Intergenerational and Transactional Sex in Hyper-endemic Countries
Putting It Into Practice
Program Guidelines and Standards
The section below highlights some interventions and recommendations to address intergenerational (IG) and transactional sex (TS). Programming that targets IG and TS is an emerging area and few evaluations have been conducted on these programs. As a result, the programs highlighted below comprise a small sample and do not capture all IG and TS interventions in the field.
Integrating Multiple Gender Strategies to Improve HIV and AIDS Intervention: A Compendium of Programs in Africa
International Center for Research on Women (2009).
The President’s Emergency Plan for AIDS Relief (PEPFAR) has articulated five focus areas in its gender framework. This compendium examines four of the five PEPFAR gender strategies being implemented in 31 programs in Africa integrating two or more of these areas, including: (1) reducing violence and sexual coercion, (2) addressing male norms and behaviors, (3) increasing women’s legal protection, and (4) increasing women’s access to income and productive resources. The compendium provides insights on how strategies are employed together, where gaps exist and what lessons and experiences are common across programs. Though not meant to be exhaustive, the compendium represents the depth and breadth of current HIV programming that includes multiple gender strategies.
Researching and designing interventions in a slum: using female out-of-school youth as researchers in Nigeria
AIDS- XVII International AIDS Conference (2008), Abstract no. MoPE08_3
Ocholi, J., et al.
Out-of-school female youth is a difficult to reach target population in HIV and AIDS prevention interventions. This program involved working with 36 out-of-school female youth as researchers, then using the research results in the design and implementation of an HIV and AIDS project. It was found that young women shared more information with the peer researchers than they would outsiders. Community-wide events for parents were also implemented such as theatre performances and house visits. Some young woman reported that their parents encouraged them to engage in intergenerational sex. The study also found that female-targeted activities would have more impact on this target group then joint male/female youth programs. Involving out of school female youth throughout the research and program design process and involving parents in activities to reduce transactional sex are the good practices demonstrated by this project.
Introduction: Addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa
AIDS (2008), Vol. 22 Supp. 4, pp. S1–S3
Stirling, M., et al.
Despite emerging evidence of declining HIV prevalence in countries such as Uganda, the levels of infection and vulnerability among young women aged fifteen to nineteen years in countries such as South Africa and Botswana remain unchanged, pointing to a continuing failure of HIV prevention efforts in this age group. It is crucial that proven interventions such as delayed sexual debut; reduced numbers of sexual partners, particularly concurrent partners; reduced age-disparate sex; increased condom use; increased male circumcision; and greater access and use of HIV counseling and testing services be implemented concurrently and scaled up to national coverage levels. Fully engaged and committed leadership at the local and national level is needed in order to implement these activities concurrently. These activities must be guided by strategies and processes defined by local communities to address their specific contexts and the existing gaps from the state to individual levels.
HIV prevention for young people through the education sector in Zambia
AIDS- XVII International AIDS Conference (2008), Abstract no. WEPE0_1
Woods, J., et al.
HIV incidence among youth in Zambia does not seem to be decreasing, and female youth are more likely to be infected than boys. Higher-risk behaviors such as intergenerational sex, transactional sex and multiple concurrent partnerships are normalized. The education sector is attempting to address these behaviors through an in-school intervention called CHANGES2, which targets primary school students and addresses barriers to safer sexual behaviors at both the individual and community levels. School-community partnerships are formed in communities to identify and analyze local risk factors. Some risk factors that were identified included student-teacher sexual relationships, gender roles that support men in having multiple partners, and lack of economic opportunities for girls. Data showed that including these partnerships into the program has had a significant positive effect on attitudes towards more equality in gender relations and a decreased tolerance for gender-based violence.
Addressing Cross-Generational Sex: a Desk Review of Research and Programs.
Population Reference Bureau (2007),
Hope, R.
This extensive review of intergenerational (IG) sex examines the range of programmatic approaches available to prevent or reduce IG sex. The review uses the “continuum of volition” framework used by Save the Children to explore the drivers of IG and transactional sex (TS). The framework assumes that not all young people are vulnerable and/or passive in entering cross-generational sexual relationships. Some empowered youth choose to engage in relationships for “security gains” (emotional or economic). Further along the continuum, “economically rational sex” ranges from sex for “desired material benefits” to sex for survival. At the other end of the continuum are coerced sex and sexual violence, where young women and boys are forced to participate. This end represents power asymmetries and lack of regard for women’s and girls’ health and well-being. The review looks at the approaches used by existing programs to address IG and TS such as: (1) creating youth livelihood opportunities, (2) mobilizing and empowering youth to adopt healthy lifestyles, (3) social advocacy, (4) social marketing and “edutainment,” (5) health education and youth rights, (6) addressing power asymmetries, inequity, and poverty, and (7) addressing social and gender norms, including working with men. Despite a gap in concrete evidence on how to reduce TS and IG sexual relationship, the review includes ten recommendations that programs can incorporate into their activities and strategies to reduce TS and IG sexual relations.
Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey
AIDS (2006), Vol. 4 No. 20, pp. 955-956
Pettifor, A. E., et al.
The objectives of this study, conducted in 2003, were to determine factors of HIV and AIDS prevalence among South African youth fifteen to twenty-four years old by exploring HIV risk factors and exposure to a national HIV prevention campaign called LoveLife. The study confirmed young women’s increased risk for HIV infection. Some key findings from the survey were that young women were significantly more likely to be infected with HIV in comparison to their male peers (15.5 percent verses 4.8 percent), and that young women with older partners were at an increased risk of HIV infection. Youth were also less likely to be infected with HIV if they reported participation in at least one LoveLife program. In addition, a number of programmatic recommendations were given including a continual reinforcement of messages on partner reduction as well as addressing contextual factors that were barriers for behavioral change.
Cross-Generational Relationships: Using a ‘Continuum of Volition’ in HIV prevention work among young people.”
Gender & Development (2006), Vol. 14 No. 1, pp. 81-94
Weissman, A., et al.
The drivers of intergenerational (IG) and transactional sex (TS) relationships occur along a “continuum of volition.” This continuum suggests that not all young people are vulnerable and/or passive when involved in sexual relationships with persons who are older or more powerful. Rather, there are empowered youth who choose to engage in sexual relationships with older people for emotional reasons; young people who engage in ‘economically rational sex’ for material things such as clothes or passing grades; and youth involuntarily coerced into sex. This paper reviews the use of a program planning tool to locate individual adolescent girls along the continuum and develop appropriate strategies to resist unwelcomed propositions from men in Malawi. The authors suggest that more reflection is needed on why TS and IG are defined as problematic and what aspects are of concern given that IG relationships occur all over the world. When defining TS and IG relationships as problematic, it is important to understand the choices, or lack thereof, that young women have and to address concerns of inequality within the socio-economic context in which they occur.
The factors influencing transactional sex among young men and women in 12 sub-Saharan African countries
Social Biology (2005), Vol. 52 No. 1-2, pp. 56-72
Chatterji, M., et al.
Twelve Demographic and Health Surveys from Sub-Saharan Africa were used in secondary data analysis to explore how transactional sex affects the risk of HIV/AIDS infection for young men and women. It was found that these young people more likely to engage in transactional sex compared to older people. Married youth were also less likely to engage in transactional sex compared to unmarried youth. Therefore, programs to reduce transactional relationships and/or to reduce the risk in these relationships should focus on young unmarried men and women.
Stepping Stones: A training package on HIV/AIDS, communication and relationship skills
Actionaid London, Strategies For Hope Training (1995), Vol. 1 No. 1
Welbourn, A.
Stepping Stones is an HIV prevention program that aims to improve sexual health through building stronger, more gender-equitable relationships with better communication between partners. The program started in Uganda and has been used in over 100 countries. It uses participatory learning techniques to develop self-awareness and knowledge about sexual health, the consequences of risk-taking, and communication skills between partners. In addition, Stepping Stones has developed a manual to train and educate men and women for up to eighteen weeks, during which time participants critically assess the societal norms and values influencing their attitudes and behaviors and identify changes they should make in order to protect themselves and others from HIV. Additionally, this training helps to bring about more general life changes and improvements, such as improved communication with their partners and children, more understanding and caring for others and increased self-respect. In 2007, the program in rural Eastern Cape Province, South Africa, was evaluated by the South African Medical Research Council. It was found that men in the program were as likely as men in control communities to have had a casual partner in the last twelve months, but a significantly lower proportion of men in the program reported having had transactional sex.
Evaluation of Stepping Stones: A gender transformative HIV prevention intervention
South African Medical Research Council (2007),
Jewkes, R., et al.
This brief describes the background and objectives of the Stepping Stones project as well as its key features. An evaluation was conducted in South Africa that had both qualitative and quantitative components. The brief goes into detail about the results of the study and demonstrates the positive impact the project had on young people’s attitudes and behaviors; it shows there was some evidence of it lowering HIV and HSV 2 infection rates.
Program Reports and Briefs
Technical Meeting on Young Women in HIV hyper-endemic Countries of Southern Africa
Intergenerational/age-disparate sex, Policy and Programme Action Brief, UNAIDS, RHRU (2008),
Leclerc-Madlala.
The brief outlines what was discussed at the Technical Meeting on Young Women in HIV Hyper-endemic Countries in Southern Africa. It provides policy and action recommendations including rapidly and greatly increasing programs that work directly with men to challenge the socio-cultural norms that allow for and sanction engagement in age-disparate sex; rapidly and greatly increasing programs aimed at empowering young women and raising risk-perception regarding involvement in age-disparate relationships; and working with cultural idioms and socio-moral frames that distinguish between normative relationships and prostitution.
Addressing the vulnerability of young women & girls to stop the HIV epidemic in southern Africa
UNAIDS (2008).
This report outlines the research and discussions of a technical meeting held in June 2008, supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Reproductive Health and HIV Research Unit of the University of Witwatersrand in South Africa. Several technical papers were presented and included the current status of the epidemic in southern Africa, age-disparate and intergenerational sex, biological vulnerability, economic empowerment, education and gender-based violence.
Cross-Generational Sex: Risks and Opportunities
USAID Technical Brief- Interagency Youth Working Group, Interagency Gender Working Group and Population Reference Bureau (2008).
This brief outlines what is known about cross-generational sexual relationships and their effect on young women’s HIV vulnerability in terms of epidemiology, increased behavioral risk factors, programmatic practices, and lessons learned from promising interventions.
Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions
World Health Organization (2007).
Research with men and boys has shown how inequitable gender norms influence how men interact with their partners, families and children on a wide range of issues, including preventing the transmission of HIV and sexually transmitted infections, contraceptive use, physical violence against women and between men, domestic chores, parenting and their health-seeking behavior. This review assessed the effectiveness of programs seeking to engage men and boys in achieving gender equality and equity in health and highlights successful program characteristics. Programs were rated on their gender approach using the following categories: gender neutral, gender sensitive, and gender transformative. Key findings were: (1) well designed programs do lead to changes in attitudes and behavior, (2) programs rated as being ‘gender transformative’ had a higher rate of change, (3) Integrated programs and programs within community outreach, mobilization and mass-media campaigns show more effectiveness in producing behavior change, (4) behavior change occurred in all program areas (e.g., sexual and reproductive health, HIV prevention) and in all types of programs (e.g., group education, service based) and (5) relatively few programs with men and boys went beyond the pilot stage or a short-term time frame.
The Young Empowered and Healthy (Y.E.A.H.) Initiative
Health Communication Partnership (2004 – 2007).
This program was implemented from 2004 to 2007 in Uganda as a coalition of community organizations and Young People's Advisory Groups, under the auspices of the Uganda AIDS Commission HIV and AIDS Partnership. Its purpose was to improve health and social practices among young people through improved and coordinated behavior change communication efforts. The initiative developed by and for young people ages fifteen to twenty-four, combined mass media, person-to-person dialogue, and community media. The mission of the Young Empowered and Healthy (Y.E.A.H.) initiative was to stimulate discussion and action among communities, families, schools, and health institutions, and through the use of local and national media encourage positive practices. The program developed a series of materials called “Something for Something,” that raised the issue of the long-term consequences of short term material gain through intergenerational or transactional sex for both men and girls. The program attempted to change male sexual norms through campaigns such as, “Be a Man” wherein men discouraged their friends from engaging in “something for something’ relationships.
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