Transactional sex and HIV: understanding the gendered structural drivers of HIV in fishing communities in Southern Malawi.
BACKGROUND
In Southern Malawi, the fishing industry is highly gendered, with men carrying out the fishing and women processing, drying and selling the fish. Research has shown that individuals living in fishing communities in low-income countries are particularly vulnerable to HIV infection. One of the key drivers of HIV in fishing communities is transactional sex. In the fishing industry this takes the form of "fish-for-sex" networks where female fish traders exchange sex with fishermen for access to or more favourable prices of fish. By controlling the means of production, the power dynamics in these exchanges favour men and can make it more difficult for women to negotiate safe sex.


METHODS
Qualitative methods were used to collect data on gendered drivers of transactional sex in the fishing community and how different groups perceive HIV risk in these transactions. Observation, focus group discussions and semi-structured interviews were undertaken with members of the fishing communities, including men and women directly and indirectly involved in fishing.


RESULTS
In fishing communities transactional sex was prevalent across a spectrum ranging from gift giving within relationships, to sex for fish exchanges, to sex worker encounters. Power differences between couples in transactional sexual encounters shape individual's abilities to negotiate condom use (with women being at a particularly disadvantaged negotiating position). The context and motivations for transactional sex varied and was mediated by economic need and social position both of men and women. Female fish traders new to the industry and boat crew members who travelled for work and experienced difficult living conditions often engaged in transactional sex.


CONCLUSIONS
Transactional sex is common in Malawian fishing communities, with women particularly vulnerable in negotiations because of existing gendered power structures. Although knowledge and understanding of the HIV risk associated with transactional sex was common, this did not appear to result in the adoption of risk reduction strategies. This suggests that specially targeted strategies to increase women's economic empowerment and tackle the structural drivers of women's HIV risk could be important in fishing communities.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri 3 Blantyre, Malawi. emacp@liverpool.ac.uk
Eleanor E
EE
MacPherson
John
J
Sadalaki
Macdonald
M
Njoloma
Victoria
V
Nyongopa
Lawrence
L
Nkhwazi
Victor
V
Mwapasa
David G
DG
Lalloo
Nicola
N
Desmond
Janet
J
Seeley
Sally
S
Theobald
D000328:Adult; D000818:Animals; D043344:Chordata; D032882:Comprehension; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D011956:Receptors, Cell Surface; D012307:Risk Factors; D012737:Sex Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D055815:Young Adult
C097871:PLXNA3 protein, human; D011956:Receptors, Cell Surface