Systematic Review of HIV through the lens of Transactional Relationships for Adolescent Girls and Young Women in Sub-Saharan Africa Público

Abstract

In Sub-Saharan Africa, adolescent girls and young women (AGYW) between the ages of 15-24 have a risk of HIV up to five times higher than their male counterparts. One of the largest factors contributing to adolescent girls' and young women’s higher susceptibility to HIV are transactional sex relationships. In this context transactional sex is typically defined as a non-marital sexual relationship between an adolescent girl or young woman and an older man where there is a mutual understanding that financial or material gain such as money and gifts are expected in exchange for sex. Transactional sex relationships are distinguished from commercial sex work because financial and material exchanges for sex are made within the context of a relationship. Poverty and low educational attainment are typically identified as factors that influence AGYW to engage in these relationships. Even though this phenomenon puts AGYW at a higher risk for HIV this population have traditionally been excluded from public health research on HIV when identifying high-risk groups for HIV. The nature of transactional relationships. Existing transactional relationships also often coincide with multiple sex partners. AGYW often engage in transactional sex relationships with older married men while simultaneously being in committed romantic relationships with younger men. This common occurrence of multiple sex partners also contributes to the rapidly increasing spread of HIV.  This systematic review will discuss the topic of transactional sex relationships for adolescent girls and young women in Sub-Saharan Africa and the public health implications this has for the HIV epidemic. This systematic review will also analyze literature on transactional sex over the past 20 years to answer which key motivators allow transactional sex relationships to persist among this population.  

Table of Contents

Chapter 1: Introduction 

  1.1 Background and Significance ...............................1

1.2 Statement of Problem .........................................4

1.3 Statement of Purpose ..........................................4

1.4 Research Questions..............................................4

 Chapter 2: Methods 

   2.1 Literature ............................................................5

   2.2 Inclusion Criteria .................................................8

   2.3 Exclusion Criteria..................................................8 

Chapter 3: Results 

 3.1 Poverty....................................................................10

 3.2 Familial Pressure .....................................................13

 3.3 Educational Attainment ........................................... 14

 3.4 Luxury ..................................................................... 17 

 3.5 Peer Pressure.............................................................20 

 3.6 Cultural Gender Roles and Expectations ......................23

 3.7 Urban vs. Rural...........................................................26 

3.8 Agency.......................................................................28 

3.9 Multiple Partners .......................................................33

3.10 Age...........................................................................36

3.11 HIV...........................................................................38 

Chapter 4: Discussion 

4.1 Limitations................................................................44 

Chapter 5: Conclusion ........................................................45

Appendix................................................................................47

References...............................................................................48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Sub Saharan Africa Studies Health Sciences, Public Health
Palavra-chave	Young Women Adolescent Girls Sub-Saharan Africa Transactional Sex HIV
Committee Chair / Thesis Advisor	Andes, Karen L., Emory University

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