"Why should I put myself at risk for something that is useless?": Emic understandings of risky transactional sex in Swaziland Open Access

Fielding-Miller, Rebecca Kathleen (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/jw827c21p?locale=en


Introduction: Transactional sex is a risk factor for HIV. Qualitative studies have described how transactional relationships manifest in sub-Saharan Africa. However, the standard definition - the exchange of gifts or money for sex as distinct from sex work - does not allow differentiation between motives It requires relationships to be classified as either economically motivated or not -- despite the fact that all relationships may have a degree of economic and sexual obligation -- and does not account for women's emic perspectives.

Methods: We used cultural consensus modeling to build an emic scale of transactional sex that reflects Swazi women's lived experiences of sexual-economic exchange, conducted qualitative interviews to build a theory describing how women navigate the social and physical risks of transactional sex, and then tested this theory using structural equation modeling.

Results: Women in Swaziland are aware of the risk of HIV and carefully navigate both the social and physical risks of transactional sex. They value receiving different types of items from their partner depending on their relationship model, but do not necessarily see these relationships as economically motivated. Male economic support within socially sanctioned relationships is considered normative and highly respectable, but support in non-socially sanctioned relationships is stigmatized and considered unacceptable. In a path analysis, relationship agency had a significant effect on the risk pathways between transactional sex and HIV. Higher social status was associated with receiving more goods from a partner, while being called a nasty name associated with mercenary sexuality reduced social status and constrained agency intensified HIV stigma.

Discussion: Rather than being a single relationship type, some element of transactional sex is inherent in nearly all relationships and can have positive or negative effects on women's social standing. Different types of transactional relationships carry different risks. Future research and interventions should focus on how to best support women as they navigate health risks and the social landscape while considering gendered economic dynamics. HIV prevention strategies must acknowledge women's need to preserve a relationship to maintain social and economic stability.

Table of Contents

Chapter 1: Introduction. 1

Social drivers of HIV. 2

Transactional sex. 3

Motives. 4

Measurement. 5

Intervention approaches. 6

Theoretical considerations. 7

Social ecological model. 7

Hegemonic gender. 8

Current study. 10

Gaps in understanding. 10

Methods and approach. 11

Cultural consensus modeling. 11

Study setting. 13

Study aims. 14

References. 16

Chapter 2: Cultural consensus modeling to measure transactional sex in Swaziland: Scale building and validation. 24

Introduction. 25

Methods. 28

Setting. 28

Ethical considerations. 28

Study design. 28

What do women hope to get in exchange for sex?. 29

How are items valued in exchange for sex?. 29

Are there distinct transactional sex CCMs?. 30

How do transactional sex CCMs differ from one another qualitatively?. 30

How does participation in a CCM affect social status and condom use?. 30

Results. 32

What do Swazi women hope to get in exchange for sex?. 32

Are there distinct CCMs that value items differently?. 32

How do CCMs differ demographically?. 33

How are items valued in exchange for sex?. 33

How do transactional sex CCMs differ qualitatively?. 33

How does participation in a CCM affect social status and condom use?. 34

Discussion. 36

Technical Appendix. 39

Model Building Using Cultural Consensus Analysis, Multiple Regression Quadratic Assignment Procedures, and Exploratory Factor Analysis. 39

Table 1: CCM groups and answer keys. 43

Table 2: IDI quotes. 45

Table 3: ANC Survey Demographics. 46

Table 4: aOR of condom use at last sex and aRRR of social status by CCM consonance quartile. Validated against etic definition of transactional sex 47

Table 5: MRQAP. 48

References. 49

Chapter 3: "She is doing the wrong things for the right reasons": Navigating hegemonic femininity and risk in sexual-economic relationships. 53

Introduction. 54

Methods. 56

Setting. 56

Study Design. 57

Participants. 57

IDI Data collection. 58

FGD Data collection. 58

Analysis. 58

Ethical considerations. 59

Results. 60

Respectability and sexual reputations. 60

Relationship Models. 62

Inkhosikati. 64

Aspirational relationships. 67

University relationships. 70

Sugar daddies. 74

Discussion. 76

Table 1: Participant competence scores and demographics. 80

Table 2: Monogamy and condom use likelihood by relationship type. 81

Figure 1: Relationship models by social acceptability across the life course. 82

References. 83

Chapter 4: Constrained agency and HIV risk in transactional sex relationships. 87

Introduction. 88

Methods. 90

Setting. 90

Participants. 91

Ethical considerations. 91

Measures. 92

Analysis. 95

Results. 97

Sample. 97

Constrained agency measurement model. 98

Summary statistics. 98

Path model. 99

Discussion. 100

Conclusion. 104

Table 1: Select measures. 105

Table 2: Summary and bivariate data by group. 106

Table 3: Transactional sex score by variable for full sample and groups. 107

Figure 1: Path model. 108

Table 4: Model fit and standardized path coefficients. 109

References. 110

Chapter 5: Overview and implications for future research and theory. 114

Main findings. 115

Value of blended emic and etic perspectives. 115

Transactional sex as a scale, not a binary. 116

Women actively manage their social and physical risks. 117

Risk pathways differ depending on relationship circumstances. 118

Strengths and limitations. 119

Implications for theory. 120

Hegemonic masculinity and the social ecological model. 120

Southern theory. 121

Future research. 122

Transactional sex as a scale. 122

Gender and transactional sex. 123

Summary and contribution. 123

References. 124

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