Three Integrated Elements of Empowerment: HIV Prevention With Sub-Saharan African Adolescent Females Involved in Transactional Sex

Abstract

While the term “transactional sex” has garnered increased attention, little is known about what it truly encompasses, or how it leads to HIV risk within the specific developmental period of adolescence. We therefore introduce a model to characterize why girls in in sub-Saharan Africa engage in transactional sex, and how this may contribute to their decisions around how, whether, and when to implement HIV/sexually transmitted infection (STI) prevention efforts. This model forms the foundation for our adolescent-specific HIV prevention efforts for young girls in sub-Saharan Africa. Within this topical review, we detail how this intervention has been adapted for cross-cultural fit and congruence, as well as for developmental factors in transactional sex decision-making, including practical avenues to navigate peer and partner risk. Together, this model and related HIV prevention program focus on empowering young girls in sub-Saharan Africa as they begin to make decisions about whether and when to engage in transactional sex, by providing girls with critical HIV risk reduction skills during this time of rapid transition into HIV/STI risk behavior.

Implications for Impact Statement

While “transactional sex” has gained recent attention, little is known about what it means, particularly for adolescent girls in sub-Saharan Africa, and how it is connected to critical health behaviors, including unprotected sex that leads to HIV. This is important, given that adolescents (ages <21) have very low rates of uptake and adherence to HIV prevention even when those options are available.