama and highlights the need address STI burden and diverse drug use among people who transact sex in the Deep South. [ABSTRACT FROM AUTHOR]

This article relies on quantitative data collected in Switzerland as part of a research study on sexual transactions among youth. Building on an analytical framework that defines sexual transactions in terms of negotiated exchanges rooted in social representations, we explored how they were perceived by the Swiss young people included in our sample at a cognitive, ethical, and political level. We found that research participants who reported having experienced sexual transactions viewed them much more positively than those who reported never having engaged in such exchanges. While this was especially true among young women, we also found that the tendency of respondents to perceive sexual transactions negatively increased with age. When analyzed in light of the qualitative results of our study, these quantitative findings suggest that negative representations of sexual transactions are less likely to be based on lived experience than on an ideal-type of sexual behavior. In other words, our research highlights how young people interpret sexuality according to norms developed within a heteronormative matrix. [ABSTRACT FROM AUTHOR]

Objective: To explore factors associated with adolescents’ sexual and reproductive health (SRH) knowledge and their engagement with educational and clinical services Design: Regression analysis of secondary data collected during a community survey Setting: Adaklu district, Volta Region, Ghana Participants: 221 adolescent caregiver pairs Main outcome measures: The study employed three main outcome measures: (1) adolescents’ level of SRH knowledge (assessed via questionnaire), (2) membership in district-sponsored adolescent health clubs (AHCs), and (3) ever-utilization of clinical SRH services. Results: Greater SRH knowledge was significantly associated with older age, AHC membership, and relying primarily on teachers or friends for SRH information. Increased odds of AHC membership were observed among females (AOR = 2.38, 95% CI 1.14-4.95); those who had communicated with one parent about sexual issues (OR 2.70, 95% CI 1.17-6.21); and those with a history of transactional sex (OR 5.53, 95% CI 1.04-29.37). Decreased odds were observed among adolescents whose caregivers were educated to the primary level (AOR = 0.24, 95% CI = 0.07-0.79). Overall, utilization of clinical SRH services was low, but higher odds were detected among individuals reporting a history of forced sex (AOR = 117.07, 95% CI 3.82-3588.52) and those who had discussed sexual issues with both of their parents (AOR = 13.11, 95% CI 1.85-92.93). Conclusions: Awareness of the predictors of knowledge, AHC involvement, and clinical service utilization can empower adolescent SRH initiatives—both present and future—to enhance their teaching, develop targeted outreach to underserved groups, and promote engagement with key clinical resources. [ABSTRACT FROM AUTHOR]

Introduction: Lesotho has the second-highest prevalence of HIV. Despite progress in achieving HIV epidemic control targets, inequities persist among certain groups, particularly associations between disability, HIV, and violence. We assessed the prevalence of disability and examined associations between disability and HIV and violence using data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS). Methods: Lesotho VACS was a nationally representative survey of females and males ages 13–24. We assessed the associations between disability status and HIV, sexual risk behaviours, and violence using logistic regression, incorporating survey weights. Results: Weighted functional disability prevalence was 14.1% for females (95% confidence interval [CI] 12.7–15.4) and 7.3% for males (5.3–9.2). Compared with females with no disabilities, females with disabilities had higher odds of being HIV positive (adjusted odds ratio [aOR] 1.92, 1.34–2.76), having transactional sex (aOR 1.79, 1.09–2.95), and experiencing any lifetime violence (aOR 2.20, 1.82–2.65), sexual violence (aOR 1.77, 1.36–2.31), emotional violence (2.02. 1.61–2.53), physical violence (aOR 1.85, 1.54–2.24), witnessing interparental violence (aOR 1.71, 1.46–2.01), and witnessing community violence (aOR 1.52, 1.26–1.84). Males with disabilities had higher odds of having transactional sex (aOR 4.30, 1.35–13.73), having recent multiple sex partners (aOR 2.31, 1.13–4.75), experiencing emotional violence (aOR 2.85, 1.39–5.82), and witnessing interparental violence (aOR 1.78, 1.12–2.84). HIV models for males did not converge due to low numbers. Conclusion: Findings emphasize the importance of inclusion and accessibility for adolescents and young adults with disabilities in prevention and services for violence and HIV. Ending HIV in Lesotho depends on addressing the vulnerabilities that lead to potential infection including violence and ensuring equitable services for all. [ABSTRACT FROM AUTHOR]

While oral pre-exposure prophylaxis (PrEP) can substantially reduce HIV risk, there are important barriers to uptake and adherence. We explored preferences for long-acting injectable and implantable PrEP among women and girls in Eswatini, Kenya, and South Africa. We conducted an online quantitative survey and discrete choice experiment (DCE) among adolescent girls (15–17), young women (18–29), and adult women (30–49). Participants completed a survey about their demographics and behavior and a DCE with 5 attributes (format, insertion location, number of insertions, dual-protection, and palpability). We recruited 1236 respondents (Eswatini = 420; Kenya = 350; South Africa = 493) in May 2022. Most participants were sexually active (72%), nearly 29% of whom reported recently engaging in transactional sex. 46% had heard of oral PrEP, but of those, only 16% reported having ever used it. Product format and dual-protection were significant predictors of product choice. Relative to a 2-month injection, participants had 1.76 times the odds (95% CI 1.08–2.04) of choosing a 6-month injectable, and 1.70 the odds (95% CI 1.06–1.92) of choosing a 12-month removable implant. Compared to a single-indication product, respondents had 2.46 times the odds (95% CI 1.04–2.68) of preferring a product also protecting against pregnancy, and 2.81 the odds (95% CI 1.04–3.05) of choosing a product that also protected against STIs. Adolescent girls and women in these countries showed strong preferences for longer-acting PrEP product formats, as well as those offering dual-protection. Introduction of long-acting options could improve PrEP uptake and reduce HIV burdens in east and southern African settings. [ABSTRACT FROM AUTHOR]

IntroductionAdolescent girls and young women (AGYW) continue to experience a high incidence of HIV in southern and eastern Africa, even in the context of large-scale HIV prevention interventions. In Tanzania, AGYW account for the largest proportion of new infections and have a higher risk of HIV acquisition than males of comparable age.MethodsWe used routinely collected data from the PEPFAR/USAID-funded Sauti Project, a large combination HIV prevention program, to examine the relationship between transactional sex and sex with older partners among AGYW in Tanzania (2015–2020). Out-of-school AGYW 15–24 years completed a vulnerability index and were tested for HIV. We estimated weighted prevalence ratios (PR) and 95% confidence intervals (CI) for the associations of transactional sex (sex exchanged for money/services/gifts outside of sex work) and sex with older partners (≥5-years older, ≥10-years older) with prevalent HIV. Age cutoffs of 5 and 10 years were used to align partner age differences with age-disparate and intergenerational sex, respectively. We assessed potential synergism between exposures, and subgroup analyses explored associations among girls 15–19.ResultsSixty seven thousand three hundred fifty seven AGYW completed the vulnerability index and 14,873 had captured HIV testing records. Median age was 20 years (IQR 18–22). Transactional sex and age-disparate sex were common (35% and 28%, respectively); 13% of AGYW reported both behaviors. HIV prevalence was associated with both transactional sex (PR: 1.28; 95% CI 1.00–1.63) and age-disparate sex (PR:1.26, 95% CI 0.99–1.60). In common referent analysis, transactional sex remained strongly associated with HIV, even in the absence of age-disparate sex (PR 1.41; 95% CI 1.02–1.94).DiscussionEvidence of statistical synergism was not present, suggesting both transactional sex and age-disparate sex operate through similar pathways to increase HIV risk. Increased specificity within HIV prevention programs is needed to better meet the sexual and reproductive health needs of AGYW at high risk of HIV in Tanzania, including investment in tailored youth-friendly strategies for AGYW who have been marginalized from the current HIV response.

Age-disparate transactional sex relationships are often coerced and exploitative. The gender and economic disparities between affluent men and economically disadvantaged girls often perpetuate these relationships, resulting in their exploitation. This qualitative study assessed men’s understanding of factors influencing schoolgirls’ engagement in age-disparate transactional sex relationships in two rural districts in Kenya. Four focus group sessions were conducted with men from two primary professions: motorcycle taxi operators (Boda Boda) and teachers from primary and secondary schools from two districts in Kitui South, Sub County, Kenya. Focus group data were analyzed using conventional content analysis. Several influential factors associated with schoolgirls’ engagement in these transactional relationships are discussed in three broad themes: access and coercion, parental influence, and peer-related factors. Study results indicate that schoolgirls in rural areas are more susceptible to predation by men willing to trade sexual favors with underage girls. These findings make it imperative to address the predation of adolescent girls by men involved in these transactional relationships by implementing comprehensive sex education programs that empower schoolgirls to recognize and resist coercion. Additionally, implementing measures involving community leaders, parents, and other stakeholders in a collective effort to combat the exploitation of underage girls is paramount. These measures should be accompanied by the stricter enforcement of laws and regulations to hold perpetrators accountable for their actions.

Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16–24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19–3.08; FI: aOR: 2.31. 95%CI: 1.36–3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24–6.17; FI: aOR: 2.62, 95%CI: 1.03–6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22–7.89; FI: aOR: 3.51, 95%CI: 1.15–10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth. [ABSTRACT FROM AUTHOR]

The Dublin regulation requires refugee applicants to submit an asylum request in first European country they enter. Yet SOGIESC refugees often fear disclosing their intimate lives or sexual details in early immigration encounters. In times of nationalistic upheavals and contested refugee laws, queer applications can further be met with distrust. Thus, in fear of repatriation, some move onwards to countries where LGBTQI+ rights are nationally celebrated, only to be sent back to the first country. This paper builds on in-depth interviews and walk-along discussions with nine Dublin-regulated SOGIE refugees, as well as documented conversations with eighteen local stakeholders, conducted in Italy and Greece between 2021 and 2023. By tracing the affective residue of events in interlocutors' accounts, this article illuminates how SOGIE experiences were repeatedly invaded by violent bordering, affectively recalled through the memory of sounds. This caused them to submerge their life rhythm as irregular subjects, fitting neither here nor there. When denied protection due to the Dublin agreement, they became homeless, dependent on precarious jobs and transactional sex work. When deported, their accounts echo emotional abandonment and lack of recourses to claim queer time, as they discover their cases expulsed from the system. When re-application was possible, they were put under the stigma of feigning their queer identities and criminalized in prolonged uncertainty. In response, they crafted themselves as event(ual) queer beings or as subjects between temporal events, through naming practices and asserting autonomy over sex time, while also visioning transactions based on emotional dignity and altruism. [ABSTRACT FROM AUTHOR]

The aim is to identify the factors determining access to health services for Venezuelan immigrants engaged in sex work in Colombia from a bioethical perspective, for which qualitative research was conducted with an interpretative hermeneutic approach. Semi-structured interviews were used for data collection, 55 of which were conducted, with 60 % being cisgender men, 31 % cisgender women, and the remaining 9 % transgender women; 89 % of these individuals are not affiliated with the General System of Social Security in Colombia, with only 11 % having some form of affiliation. 69 % of the interviewees are irregularly present in the country, with only 31 % being regularized. Four areas were identified where limitations to access health services are evident, namely the General System of Social Security in Health (sgsss), the institutional, social, and personal spheres, where barriers range from the requirement of identification documents for immigrants to be attended to xenophobic attitudes from healthcare professionals. For Venezuelan immigrants engaged in sex work, irregular migratory status constitutes the greatest difficulty in accessing healthcare. However, this barrier is compounded by other personal, social, and institutional aspects that further complicate their situation, especially due to the stigma and discrimination associated with transactional sex, sexual practices, and immigrant nationality. [ABSTRACT FROM AUTHOR]

We assessed if acceptability of the dapivirine vaginal ring for HIV prevention differed among the subgroup of women who reported engaging in transactional sex prior to enrollment in MTN-020/ASPIRE (phase III trial in Malawi, South Africa, Uganda, and Zimbabwe, 2012-2015; n = 2629). Transactional sex was defined as receipt of money, goods, gifts, drugs, or shelter in exchange for sex in the past year. Dimensions of acceptability included: ease of use and physical sensation in situ, impacts on sex, partner's opinion, and likelihood of future use. We used Poisson regression models with robust standard errors to compare risk of acceptability challenges by baseline history of transactional sex. At product discontinuation, women exchanging sex found the ring comfortable (90%), easy to insert (92%) and nearly all (96%) were likely to use the ring in the future. Women who had exchanged sex were more likely to report feeling the ring during sex (ARR 1.43, 95% CI: 1.09, 1.89; p = 0.01) and slightly more likely to mind wearing the ring during menses (ARR 1.22, 95% CI: 1.01, 1,46; p = 0.04) and during sex (ARR 1.22, 95% CI: 1.02, 1.45; p = 0.03). Messaging and counseling should include enhanced support for use during sex and menses to support optimal use. [ABSTRACT FROM AUTHOR]

Albeit the social disapproval and stigmatization, romance is an incontrovertible feature of youth culture in Pakistan. This study generates a multifaceted understanding about the intimate relationship development and dissolution, in particular the pre-dissolution conditions and post-dissolution adjustment among unmarried, non-cohabiting emerging adults. Qualitative methods were applied, comprising 129 in-depth interviews and three focus group discussions among undergraduate students at XYZ university located in Lahore city, Pakistan. Despite the public disapproval of intimacy out of wedlock and expression of love in public, the young adults reported finding ways to dealt with this situation and make intimate relationships. The nature of romantic affiliation is thereby diverging from that of the earlier generation. The attachment level to partner was primarily emotional and spiritual in the past, while it is physical and sexual for the new generation. Based on these findings, it is anticipated that the nature of intimate relationships might induce change in marriage and family system in broader society. [ABSTRACT FROM AUTHOR]

Extending feminist geographic endeavours in the present geopolitical conjuncture, this critical intervention calls into question the everyday gendered geographies of Dubai, United Arab Emirates (UAE) in their contextual heterogeneity. In the epoch of conspicuous consumption, women-dominated shopping malls in the Gulf space can be read as material-discursive sites in and through which gendered belonging is (re)constructed. Paradoxically, frenetic economic development is marked by deeply entrenched logics of segregation, unearthing conditions of unbelonging. In particular, urbanity is predicated upon the abjection of ‘bachelors’ (low-wage immigrant men of South Asian descent) from the Emirati body politic. I then employ intersectional frameworks to counter-map the affective contours of Dubai’s urban sexscape, where spatially and temporally provisional moments of queer existence (re)surface at nighttime. Similarly, intersectional feminist geographies of sex work grapple with existing and emergent strands of spatial inequality in ways a single-axis framework cannot hope to exhaust. Whilst sexed/gendered/racialised bodies are hierarchically stratified in Emirati moral economies of transactional sex, sex worker subjectivities at once refuse rigidly boxed categories by being continually reworked at the local, national and global levels. [ABSTRACT FROM AUTHOR]

The relationship between food insecurity and transactional sex is well recognized, but less is known about this relationship among adolescents. We analyzed cross-sectional baseline data from 3,130 female secondary students aged 12–19 enrolled in a three-arm, cluster randomized controlled trial to examine the association between food insecurity and transactional sex. The explanatory variable was food security and the outcome was ever engaging in transactional sex. Over one quarter (28.7%) reported any food insecurity and 1.9% of all participants (9.6% of sexually active participants) reported ever engaging in transactional sex. In adjusted models, ever experiencing any food insecurity was associated with a higher prevalence of ever transactional sex (PR: 1.60; 95% CI: 1.02, 2.49) compared to little to no food insecurity. These results provide insight into potential predictors of higher-risk sexual behavior in Rwanda; they also provide policy-makers with populations with whom to intervene on upstream determinants of transactional sex, notably poverty and food insecurity. Resumen: La inseguridad alimentaria y el sexo transaccional están poco estudiados entre las adolescentes ruandesas. Analizamos datos de referencia transversales de 3,130 estudiantes secundarias de 12 a 19 años de edad inscritas en un ensayo controlado aleatorio por grupos de tres brazos para examinar la asociación entre la inseguridad alimentaria y el sexo transaccional. La variable independiente fue la seguridad alimentaria y la variable dependiente fue participation en sexo transaccional por lo menos una vez. Más de una cuarta parte (28,7%) informó alguna inseguridad alimentaria y el 1,9% de todos los participantes (9,6% de los participantes sexualmente activos) informaron haber tenido relaciones sexuales transaccionales alguna vez. En modelos ajustados, experimentar alguna inseguridad alimentaria alguna vez se asoció con una mayor relación sexual transaccional (PR: 1,60; IC del 95%: 1,02, 2,49) en comparación con poca o ninguna inseguridad alimentaria. Estos resultados brindan información sobre posibles predictores de comportamiento sexual de mayor riesgo en Ruanda; también brindan a los formuladores de políticas poblaciones para intervenir en los determinantes anteriores del sexo transaccional, en particular la pobreza y la inseguridad alimentaria. [ABSTRACT FROM AUTHOR]