Associations Between Mobility, Food Insecurity, and Transactional Sex Among Women in Cohabitating Partnerships: An Analysis From 6 African Countries 2016-2017

Abstract

Background: Mobile women are at risk of HIV infection in sub-Saharan Africa, although we lack evidence for HIV risk among women in mobile partnerships, especially in the context of household food insecurity, a growing concern in the region.

Setting: Women aged 15-59 years with a cohabitating male partner who participated in population-based HIV impact assessment surveys in Eswatini, Lesotho, Namibia, Tanzania, Uganda, and Zambia.

Methods: We evaluated the association between women's and their partner's mobility (being away from home for more than 1 month or staying elsewhere) and transactional sex (selling sex or receiving money or goods in exchange for sex). We examined associations for effect measure modification by food insecurity level in the household in the past month. We used survey-weighted logistic regression, pooled and by country, adjusting for individual, partner, and household-level variables.

Results: Among women with a cohabitating male partner, 8.0% reported transactional sex, ranging from 2.7% in Lesotho to 13.4% in Uganda. Women's mobility [aOR 1.35 (95% CI: 1.08 to 1.68)], but not their partner's mobility [aOR 0.91 (0.74-1.12)], was associated with transactional sex. Food insecurity was associated with transactional sex independent of mobility [aOR 1.29 (1.10-1.52)]. Among those who were food insecure, mobility was not associated with increased odds of transactional sex.

Conclusion: Food insecurity and women's mobility each increased the odds of transactional sex. Because transactional sex is associated with HIV risk, prevention programs can address the needs of mobile and food-insecure women, including those in cohabitating relationships.

Figure 1.. Adjusted odds ratios for transactional sex within the last 12 months among women aged 15-59 in a domestic or marital partnership in six sub-Saharan African countries, pooled and by country, 2016-2017, Model 2 (N = 19,317)

Note: For visualization purposes, the x-axis has been truncated to values between 0.0 and 5.0. Lesotho is missing cases of transactional sex in the “Both mobile” grouping. aOR adjusted for covariates in Model 2: food insecurity, gender of household head, wealth quintile, urban geography, woman and partner's age, type of partnership, woman and partner's education, and woman and partner’s employment Data presented in this figure can be found in Supplement, Table 3.