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

Bibliographic Data

ID4592803
AuthorsKirsten Stoebenau (0000-0002-6531-1892, University of Maryland, College Park, corresponding author), Kristin Dunkle (0000-0003-3071-5544, South African Medical Research Council), Samantha Willan (0000-0001-8629-887X, South African Medical Research Council), Nwabisa Shai (0000-0003-4171-9129, South African Medical Research Council), A Gibbs (0000-0003-2812-5377, University of Exeter)
Year2023
Volume318
Pages115637
Publication date2023-02-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2022.115637
PMID36628880
OpenAlexW4313478447
LanguageEN
Citations received14
References cited39

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

Casual · Cross-sectional study · Developmental psychology · Domestic violence · Environmental health · Family medicine · Human immunodeficiency virus (HIV · Injury prevention · Poison control · Political science · Population · Public health · Reproductive health · Sex work · Sociology · Transactional sex · Adolescent Sexual and Reproductive Health · Demography · HIV, Drug Use, Sexual Risk · Medicine · Psychology · Sex work and related issues · Social Psychology