Many HIV prevention strategies identify ‘transactional sex’ as a practice that contributes to young African women’s extreme vulnerability to HIV, but partial or narrow understandings of what is meant by transactional sex are likely to hinder the development of effective interventions to protect women from HIV, according to a review article published last month in Social Science & Medicine.
Kirsten Stoebenau and colleagues conducted a comprehensive literature review on the nature and motivations for women’s participation in transactional sex in sub-Saharan Africa. They identified three broad narratives explaining the practice – ‘sex for basic needs’, ‘sex for improved social status’, and ‘sex and material expressions of love’.
“Any one paradigm taken alone provides an incomplete view of the practice,” the researchers say. “However, there is a tendency among donors and civil society groups to emphasize one paradigm at the expense of others.”
The researchers define transactional sex as “non-commercial, non-marital sexual relationships motivated by the implicit assumption that sex will be exchanged for material support or other benefits”.
Some studies have found that a majority of adolescent girls in African countries have engaged in transactional sex. Other studies have demonstrated a significant association between transactional sex and HIV infection.
Their search identified 339 different research articles, reports and books dealing with transactional sex in sub-Saharan Africa.
Other terms sometimes used in the literature include survival sex, commodified sex, intergenerational sex and sugar daddies. Of note, transactional sex is seen as distinct from commercial sex work (in which the exchange is explicit and sex is immediately remunerated).
The first broad narrative, or paradigm, portrays women and girls as vulnerable victims who have little choice but to exchange sex for money, food, or other material support as a result of their economic and social marginalisation. Attention is given to gender inequality, women’s economic dependence on men, and the different impact of economic changes on men and women. For example, in contexts where many men are absent due to labour migration, women are described as using multiple sexual partnerships to get hold of resources.
This approach also emphasises women’s lack of power in sexual relationships and describes women as victims of men’s privileged status.
HIV prevention interventions informed by this paradigm may seek to develop economic empowerment or provide financial resources, so as to reduce women's economic dependency on men. Moreover, programmes to protect women and girls from sexual exploitation and coercion would be appropriate.
A number of researchers have questioned the vulnerability paradigm, noting that transactional sex is not only practiced by women who are destitute and that the items exchanged – such as clothes or make up – often go beyond basic needs.
In the second narrative, a subjective experience of inequality is a more important motivator than absolute poverty. Consumer goods are valued, with young women wishing to differentiate themselves from poorer people or feeling peer pressure to have a lifestyle similar to that of wealthier friends.
This account emphasises women’s roles as active, sometimes powerful, agents in transactional relationships – women use their erotic power to charm wealthier men and get hold of resources. Some locally used expressions imply that it is the woman who is in control – she is “milking the cow”, “de-toothing” or “skinning the goat”.
At the same time, researchers have noted the limits to women’s agency in these relationships. For example, once they have entered into a relationship, women may have little say over when sex takes place or whether condoms are used.
This narrative suggests that the small micro-loans or cash transfer interventions suggested by the first approach may not provide enough cash to meet women’s consumer needs – so can’t be expected to limit their engagement in transactional sex.
Moreover, HIV prevention programmes should recognise young women's understanding of their position in these relationships. But they should work with women to then critically assess the limits of their agency.
Whereas the first two paradigms focused on instrumental exchanges, the third paradigm draws attention to the emotional intimacy of many ‘transactional’ relationships. Researchers have noted that an exchange of gifts and resources is central to romantic relationships in many contexts – love and money are often tightly intertwined. Men are typically seen as providers of material support, while women provide sex, childbearing and domestic support.
In this paradigm, men who offer gifts are not necessarily seen as exploitative, but as expressing commitment. “How would I know he likes me if he does not buy me nice things?” asked one Ugandan woman in a study. Analyses rooted in this paradigm note how people’s expectations of relationships are highly gendered – ‘real men’ provide for their girlfriends and wives.
Therefore, interventions which respond to this paradigm would address fundamental gendered belief systems, especially those that position women as sexually subordinate to men who provide material support. Interventions should engage both men and women with the aim of ‘taking on’ gender beliefs, with the aim of supporting gender-equitable relationships.
Moreover, HIV prevention programmes should acknowledge that young women may see a material exchange as part of nurturing or loving relationship.
The researchers stress the danger of over-simplifying descriptions of transactional sex into unidimensional portrayals. Their article attempts to provide a single conceptualisation of transactional sex: “non-commercial, non-marital sexual relationships motivated by the implicit assumption that sex will be exchanged for material support or other benefits”.
Within this, different women’s experiences at different times may be considered in terms of where they sit on three continua:
Taking account of the variety, ambiguity and complexity of women’s experiences is essential to designing effective interventions, they suggest.
Stoebenau K et al. Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature. Social Science & Medicine 168: 186–197, 2016. (Full text freely available.)
