Intergenerational and Transactional Sex in Hyper-endemic Countries

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Hyper-endemic scenarios, where HIV prevalence is over fifteen percent in the general adult population driven through extensive heterosexual multiple concurrent partner relations¹ are occurring in sub-Saharan Africa. Almost two-thirds of all young people with HIV live in sub-Saharan Africa and 75 percent of all infections among young people aged fifteen to twenty-four years are among young women.² Young women are two to four and a half times more likely to be infected than their male counterparts. For example, in South Africa, 15.5 percent of women aged fifteen to twenty-four are HIV-infected compared to 4.8 percent of men the same age. One hypothesis for this higher HIV infection rate is that younger women are having relationships with older men who are more likely to be HIV infected than younger men. When young women have sexual relationships with men who are older, these relationships are referred to as ‘intergenerational’ (IG) or cross-generational relationships. Intergenerational relationships often, but not always, involve the exchange of goods or money for sex, i.e., transactional sex (TS).

Both the United Nations Joint Programme on HIV/AIDS (UNAIDS) general population survey and the Demographic Health Surveys define IG sex as having a partner ten years or older. Intergenerational and TS can include sexual relationships between adult women with younger men and older men engaging in IG and TS with younger men; the emphasis in this document will be on IG and TS involving older men and young women.

There is direct evidence that intergenerational relationships place young women at high risk for HIV infection. For example, one study in Uganda demonstrated that HIV risk doubled for women who were fifteen to nineteen years old when they had a partner ten years or older compared to those who had partners who were zero to four years older. Some researchers have expanded the definition of intergenerational partnerships to include those in which the male partner is five years or older since there is also an increased risk of HIV infection as a result of this age difference.

The research literature recognizes that there is a continuum from coercion and vulnerability to active agency that factors into intergenerational and transactional relationships. One extreme is coercion in which girls and women have no control of when and with whom they have sex. Engaging in sex to meet basic survival needs, i.e., food, shelter, and clothing, is another motivator for IG sex. Globalization, civil conflict, displacement, and food insecurity have heightened the economic conditions that lead to poverty, and sex in exchange for economic or material support is one way for young people to survive. On the other hand, for some young women the motivation to engage in intergenerational and transactional sex are numerous and often intertwined, including strategies to find love and affection, a marriage partner³ and the desire for economic security or economic comfort, i.e., wants rather than needs. Given the lack of access to other resources some women willingly initiate relationships with older men and use transactional sex as a way to increase their power and social status. However, despite these young women’s control over establishing or terminating transactional relationship with older men, several studies have demonstrated men have a great degree of bargaining power within sexual partnerships, specifically condom use and sexual activities.

A key theme that emerges from the literature is that effective programming will have to be responsive to the context that influences sexual behavior, among adult men as well as adolescents. Promising practices have included a combination of micro-economic approaches linked with interpersonal and community activities that challenge socio-cultural norms that allow for age-disparate sex and empower girls and women to make healthier sexual decisions. Leaders in the field also call for greater involvement of men in HIV and AIDS prevention programs that challenge social and gender norms. Experts call for more programs that address intergenerational partnerships as well as evaluations to assess their impact.

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