title: Transactional sex and HIV risks - evidence from a cross-sectional national survey among young people in Uganda.
abstract: BACKGROUND
  Transactional sex is associated with the HIV epidemic among young people in Uganda. Few quantitative studies based on nationally representative survey data explored the relationship between sexual behaviors, HIV infection, and transactional sex.
  
  
  OBJECTIVE
  This study aimed to determine the associations between risky sexual behaviors, participation in transactional sex, and HIV sero-status among men and women aged 15-24 in Uganda.
  
  
  METHODS
  The study uses data from the Uganda AIDS Indicator Survey, a cross-sectional national HIV serological study conducted in 2011. We analyzed data on 1,516 men and 2,824 women aged 15-24 who had been sexually active in the 12 months preceding the survey. Private, face-to-face interviews were also conducted to record the sociodemographics, sexual history, and experiences of sexual coercion. Logistic regression analysis was performed to measure associations between sexual behaviors and transactional sex, and associations between HIV sero-status and transactional sex.
  
  
  RESULTS
  Among young people who had been sexually active in the 12 months prior to the survey, 5.2% of young men reported paying for sex while 3.7% of young women reported receiving gifts, favors, or money for sex. Lower educational attainment (ORadjusted 3.25, CI 1.10-9.60) and experience of sexual coercion (ORadjusted 2.83, CI 1.07-7.47) were significantly associated with paying for sex among men. Multiple concurrent sexual relationships were significantly associated with paying for sex among young men (ORadjusted 5.60, CI 2.08-14.95) and receiving something for sex among young women (ORadjusted 8.04, CI 2.55-25.37). Paying for sex among young men and having three to five lifetime sexual partners among young women were associated with increased odds of testing positive for HIV.
  
  
  CONCLUSIONS
  Transactional sex is associated with sexual coercion and HIV risk behaviors such as multiple concurrent sexual partnerships among young people in Uganda. In addition, transactional sex appears to place young men at increased risk for HIV in Uganda. Both sexes appear equally vulnerable to risks associated with transactional sex, and therefore should be targeted in intervention programs. In addition, strengthening universal education policy and improving school retention programs may be beneficial in reducing risky sexual behaviors and transactional sex.
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden; Vikas.Choudhry@med.lu.se.
authors.forename: Vikas
authors.initials: V
authors.lastname: Choudhry
authors.affiliation: Multidisciplinary Unit for Adolescent Health, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Anne-Emmanuelle
authors.initials: AE
authors.lastname: Ambresin
authors.affiliation: Institute of Interdisciplinary Training and Research (IITR), Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Viola Nilah
authors.initials: VN
authors.lastname: Nyakato
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Agardh
mesh_terms: D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012309:Risk-Taking; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult
keywords: HIV; Uganda; multiple concurrent sexual relationships; sexual coercion; transactional sex; young people