Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis
This review concluded that transactional sex is associated with HIV among women, whereas findings for men were inconclusive
Introduction: Young women aged 15 to 24 years in sub-Saharan Africa continue to be disproportionately affected by HIV. A growing number of studies have suggested that the practice of transactional sex may in part explain women’s heightened risk, but evidence on the association between transactional sex and HIV has not yet been synthesized. The author set out to systematically review studies that assess the relationship between transactional sex and HIV among men and women in sub-Saharan Africa and to summarize the findings through a meta-analysis.
Methods: The search strategy included 8 databases, hand searches in 10 journals, and searches across 17 websites and portals for organizations as informed by expert colleagues. A systematic review of cross-sectional and longitudinal studies was carried out for studies on women and men who engage in transactional sex published up through 2014. Random effects meta-analysis was used to further examine the relationship between transactional sex and prevalent HIV infection across a subset of studies with the same exposure period. Analyses were conducted separately for men and women.
Conclusions: Transactional sex is associated with HIV among women, whereas findings for men were inconclusive. Given that only two studies used a longitudinal approach, there remains a need for better measurement of the practice of transactional sex and additional longitudinal studies to establish the causal pathways between transactional sex and HIV.
This research is supported by the Department for International Development’s STRIVE Programme which is led by London School of Hygiene and Tropical Medicine (LSHTM)
Joyce Wamoyi, Kirsten Stobeanau, Natalia Bobrova, Tanya Abramsky and Charlotte Watts. Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. Journal of the International AIDS Society 2016 19:20992 DOI: 10.7448/IAS.19.1.20992