title: Community environments shaping transactional sex among sexually active men in Malawi, Nigeria, and Tanzania.
abstract: Transactional sex, or the exchange of sex for material goods or money, is a risky sexual behavior that has been linked to HIV/AIDS and gender-based violence. Throughout sub-Saharan Africa, transactional sex remains a common practice, putting men and women at risk of HIV. However, little is known of how community environments shape men's participation in risky transactional sex. This analysis examines community-level influences on participation in risky transactional sex among sexually active men in three African countries (Malawi, Tanzania, and Nigeria). The analysis uses Demographic and Health Survey (DHS) data to examine the association between men's report of risky transactional sex and community characteristics including economic, gender norms, HIV behavior and knowledge, and demographic factors. The results show that men residing in communities with more female education and later age of first birth are less likely to report risky transactional sex, while men who live in communities where men report higher number of sexual partners are more likely to report risky transactional sex. While programmatic interventions should continue to improve women's status individually and relative to men, such efforts should be extended to recognize that many community and cultural influences also affect men's sexual behavior. Programs that understand, discuss, and challenge community factors that influence men's sexual behavior may be able to provide a more effective intervention resulting in opportunities for communities to initiate behavioral change.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emroy University, Atlanta, GA, USA. rbsteph@sph.emory.edu
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.forename: Amy
authors.initials: A
authors.lastname: Winter
authors.forename: Miriam
authors.initials: M
authors.lastname: Elfstrom
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000367:Age Factors; D003430:Cross-Sectional Studies; D004467:Economics; D004522:Educational Status; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012111:Residence Characteristics; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012747:Sexual Partners; D012931:Social Environment; D013636:Tanzania / Q000453:epidemiology; D014754:Violence; D055815:Young Adult