IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v318y2023ics0277953622009479.html
   My bibliography  Save this article

Assessing risk factors and health impacts across different forms of exchange sex among young women in informal settlements in South Africa: A cross-sectional study

Author

Listed:
  • Stoebenau, Kirsten
  • Dunkle, Kristin
  • Willan, Samantha
  • Shai, Nwabisa
  • Gibbs, Andrew

Abstract

For women in South Africa, engaging in exchange sex, including transactional sex (TS), or sex work (SW), is associated with several shared poor health outcomes; yet the practices themselves differ in meaningful ways. SW is a form of commodity exchange, while TS is grounded in gendered relationship expectations of male provision and aspects of emotional intimacy. Additionally, exchange sex types could be imagined on a “continuum of instrumentality” from relationships that do not include material support; to those characterized, but not driven by support; to those primarily motivated by material support. We use cross-sectional data from 644 women ages 18-30 enrolled in a trial addressing intimate partner violence in urban KwaZulu-Natal, South Africa to assess whether these conceptualizations may also map onto different types or levels of risk. Using self-reports, we developed four exchange sex relationship categories corresponding to a continuum of instrumentality: no exchange-based relationship; TS with a main partner only; TS with a casual partner; and SW. Using tests of association and adjusted logistic regression models, we compared socio-economic and behavioural risk factors, and health outcomes across reported forms of exchange sex. We find little difference between women who report no exchange sex and those who report TS only with a main partner. By contrast, as compared to women not in exchange sex, women in casual TS and SW were poorer, and significantly more likely to report problematic alcohol use, past drug use, prior non-partner sexual violence, and PTSD; with aOR higher for women in SW for many outcomes. When comparing casual TS to SW, we find women in SW held more gender equitable attitudes and were more likely to report modern contraceptive use. We discuss the implications for distinguishing between TS and SW, and use of the continuum of instrumentality conceptualization for research and programming.

Suggested Citation

  • Stoebenau, Kirsten & Dunkle, Kristin & Willan, Samantha & Shai, Nwabisa & Gibbs, Andrew, 2023. "Assessing risk factors and health impacts across different forms of exchange sex among young women in informal settlements in South Africa: A cross-sectional study," Social Science & Medicine, Elsevier, vol. 318(C).
    • Handle: RePEc:eee:socmed:v:318:y:2023:i:c:s0277953622009479
    DOI: 10.1016/j.socscimed.2022.115637
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953622009479
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.115637?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Dunkle, Kristin L. & Jewkes, Rachel K. & Brown, Heather C. & Gray, Glenda E. & McIntryre, James A. & Harlow, Siobán D., 2004. "Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection," Social Science & Medicine, Elsevier, vol. 59(8), pages 1581-1592, October.
    2. Stoebenau, K. & Hindin, M.J. & Nathanson, C.A. & Rakotoarison, P.G. & Razafintsalama, V., 2009. ""... but then he became my sipa": The implications of relationship fluidity for condom use among women sex workers in Antananarivo, Madagascar," American Journal of Public Health, American Public Health Association, vol. 99(5), pages 811-819.
    3. Scorgie, Fiona & Khoza, Nomhle & Delany-Moretlwe, Sinead & Velloza, Jennifer & Mangxilana, Nomvuyo & Atujuna, Millicent & Chitukuta, Miria & Matambanadzo, Kudzai V. & Hosek, Sybil & Makhale, Lerato & , 2021. "Narrative sexual histories and perceptions of HIV risk among young women taking PrEP in southern Africa: Findings from a novel participatory method," Social Science & Medicine, Elsevier, vol. 270(C).
    4. Stoebenau, Kirsten, 2009. "Symbolic capital and health: The case of women's sex work in Antananarivo, Madagascar," Social Science & Medicine, Elsevier, vol. 68(11), pages 2045-2052, June.
    5. Jewkes, R. & Morrell, R., 2012. "Sexuality and the limits of agency among South African teenage women: Theorising femininities and their connections to HIV risk practises," Social Science & Medicine, Elsevier, vol. 74(11), pages 1729-1737.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Stoebenau, Kirsten & Heise, Lori & Wamoyi, Joyce & Bobrova, Natalia, 2016. "Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature," Social Science & Medicine, Elsevier, vol. 168(C), pages 186-197.
    2. Fielding-Miller, Rebecca & Dunkle, Kristin L. & Cooper, Hannah L.F. & Windle, Michael & Hadley, Craig, 2016. "Cultural consensus modeling to measure transactional sex in Swaziland: Scale building and validation," Social Science & Medicine, Elsevier, vol. 148(C), pages 25-33.
    3. Marshall Burke & Erick Gong & Kelly Jones, 2015. "Income Shocks and HIV in Africa," Economic Journal, Royal Economic Society, vol. 125(585), pages 1157-1189, June.
    4. Watt, Melissa H. & Aunon, Frances M. & Skinner, Donald & Sikkema, Kathleen J. & Kalichman, Seth C. & Pieterse, Desiree, 2012. "“Because he has bought for her, he wants to sleep with her”: Alcohol as a currency for sexual exchange in South African drinking venues," Social Science & Medicine, Elsevier, vol. 74(7), pages 1005-1012.
    5. Pronyk, Paul M. & Harpham, Trudy & Morison, Linda A. & Hargreaves, James R. & Kim, Julia C. & Phetla, Godfrey & Watts, Charlotte H. & Porter, John D., 2008. "Is social capital associated with HIV risk in rural South Africa?," Social Science & Medicine, Elsevier, vol. 66(9), pages 1999-2010, May.
    6. Jonathan Robinson & Ethan Yeh, 2011. "Transactional Sex as a Response to Risk in Western Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 35-64, January.
    7. Neetu A. John & Kirsten Stoebenau & Samantha Ritter & Jeffrey Edmeades & Nikola Balvin & UNICEF Office of Research - Innocenti, 2017. "Gender Socialization during Adolescence in Low- and Middle-Income Countries: Conceptualization, influences and outcomes," Papers indipa885, Innocenti Discussion Papers.
    8. Lori Hunter & John Reid-Hresko & Thomas Dickinson, 2011. "Environmental Change, Risky Sexual Behavior, and the HIV/AIDS Pandemic: Linkages Through Livelihoods in Rural Haiti," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 30(5), pages 729-750, October.
    9. Poulin, Michelle, 2007. "Sex, money, and premarital partnerships in southern Malawi," Social Science & Medicine, Elsevier, vol. 65(11), pages 2383-2393, December.
    10. Stadler, Jonathan J. & Delany, Sinead & Mntambo, Mdu, 2008. "Women's perceptions and experiences of HIV prevention trials in Soweto, South Africa," Social Science & Medicine, Elsevier, vol. 66(1), pages 189-200, January.
    11. Lauren Graham & Memory Mphaphuli, 2018. "“A Guy ‘Does’ and You Don’t, They Do You Instead†: Young People’s Narratives of Gender and Sexuality in a Low-Income Context of South Africa," SAGE Open, , vol. 8(4), pages 21582440188, December.
    12. Sandra I McCoy & Lauren J Ralph & Wema Wilson & Nancy S Padian, 2013. "Alcohol Production as an Adaptive Livelihood Strategy for Women Farmers in Tanzania and Its Potential for Unintended Consequences on Women’s Reproductive Health," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-10, March.
    13. Hadley, Craig & Maxfield, Amanda & Hruschka, Daniel, 2019. "Different forms of household wealth are associated with opposing risks for HIV infection in East Africa," World Development, Elsevier, vol. 113(C), pages 344-351.
    14. Chigbu, Uchendu Eugene, 2019. "Anatomy of women’s landlessness in the patrilineal customary land tenure systems of sub-Saharan Africa and a policy pathway," Land Use Policy, Elsevier, vol. 86(C), pages 126-135.
    15. Jewkes, Rachel & Dunkle, Kristin & Koss, Mary P. & Levin, Jonathan B. & Nduna, Mzikazi & Jama, Nwabisa & Sikweyiya, Yandisa, 2006. "Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors," Social Science & Medicine, Elsevier, vol. 63(11), pages 2949-2961, December.
    16. Leach, Fiona, 2006. "Researching gender violence in schools: Methodological and ethical considerations," World Development, Elsevier, vol. 34(6), pages 1129-1147, June.
    17. Rachel E. Baker, 2020. "Climate change drives increase in modeled HIV prevalence," Climatic Change, Springer, vol. 163(1), pages 237-252, November.
    18. Max-Louis G Buot & Jeffrey P Docena & Brenda K Ratemo & Matthew J Bittner & Jacob T Burlew & Aziz R Nuritdinov & Jennifer R Robbins, 2014. "Beyond Race and Place: Distal Sociological Determinants of HIV Disparities," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-15, April.
    19. Gibbs, Andrew & Abdelatif, Nada & Washington, Laura & Chirwa, Esnat & Willan, Samantha & Shai, Nwabisa & Sikweyiya, Yandisa & Jewkes, Rachel, 2020. "Differential impact on men in an IPV prevention intervention: A post hoc analysis using latent class analysis of the Stepping Stones and Creating Futures intervention in South Africa," Social Science & Medicine, Elsevier, vol. 265(C).
    20. Rock, Amelia & Barrington, Clare & Abdoulayi, Sara & Tsoka, Maxton & Mvula, Peter & Handa, Sudhanshu, 2016. "Social networks, social participation, and health among youth living in extreme poverty in rural Malawi," Social Science & Medicine, Elsevier, vol. 170(C), pages 55-62.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:318:y:2023:i:c:s0277953622009479. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.