Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania

Katherine B. Rucinski; Gaspar Mbita; Kaitlyn Atkins; Esther Majani; Albert Komba; Caterina Casalini; Mary Drake; Neema Makyao; Anthony Galishi; Yeronimo Mlawa; Joyce Wamoyi; Sheree Schwartz; Stefan Baral; Kelly Curran

doi:10.3389/frph.2024.1360339

Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania

Katherine B. Rucinski^*
, Gaspar Mbita
, Kaitlyn Atkins
, Esther Majani
, Albert Komba
, Caterina Casalini
, Mary Drake
, Neema Makyao
, Anthony Galishi
, Yeronimo Mlawa
, Joyce Wamoyi
, Sheree Schwartz
, Stefan Baral
, Kelly Curran

^*Corresponding author for this work

Athena Institute

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Article number	1360339
Pages (from-to)	1-11
Number of pages	11
Journal	Frontiers in Reproductive Health
Volume	6
Early online date	11 Jul 2024
DOIs	https://doi.org/10.3389/frph.2024.1360339
Publication status	Published - 2024

Bibliographical note

Publisher Copyright:
2024 Rucinski, Mbita, Atkins, Majani, Komba, Casalini, Drake, Makyao, Galishi, Mlawa, Wamoyi, Schwartz, Baral and Curran.

Funding

This analysis was conducted under the Sauti Project, which received a grant from U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID), Grant number AID-AID-621-A-15-00003. The funder provided support in the form of salaries for the co-authors at Jhpiego and the co-author from USAID, who approved the submitted manuscript. KR was supported by an award through the National Institute of Mental Health (NIMH; K01MH129226) and an award through the National Institute of Infectious Diseases (NIAID; T32AI102623). KA was supported by NIMH awards (F31MH124583 and R25MH083620). SB received funding from NIAID award R01AI170249 and NIMH award R01MH110358. This publication was also made possible with help from the Johns Hopkins University Center for AIDS Research (P30AI094189), an NIH funded program, which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The contents are the authors\u2019 responsibility and do not necessarily reflect the views of USAID, PEPFAR, the National Institutes of Health, or the United States Government. Acknowledgments

Funders	Funder number
U.S. President’s Emergency Plan for AIDS Relief
National Institute of General Medical Sciences
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institute of Diabetes and Digestive and Kidney Diseases
Office of AIDS Research
National Institutes of Health
National Cancer Institute
National Institute on Drug Abuse
Fogarty International Center
National Heart, Lung, and Blood Institute
National Institute on Aging
National Institute of Mental Health	K01MH129226
National Institute of Allergy and Infectious Diseases	R01MH110358, R01AI170249, F31MH124583, T32AI102623, R25MH083620
United States Agency for International Development	AID-AID-621-A-15-00003
Johns Hopkins University	P30AI094189

Keywords

AGYW
epidemiology
HIV prevention
older partners
transactional sex

Access to Document

10.3389/frph.2024.1360339

Persistent URL (handle)

Persistent link

Cite this

Rucinski, K. B., Mbita, G., Atkins, K., Majani, E., Komba, A., Casalini, C., Drake, M., Makyao, N., Galishi, A., Mlawa, Y., Wamoyi, J., Schwartz, S., Baral, S., & Curran, K. (2024). Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania. Frontiers in Reproductive Health, 6, 1-11. Article 1360339. https://doi.org/10.3389/frph.2024.1360339

@article{cd4b7ad2764c43048b3ba18f4c86ea4a,

title = "Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania",

abstract = "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.",

keywords = "AGYW, epidemiology, HIV prevention, older partners, transactional sex",

author = "Rucinski, \{Katherine B.\} and Gaspar Mbita and Kaitlyn Atkins and Esther Majani and Albert Komba and Caterina Casalini and Mary Drake and Neema Makyao and Anthony Galishi and Yeronimo Mlawa and Joyce Wamoyi and Sheree Schwartz and Stefan Baral and Kelly Curran",

note = "Publisher Copyright: 2024 Rucinski, Mbita, Atkins, Majani, Komba, Casalini, Drake, Makyao, Galishi, Mlawa, Wamoyi, Schwartz, Baral and Curran.",

year = "2024",

doi = "10.3389/frph.2024.1360339",

language = "English",

volume = "6",

pages = "1--11",

journal = "Frontiers in Reproductive Health",

issn = "2673-3153",

publisher = "Frontiers Media SA",

}

Rucinski, KB, Mbita, G, Atkins, K, Majani, E, Komba, A, Casalini, C, Drake, M, Makyao, N, Galishi, A, Mlawa, Y, Wamoyi, J, Schwartz, S, Baral, S & Curran, K 2024, 'Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania', Frontiers in Reproductive Health, vol. 6, 1360339, pp. 1-11. https://doi.org/10.3389/frph.2024.1360339

TY - JOUR

T1 - Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania

AU - Rucinski, Katherine B.

AU - Mbita, Gaspar

AU - Atkins, Kaitlyn

AU - Majani, Esther

AU - Komba, Albert

AU - Casalini, Caterina

AU - Drake, Mary

AU - Makyao, Neema

AU - Galishi, Anthony

AU - Mlawa, Yeronimo

AU - Wamoyi, Joyce

AU - Schwartz, Sheree

AU - Baral, Stefan

AU - Curran, Kelly

N1 - Publisher Copyright: 2024 Rucinski, Mbita, Atkins, Majani, Komba, Casalini, Drake, Makyao, Galishi, Mlawa, Wamoyi, Schwartz, Baral and Curran.

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - AGYW

KW - epidemiology

KW - HIV prevention

KW - older partners

KW - transactional sex

UR - https://www.scopus.com/pages/publications/85199371862

UR - https://www.scopus.com/pages/publications/85199371862#tab=citedBy

U2 - 10.3389/frph.2024.1360339

DO - 10.3389/frph.2024.1360339

M3 - Article

AN - SCOPUS:85199371862

SN - 2673-3153

VL - 6

SP - 1

EP - 11

JO - Frontiers in Reproductive Health

JF - Frontiers in Reproductive Health

M1 - 1360339

ER -

Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania

Abstract

Bibliographical note

Funding

Keywords

Access to Document

Persistent URL (handle)

Other files and links

Fingerprint

Cite this