IDEAS home Printed from
   My bibliography  Save this article

Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection


  • Dunkle, Kristin L.
  • Jewkes, Rachel K.
  • Brown, Heather C.
  • Gray, Glenda E.
  • McIntryre, James A.
  • Harlow, Siobán D.


Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing. Private face-to-face interviews covered socio-demographics, sexual history and experience of gender-based violence. 21.1% of participants reported having ever had sex with a non-primary male partner in exchange for material goods or money. Women who reported past experience of violence by male intimate partners, problematic substance use, urban residence, ever earning money, or living in substandard housing were more likely to report transactional sex, while women who reported delayed first coitus, were married, or had a post-secondary education were less likely to report transactional sex. Transactional sex was associated with HIV seropositivity after controlling for lifetime number of male sex partners and length of time a woman had been sexually active (OR=1.54, 95% CI: 1.07, 2.21). Women who reported non-primary partners without transactional sex did not have increased odds of being HIV seropositive (OR=1.04, 95% CI: 0.75, 1.43). We conclude that transactional sex may place women at increased risk for HIV, and is associated with gender-based violence, substance use and socio-economic disadvantage. Research, policy and programmatic initiatives should consider the role of transactional sex in women's HIV risk, with attention to the intersecting roles of violence, poverty, and substance use in shaping women's sexual behaviour.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:socmed:v:59:y:2004:i:8:p:1581-1592

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

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


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Durevall, Dick & Lindskog, Annika, 2012. "Economic Inequality and HIV in Malawi," World Development, Elsevier, vol. 40(7), pages 1435-1451.
    2. 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.
    3. Hunter, Mark, 2007. "The changing political economy of sex in South Africa: The significance of unemployment and inequalities to the scale of the AIDS pandemic," Social Science & Medicine, Elsevier, vol. 64(3), pages 689-700, February.
    4. Poulin, Michelle, 2007. "Sex, money, and premarital partnerships in southern Malawi," Social Science & Medicine, Elsevier, vol. 65(11), pages 2383-2393, December.
    5. Leach, Fiona, 2006. "Researching gender violence in schools: Methodological and ethical considerations," World Development, Elsevier, vol. 34(6), pages 1129-1147, June.
    6. 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.
    7. 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.
    8. Needle, Richard & Kroeger, Karen & Belani, Hrishikesh & Achrekar, Angeli & Parry, Charles D. & Dewing, Sarah, 2008. "Sex, drugs, and HIV: Rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa," Social Science & Medicine, Elsevier, vol. 67(9), pages 1447-1455, November.
    9. 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.
    10. Choi, Susanne Y.P. & Cheung, Yuet Wah & Chen, Kanglin, 2006. "Gender and HIV risk behavior among intravenous drug users in Sichuan Province, China," Social Science & Medicine, Elsevier, vol. 62(7), pages 1672-1684, April.
    11. 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.
    12. Hirsch, Jennifer S., 2014. "Labor migration, externalities and ethics: Theorizing the meso-level determinants of HIV vulnerability," Social Science & Medicine, Elsevier, vol. 100(C), pages 38-45.
    13. 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.
    14. Dunkle, Kristin L. & Jewkes, Rachel & Nduna, Mzikazi & Jama, Nwabisa & Levin, Jonathan & Sikweyiya, Yandisa & Koss, Mary P., 2007. "Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: Prevalence, predictors, and associations with gender-based violence," Social Science & Medicine, Elsevier, vol. 65(6), pages 1235-1248, September.
    15. 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.
    16. Burke, Marshall & Gong, Erick & Jones, Kelly, 2011. "Income shocks and HIV in Sub-Saharan Africa:," IFPRI discussion papers 1146, International Food Policy Research Institute (IFPRI).
    17. Leigh Johnson & Rob Dorrington & Debbie Bradshaw & Victoria Pillay-Van Wyk & Thomas Rehle, 2009. "Sexual behaviour patterns in South Africa and their association with the spread of HIV: insights from a mathematical model," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 21(11), pages 289-340, September.
    18. Stadler, Jonathan & Delany-Moretlwe, Sinead & Palanee, Thesla & Rees, Helen, 2014. "Hidden harms: Women's narratives of intimate partner violence in a microbicide trial, South Africa," Social Science & Medicine, Elsevier, vol. 110(C), pages 49-55.
    19. 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.
    20. 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.
    21. Fielding-Miller, Rebecca & Dunkle, Kristin L. & Jama-Shai, Nwabisa & Windle, Michael & Hadley, Craig & Cooper, Hannah L.F., 2016. "The feminine ideal and transactional sex: Navigating respectability and risk in Swaziland," Social Science & Medicine, Elsevier, vol. 158(C), pages 24-33.


    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:59:y:2004:i:8:p:1581-1592. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    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.

    We have no references for this item. You can help adding them by using 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.