title: Alcohol Use and Transactional Sex among Women in South Africa: Results from a Nationally Representative Survey.
abstract: BACKGROUND
  Transactional sex is a risk factor for HIV infection. Alcohol use may increase the risk of transactional sex. No nationally-representative studies have examined the relationship between multiple dimensions of alcohol use and transactional sex in women in South Africa. The aim of the study was to examine the relationship between alcohol dependence, binge drinking and frequency of drinking in the past month and transactional sex in adult women in South Africa.
  
  
  METHODS
  A cross-sectional study using multi-stage, cluster sampling collected data from a nationally representative sample of 5,969 women aged 16-55 years in 2012. The analysis conducted for this paper was restricted to women reporting sexual activity in the past 12 months (n = 3,594). Transactional sex was defined as having received money/gifts in exchange for sex with any sex partner in the past year. Alcohol use measures included: alcohol dependence (≥2 positive responses to the CAGE questionnaire); binge drinking (≥4 drinks for women on one occasion); and drinking frequency in the previous month. Logistic regression models were built to test the hypotheses that each dimension of alcohol use was associated with transactional sex.
  
  
  RESULTS
  About 6.3% (n = 225) of sexually active women reported transactional sex. Almost a third (30.6%) of sexually active women had ever drunk alcohol, and 19.2% were current (past month) drinkers. Among lifetime drinkers, 28.0% were alcohol dependent and 56.6% were binge drinkers. Alcohol dependent women were twice as likely to report transactional sex (AOR 2.0, 95% CI 1.1-4.3, p<0.05) than those not alcohol dependent. Binge drinkers were 3.1 times more likely to have had transactional sex (95% CI 1.5-6.6, p<0.01) than non-binge drinkers. There was no significant relationship between frequency of drinking in the past month and transactional sex.
  
  
  CONCLUSIONS
  Alcohol dependency and binge drinking are significantly associated with transactional sex in South African women. HIV prevention programmes need to target these women, and address both their alcohol use, as well as the HIV risks associated with transactional sex.
authors.affiliation: University of the Witwatersrand, Johannesburg, South Africa.|Anansi Health Consulting, Johannesburg, South Africa.
authors.forename: Sarah
authors.initials: S
authors.lastname: Magni
authors.affiliation: University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nicola
authors.initials: N
authors.lastname: Christofides
authors.affiliation: Anansi Health Consulting, Johannesburg, South Africa.
authors.forename: Saul
authors.initials: S
authors.lastname: Johnson
authors.affiliation: University of the Witwatersrand, Johannesburg, South Africa.|Soul City Institute for Health and Development Communication, Johannesburg, South Africa.
authors.forename: Renay
authors.initials: R
authors.lastname: Weiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D057566:Self Report; D011477:Sex Work; D060386:Sex Workers; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult