Transactional Sex and Incident HIV Infection in a Cohort of Young Women from Rural South Africa Enrolled in HPTN 068

Citation

Kilburn, Kelly N.; Ranganathan, Meghna; Stoner, Marie C. D.; Hughes, James P.; MacPhail, Catherine Lorne; Agyei, Yaw; Gómez-Olivé, F. Xavier; Kahn, Kathleen; & Pettifor, Audrey E. (2018). Transactional Sex and Incident HIV Infection in a Cohort of Young Women from Rural South Africa Enrolled in HPTN 068. AIDS, 32(12), 1669-1677. PMCID: PMC6082595

Abstract

OBJECTIVE: In sub-Saharan Africa, young women who engage in transactional sex (the exchange of sex for money or gifts) with a male partner show an elevated risk of prevalent HIV infection. We analyse longitudinal data to estimate the association between transactional sex and HIV incidence. DESIGN: We used longitudinal data from a cohort of 2,362 HIV negative young women (aged 13-20) enrolled in a randomized controlled trial in rural, South Africa who were followed for up to 4 visits over 6 years. METHODS: The effect of transactional sex on incident HIV was analysed using stratified Cox proportional hazards models and cumulative incidence curves. Risk ratios were estimated using log-binomial models to compare the effects across visits. RESULTS: HIV incidence was higher for young women that reported transactional sex (HR 1 59, 95% CI 1 02 - 2 19), particularly when money and/or gifts were received frequently (at least weekly) (HR 2 71, 95% CI 1 44 - 5 12). We also find that effects were much stronger during the main trial and dissipate at the post-intervention visit, despite an increase in both transactional sex and HIV. CONCLUSIONS: Transactional sex elevates the risk of HIV acquisition among young women, especially when it involves frequent exchanges of money and/or gifts. However, the effect was attenuated after the main trial, possibly due to the changing nature of transactional sex and sexual partners as women age. These findings suggest that reducing transactional sex among young women, especially during adolescence, is important for HIV prevention.

URL

http://dx.doi.org/10.1097/qad.0000000000001866

Reference Type

Journal Article

Year Published

2018

Journal Title

AIDS

Author(s)

Kilburn, Kelly N.
Ranganathan, Meghna
Stoner, Marie C. D.
Hughes, James P.
MacPhail, Catherine Lorne
Agyei, Yaw
Gómez-Olivé, F. Xavier
Kahn, Kathleen
Pettifor, Audrey E.

PMCID

PMC6082595

ORCiD

Pettifor - 0000-0002-3387-0817
Stoner - 0000-0002-7189-8669
Kilburn - 0000-0002-3069-3958