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African Journal of Reproductive Health
Women's Health and Action Research Centre
ISSN: 1118-4841
Vol. 8, Num. 2, 2004, pp. 13-37

African Journal of Reproductive Health, Vol. 8, No. 2, Aug, 2004 pp. 13-37

REVIEW ARTICLE

Young People's Relationships with Sugar Daddies and Sugar Mummies: What do We Know and What do We Need to Know?

Barthelemy Kuate-Defo

Correspondence: Professor Barthelemy Kuate-Defo, University of Montreal's Hospitals-Clinics (CHUM) Research Center & Director, PRONUSTIC Research Laboratory, University of Montreal, C.P. 6128 Succursale Centre-Ville, Montreal QC H4A 2L2, Canada. Tel: (514) 343-7611; Fax: (514) 343-2309; Email: barthelemy.kuate.defo@umontreal.ca

Code Number: rh04023

Abstract

This paper critically synthesises available research that examines young people's relationships with sugar daddies and mummies. It considers definitional, measurement and analytical issues involved in assessing these relationships, their magnitude, patterns, determinants and consequences. The review compares and contrasts the experiences of young people in a variety of settings in developing countries versus developed countries, and identifies key associated factors perpetuating those relationships. The implications of this endeavour for data needs and future research and intervention studies targeted at promoting young people's health and well being are discussed within the contexts of globalisation and localisation and recommendations for dealing with these experiences. (Afr J Reprod Health 2004; 8[2]:13-37)

Key Words: Sugar daddies/mummies, young people, sexual and reproductive health, STI, HIV/AIDS

Résumé

Rapports des jeunes gens avec leurs vieux protecteurs et leurs vieilles protectrices: que savons-nous et que faut-il savoir? Cet article fait, des façon critique, la synthèse de la recherche disponible sur les études des rapports des jeunes gens avec leurs vieux protecteurs et vieilles protectrices. Il étudie les questions concernant les définitions, les mesures et les analyses impliquées dans l'évaluation de ces rapports, leur ampleur, leurs modes, leurs déterminants et leurs conséquences. L'étude fait la comparaison et le contraste des expériences des jeunes gens dans des cadres divers dans les pays en voie de développement par rapport aux pays développés. Elle identifie en même temps les facteurs associés clé qui perpectuent ces rapports-là. L'étude discute les implications de cet effort pour les banques de données et pour les études de recherches et d'intervention futures qui visent la promotion de la santé et du bien-être des jeunes gens dans le contexte de la mondialisation et de la localisation et des recommendations qui permettront de s'occuper de ces expériences. (Rev Afr Santé Reprod 2004; 8[2]:13-37)

Introduction

There is a great deal of research on cross-generational, intra-generational and inter-generational sexual relationships both in developed and developing countries.1-5 These relationships can be considered broadly as relationships within and across generational configurations (adolescence, youthhood, adulthood, midlife and elderly). Across countries, societies and cultures in human history, such relationships have been of heterosexual or homosexual nature.2,3,6 They may be free, transactional, exploitative, coercive or unlawful. Many theories exist on human sexuality, motives, associated factors and consequences of sexual activity.7-10 Available evidence suggests that young people in many countries are exploited or attempt to take advantage of such relationships to meet their basic needs, upscale their living standing and outlook among peers, and/or get money, clothes, school fees, gifts and various favours in return for sexual relationships of some duration. The legal provisions surrounding sexual relationships in various countries have led to their labelling in various ways including the `sugar daddy' or `sugar mummy' practice, boyfriend and girlfriend relationships, dating, or criminal juvenile prostitution.11-15 These relationships often involve an exchange, an element in social and/or sexual relationships common in all cultures.16

While cross-generational sexual relationships have been in existence in the history of mankind, their extent with respect to sexual behaviours associated with the `sugar daddy' or `sugar mummy' practice deserves a review and update. This is partly due to the current context of emerging threats to adolescent reproductive health confronting the sexually transmitted infections (STIs), human immunodeficiency virus (HIV) infection and AIDS mortality affecting primarily young people and the most productive segments of populations worldwide.17 Precocious experiences with reproductive health outcomes such as sexual debut and pregnancy with the risks associated with them, including abortions and sexually transmitted infections and the increase in HIV infection remain of great concern to policymakers, researchers, planners and the international community. The individual, familial, household, neighbourhood, community, regional, national and international contexts and factors quite often influence those outcomes. Indeed, a growing body of evidence points to the complexity of sexual behaviour among young people in both developed and developing countries.3,18-20

The purpose of this paper is to review existing research on factors promoting and perpetuating unsafe sexual behaviour in young people with special attention to their relationships with sugar daddies or mummies. It is of paramount importance to stress that while most studies of `sugar daddies' and `sugar mummies' in this review are from Africa, it does not mean that there are no published studies involving cross-generational transactional sex of similar causes and consequences that occur in developed and developing countries of other continents. It synthesises available research that explores young people's relationships with sugar daddies and sugar mummies, with cautionary notes regarding definitional, conceptual and measurement issues inherent in current research in this area and the need for more rigorous and methodologically sound investigation on the nature, scope, magnitude, features and risk/protective factors of the sugar daddy/mummy practice. It documents associated factors and consequences of these relationships for young people, particularly the extent to which force, coercion and power differentials shape the relationships. The study compares and contrasts the experiences of young people in a variety of settings in developing and developed countries within the broader context of non-consensual sexual experiences of young people around the world and makes some recommendations for dealing with these experiences.

The remainder of the paper is organised into subsections that address (i) issues of meaning, measurement and prevalence of young people's relationships with older people and the practice of `sugar daddy' and `sugar mummy' in particular; (ii) the contexts and associated factors involved in these relationships; (iii) the major consequences of such relationships; and (iv) evidence concerning these relationships and their implications.

Meaning and Measurement of Young People's Relationships with Sugar Daddies and Sugar Mamas

Strategy for the Review and Definition of the Practice of Sugar Daddy and Sugar Mummy

A literature search was carried out on Medline, Popline, PubMed, google and many search engines available on the WWW, using the labels associating young people's relationships with older people and involving monetary or non-monetary incentives or rewards. Key words used in the search included `sugar daddy', `sugar daddies', `sugar papa', `sugar papas', `sugar poppy' , `sugar poppies', `sugar mommy', `sugar mommies', `sugar mummy', `sugar mummies', `sugar mama', `sugar mamas'. In this paper, these key words will be used interchangeably. The search was repeated using authors known to have published studies concerned with such relationships, as well as all journals dealing with reproductive health, sexual behaviour, sexuality and economics of sex. The final selection of studies was based on two criteria: (i) their publication in peer-reviewed journals; and (ii) for unpublished manuscript or working papers, their publication or author's affiliation with a credible institution. Literature was also trawled for data presentation and method of inquiry.

In literature, a sugar daddy (respectively a sugar mummy) is the name given to elder men (respectively elder women) having sexual relationships with young girls (respectively young boys) in exchange for money and/or material goods, drinks, gifts, clothes and favourable treatment including favours in many aspects of life such as education, employment and payment of tuition fees, financial support for living costs, and other kinds of support. More recently, it has been noted that in some settings such relationships occur in the belief that the young people are free from HIV.

Some characterisation of this practice is emerging from literature, which suggests that the practices of `sugar daddy', `sugar mama' and the behaviours of `sugar daddy' girls and `sugar mama' boys is at least in part influenced by an increasingly materialistic society in the context of globalisation. As a symbol of their wealth and prosperity, sugar daddies and sugar mommies are often characterised in focus group discussions with adolescents by assets-related labels and nick names including `4 Cs' (i.e., car, cellular phone, cash and clothes) in Swaziland,21 `sponsors' in Ghana,22 Cameroon23 or Swaziland24 and `buzi' in Tanzania.25 Other terms may exist in other parts of the world without linking them to the practice of `sugar daddy' and `sugar mommy' as in Africa, a point rightly stressed by Jejeebhoy and Bott.26 A South African NGO volunteer noted that schoolgirls see older wealthier men with the `3e Cs' as an avenue where they will be able to attain material goods.27

Meaning and Measurement of the Practice of `Sugar Daddy' and `Sugar Mummy'

Definition and specificity issues

The convention on the Rights of the Child defines children as every human being under the age of 18 years unless, under the law applicable to the child, majority is attained earlier.28 Moreover, Human Rights Watch considers all persons under age 18 to be children, and in many countries around the world, minors are considered to be children under age 18. The problems associated with the practice of `sugar daddy' and `sugar mummy' stem from the fact that an accurate account for the events and specific features defining such practice and how it differs from child sexual abuse or other unacceptable forms of exploitation of children at work around the world are lacking in all studies reviewed. Slavery, debt bondage, trafficking, sexual exploitation, use of children in the drug trade and in armed conflict as well as hazardous work are all defined as `Worst Forms of Child Labour' under the International Labour Office (ILO)'s International Programme on the Elimination of Child Labour.

It is useful to elicit information on the various components of these relationships, the age of the young person and his/her partner's age at the time of initiating the sexual relationship, the circumstances under which they have encounters and the young person's feelings and expectations toward the partner. Other useful information includes the extent of multi-partnership, the duration of the relationship and whether there is promise of marriage or some form of stable union. There is still considerable gap in knowledge concerning the variety of forms and conditions under which young people engage in sexual activities with older people around the world, especially their relationships with sugar daddies or sugar mommies. This is in part because studies of the practice of sugar daddies or sugar mamas are generally based on reports from young people themselves or are based on broadly asked questions about transaction (financial or in kind) involved, or favours received in the context of these sexual relationships.

In defining sugar daddies or mummies, what `older men' or `older women' means varies from one study to the other. The notion is often surmised both for the researcher and respondents, and there is no standard age difference between partners in age mixing sexual relationships beyond which a relationship between a younger and older person can be treated as a sugar daddy or sugar mummy relationship. To date, it is left for speculation whether the content and nature of the information collected about the sexual relationships refer to the same construct. No study, to our knowledge, has looked at these relationships focusing on direct reports from older men's and women's that are matched with reports from young people within the same setting and its relevant socio-economic and cultural nuances. For instance, while available studies all found that a substantial proportion of sugar daddies and mummies were married and even have many children and/or wives, according to young people's reports, the marital status of men and women who have affairs with young people is difficult to establish solely from the young people's accounts or from cross-sectional data lacking a retrospective event-history approach. This is partly because young people rarely, if ever, inquire about the marital status of their sugar daddies or mummies and even when they do, their sexual partner might not reveal the truth to them.

Missing length of relationships

The duration of the sexual relationships between young and older people are virtually inexistent in literature, and in rare cases where some infor-mation vaguely exist about the length of such relationships, it tends to show stable pattern with relationships being quite regular (involving up to three sexual contacts with their partners weekly) and lasting even one year or more. In Tanzania, for instance, four types of relationships in young girls' relationships with their sexual partners in Dar es Salaam have been identified.25,29 The first, known as rafiki, concerns a boyfriend with whom the young girl has regular sexual contacts. This type appears to be receiving more social acceptance and recognition than the second type, termed mshikaji wa muda, which refers to a temporary partner with whom sexual contacts are short-termed but nonetheless often involving acquisition of property, money and gifts in exchange for sexual favour. The third type comprises men with whom contact is one-time or sporadic. The fourth type, termed mpenzi, involves a sugar daddy sexual partner with whom a young girl has a love relationship and even hopes to marry. In all these types of relationships, girls expect to trade in their sexual services in exchange for goods and/or money including food, underwear, clothes, soap, cream, pocket money, rent payment, school fees and/or textbooks.

Non-consensual sex, safe sexual self-determination and unlawful sex

One of the fundamental issues that deserve attention in studying the relationships between younger people and their older counterparts is the extent of coercion, sexual self-determination and unlawfulness of the relationships. It is unknown from existing studies the extent of sexual/physical abuse or sexual/physical assault of young people of any kind in those relationships. I consider sexual abuse to involve forcing a young person to take part in sexual activities, whether the young individual is aware of what is happening or not, whether it is perpetuated by an older man or woman, and the extent to which sexual abuse and consensual sexual activity may have co-existed during the course of these relationships. At issue is the extent of coercion in these sexual relationships and whether the sexual intercourse is without any form of protection (notably barrier methods) from pregnancy or sexually transmitted infections including HIV. Given that gender inequalities are at the core of the spread of the AIDS epidemic, gender issues have to be systematically addressed in any study of such relationships in order to devise better prevention strategies and develop an effective strategy to tackle unequal relations between men and women, which are the kernel of the spread of the epidemic. Unfortunately, the fact that governments as well as non-governmental organisations (NGOs) and United Nations agencies are sectorialised, and that there is frequently little coordination among sectors at both central and field levels, creates a significant obstacle for addressing a cross-sectoral issue such as gender in a systemic way.

Another measurement issue in the relationships between young and older people is the extent and nature of their exploitative features and whether it is fortuitous, sporadic, short-term or permanent. Furthermore, existing studies do not always allow a formal distinction between sexual behaviours involved in relationships with sugar daddy or sugar mama from sexual behaviours associated with prostitution or other forms of sexual relations for which sexual favour are traded for something material or financial by forcing the victim, or willingly with a consenting partner.

Survey and studies on relationships between younger and older people in view of teasing out the extent of the practice measuring the `sugar daddy' or `sugar mama' should also attempt to pinpoint whether the partner would like to marry or have a child with the young person and if the partners had other sexual encounters at the time of their relationships, and if each partner would have continued the relationship without material or financial benefits. It is not known from available studies how young people interpret their relationships with older people and vice versa. Because of gender power differentials and socio-cultural norms and practices influencing such relationship in different societies, existing research has not yet been able to capture some of these nuances so as to provide a better picture of the young people's voices and situations contrasted with those of their older partners. Clearly, people engage in sexual relationships for numerous reasons including love, affection, pleasure, conformity, recognition, competition, power, dominance, submission, stress reduction, prestige, procreation, material and financial exchange and benefits, companionship, and possibly others.30,31 Therefore, knowledge, understanding and prediction of any dimension of sexual behaviours are extremely complex in part because of some intimate and private aspects of such behaviours. Care should be taken to be as specific as possible in characterising them.

The scope and content of young people's relationships with older men and the transaction involved, the role that these men play in young girls' lives, the use of contraceptive methods and the degree of male involvement in the girls' decision-making process and choices are not addressed in the handful of available studies. For instance, several studies have shown that young males and females engage in sex with partners of various ages and degree of intimacy including friends, sugar daddies or sugar mummies, aunties and casual strangers in settings as diverse as Nairobi (Kenya),32 Yaounde (Cameroon),33 Dar es Salaam,25 Dodowa (Ghana),22 Trinidad and Tobago,34 Zambia,35 Sweden,11 Jamaica,12 South Africa,36 Tanzania,13 Mumbai City (India),37 Quezon City in the Philippines38 and Korea.39 Such age mixing sexual relationships usually take place between young people and people of other age groups in exchange for assistance for economic survival via (e.g., via money and fulfilment of basic needs) favours in educational achievement and/or job opportunities and various gifts and commodities that will boost their status among their youth peers.

From a legal standpoint, criminal law is the strongest tool a country has in dealing with or as a deterrent to socially or morally reprehensible sexual behaviours including, but not limited to, child or minor sexual abuse or sexual exploitation. Such law should specify the age limit of pro-tection and who is a child, a minor or juvenile under legal protection from abuse or exploitation. If the age limit is set too high, the law can become at odd with the need of adolescents for sexual liberty, and instead of being a means of protection may become a threat to an individual's capacity to sexual self-determination. Because of this, a number of countries have legislations regarding the minimal age limits for sexual relationships, seduction, including but limited to monetary exchange with/without sexual coercion, sexual consent and marriage.14,15,40 In all studies of sexual relationships involving adolescents and their peers or older people reviewed in developing countries of Africa, Latin America and Asia as well as in developed countries,4,5,11-13,15,24 the absence of reference to such age for the young people as well as the lack of information on age of the older partner with whom sexual relationships involving exchange of financial or non-monetary nature took place constitute one of the main drawbacks. In all countries, the minimal legal age at experiencing these sexual events for girls is lower than or equal to that of boys. It is worth noting that legal age at marriage, even where it exists, rarely corresponds to the actual age at which sexual initiation or entry into union occurs. For example, in Cameroon, where the minimum legal age at marriage is 15 years and 18 years for women and men respectively, 22.6% of women aged 15-49 years in 1998 reported that they entered their first union by age 15.41 One way to start formalising the features of a sugar daddy or sugar mama is to consider some threshold, below or above which sexual relationships between two individuals fall within the context of this type. One entry point can be to situate sexual relation-ships in relation to (a) legal age at marriage; (b) socio-economic and demographic attributes of the older man or woman; (c) financial status of the older man or woman; (d) multifaceted power relationships involved; and (e) legal, religious or moral codes (if any) governing sexual relationships and the extent to which they are enforced. For instance, adolescent girls' preco-cious sexual debut, unintended pregnancies, induced abortions and deteriorating sexual and reproductive health are often associated with the fact that young girls are objects of older men's choices.

Does marital status matter in the timing and sequencing of exchange in sexual relationships?

Existing studies rarely pay attention to the marital status of young people and their sugar daddies or mummies. This omission makes it difficult to differentiate relationships between younger and older people who are unmarried and are `dating' with a possibility of forming a union, as opposed to older people who are married and are involving in exploitative relationships with the young basically for sexual favours. Taking into account the marital status of those involved in these relationships is important because of its ramifications regarding the living arrangements and visit patterns between the young person and his/her older partner. Another issue concerns the timing and sequencing of sexual relationships and of money/gift/favours received or exchanged between the young and older person. Does such reception/exchange occur before or after each sexual relationship? If one partner or both of them are married, how much information about this relationship is filtered to their husband or wife? These are some fundamental questions that must be considered in studies on the practice of sugar daddy/mummy.

Without being exhaustive, I have highlighted some definitional, measurement and analytical problems that make the quality of and comparisons across studies at best conjectural. While many studies have tended to extrapolate findings from localised studies and groups of the populations in specific settings to the general urban/rural, regional or national environments of countries where these studies have been conducted, there is extreme caution to be exercised in such generalisations. First of all, consensual or non-consensual sexual relationship across generations (younger and older people) is a difficult area to study because its representation and nuances are greatly influenced by the individual and its family and community, the society, the legal and judiciary systems and various norms and practices tolerated or discouraged by the various levels of nesting of individuals. Hence, qualifying the sexual relationships between younger and older people is complicated by the multiple forms they take and contexts in which they occur in different societies of the developed and developing countries. Second, there is considerable overlap between various forms of sexual encounters. It has been shown that in terms of explanations for unsafe sexual behaviour among youth, there is a powerful impact of the proximal and distal contexts (as opposed to individual factors), and in particular the pervasive effect of poverty and social norms that perpetuate women's subordination within sexual relationships.42 These are important issues with distinct implications for the reproductive health of young people and the type of interventions and legal provisions that may be required to protect their rights and their life prospects.

How Good is the Evidence Regarding the Prevalence and Magnitude of the Practice of Sugar Daddy and Sugar Mummy?

There is no doubt that sexual behaviours that amount to the practice of sugar daddy/mummy is as old as the existence of mankind, to the extent that it portrays young people engaging in sexual relationships with older persons along with associated transactions and exchanges. Indeed, many countries and international organisations have enacted legislations and international conventions to protect minors and juveniles seduced by and/or engaged in sexual relationships with older and/or wealthy older people in part in response to the existence of that practice around the world.14,15,21 There are also inherent difficulties associated with measurement of relations and interactions among individuals. Measuring relations poses practical problems, which are not unsolvable but are more easily addressed through methods such as in-depth qualitative methods followed by structured quantitative surveys, which are inexistent in current literature. This makes comparisons and trends assessment impossible. In addition, few of the available studies are grounded on empirically sound evidence. Another measurement difficulty arises from the fact that changes in gender relations are only possible through a process, which takes place in the long term, or at the very least in the medium term, but in any case usually longer than the span of most encounters between younger and older people often treated as `sugar daddies' or `sugar mamas' irrespective of the duration of the relationships.

Recent evidence of this practice around the world in both developed and developing countries4,11-15,21,26,43 point to their continuing existence despite scanty evidence on its prevalence over time and space. Yet, how to situate the boundaries of events defining the practice of `sugar daddy' and `sugar mummy' compared to other sexual and reproductive health events such as coerced sex, rape, sexual harassment, and so forth. There is a lot of misclassification of events defining these phenomena and, therefore, interpreting some of the available evidence concerning `sugar daddy' or `sugar mama' as an indication of a `common phenomenon' as suggested in some quarters4 is misleading. Therefore, the extent to which the `sugar daddy' or `sugar mama' practice as characterised in literature on this practice since the 1980s3,11-13,25,33,36,44,45 is of recent origin. How widespread it is over time and space is marred by shortcomings ranging from a lack of definition of `older men' or `older women' versus young men or women to the form, duration and content of the relationships between younger and older people within socially or legally sanctioned norms and provisions.

Evidence regarding the prevalence of `sugar daddy' and `sugar mummy' practices is at best conjectural from available studies, in part because of problems in data quality and methodologies, as well as a lack of a gold standard age range given the country-specific minimum legal age of sexual relationships (if any). There seems to be a great degree of variability across and within countries regarding age mixing and the nature of sexual activity of adolescents, young and older people, as documented in a number of studies conducted in Africa and elsewhere about age mixing in sexual relationships and the extent of transactions between partners during the course of such relationships.4,7,46 Görgen and colleagues47 noted in their study of sexual partners among 3603 unmarried men and women aged 15-24 years in Africa using both quantitative and qualitative methodologies that the majority of relationships were among youths (e.g., pupil with pupil, apprentice with apprentice, and apprentice with pupil). Younger women tended to have a partner of their own social group while older women generally had a relationship with a wealthy man. According to the explanations provided in the focus groups, relationship with an older partner is not the preferred choice for young people. Young women accept a few years age difference, but they do not want their partner to be much older, for fear that such a relationship will endanger their health, destroy their youth and contribute to early aging. Young men try to avoid contact with older women. They believe that a relationship with an older woman makes a young man grow old or causes diseases, or even an early death, while it rejuvenates the woman and makes her more beautiful. Participants observed that it is often difficult to refuse an offer from an older woman especially if she is a member of one's family (e.g., a sister-in-law).

There are no data on the prevalence of this practice, not only because no quantitative survey has been designed with the aim of measuring and analysing it with the practices and behaviours it entails, but also because the few existing studies lack methodological foundations that can lead to testable hypotheses. Hence, it is not possible to situate these practices vis-à-vis other sexual behaviours. While there is no doubt that behavi-ours embodied in the `sugar daddy' or `sugar mummy' practice exist in Africa and elsewhere around the world, the methodological and analytical approaches and the ensuing evidence on sugar daddies and sugar mummies in African settings is often anecdotal, media-driven and based on studies with major flaws and misleading conclusions. This is in contrast to some rigorous studies that have been conducted in countries like Jamaica12 and Tanzania,13 which attempt to capture all forms of sexual behaviours and aspects of the relationships involving adolescents, within which one can calibrate the place of the `sugar daddy' and `sugar mommy' practice, since such practice cannot be assessed in isolation and without taking into account competing alternatives.

Young People's Relationships with Sugar Daddies and Sugar Mama: Associated Factors

Non-consensual and consensual sexual relationships between young people and older individuals called `sugar daddies' or `sugar mamas' are influenced by factors operating at several levels including individual, family, community, neighbourhood, province, region within a country, and by the international context of globalisation. Individuals engage in such sexual behaviours for a variety of motives including procreation, love and affection, pleasure, entertainment, conformity, recognition, competition, power, domination, submission, self-determination, stress reduction, financial security, favours, money and presents. These motives are usually age-dependent and are greatly influenced by individual attributes, conditions, life options and opportunities. Examined in this paper are the emerging factors associated with young people's relationships with sugar daddies and sugar mommies, but those correlates remain tentative and should be taken with great caution given data and methodological shortcomings inherent in most studies available on this topic.

Sexual Partner Age Preferences

A number of studies on cross-generational sexual relationships with/without financial or material transactions have documented a wide range of age gap between sexual partners, varying from a couple of years to over 25 years around the world.1-3,11,12,26,48 In their study in Dar es Salaam, Silberschmidt and Rasch25 found that most of the girls were currently in relationships with married men who were twice their age. On the other hand, many studies have shown a remarkable consistency in sexual age preferences and sexual attractiveness across cultural settings around the world. For instance, Cunningham and collaborators49 found that exposure to Western media was not responsible for the high level of agreement on female attractiveness ranging between 0.91 and 0.94 among different groups of men, with American men, rural Chinese men and rural African men sharing high levels of agreement (r = 0.90) on female attractiveness.

Precocious unions, still grounded in most developing countries, compound the age gap between partners in sexual relationships involving young and older people,20 as long as it is not known whether the money or gifts received by the younger person or other exchanges that take place are prelude to the payment of the matrimonial dowry.50 In many societies where polygamy still prevails in both urban and rural areas like in Africa, large age gap between the husband and his wife is inherent to the practice of polygamy.51,52 Clearly, unbiased analyses of age differentials between partners in sub-Saharan Africa cannot be conducted without taking into account the type of sexual union (polygamous, monogamous, informal, formal), which is more than just a dichotomous `married' and `unmarried', since in most instances marriage in Africa is a process which evolves over a period of time during which sexual relationships may take place while the partner cannot claim a married status. Indeed, in some studies of the practice of `sugar daddy', some girls reported that their motivation for choosing older male partners was marriage because of the economic security these older men would provide in the marriage or in case of an unintended pregnancy,33,47,48,53,54 while others may have sexual relationships with older men without being interested in marriage.25,33,44

Gender Differences in Sugar Daddy and Sugar Mummy Practices

Gender differences in sexual behaviour are well documented in studies conducted around the world.3,7,9,19,43 Overwhelming evidence suggests that females, compared to males, are more likely to report love and less likely to report pleasure as a reason for engaging in sexual behaviour.43,55 The few studies that have explored gender differentials in young people's relationships with sugar daddies and sugar mummies have consistently indicated gender gap in motives and expectations from these relationships. In general, available studies tend to suggest that more girls are involved in (or vulnerable to) relationships with sugar daddies than young boys involved in relationships with sugar mummies.3,22,26,47,48 For instance, Goparaju and collaborators22 found that in Ghana, adolescent boys reported that their sexual partners are usually their female peers including studymates. In contrast, adolescent girls reported that their partners include, solely or in combination, their male peers as well as older men of various ages. These girls' younger male sexual partners are their romantic partners whom they call `boy lovers' and may be their classmates or peers they met outside school and with whom they have casual sex in exchange for small favours. They have different reasons for having sex with different partners: their older male partners or `sponsors' provide financial support, which may be used to pay their school tuition or used for other needs. In the case of in-school female adolescents, teachers and school administrators pressure girls for sex and in some cases girls use sex to obtain academic or administrative favours. But no data on a large scale has been collected to document the extent of gender differences, and caution is needed in interpreting these pictures.

Lazare Kaptue, the first director of the National Committee to Fight AIDS in Cameroon from its inception in January 1985 (1985-1990), found in a qualitative study in Cameroon that despite high awareness levels of the modes of transmission and means of prevention of HIV/AIDS, teenage boys and girls continue to demonstrate high-risk sexual behaviour very often for economic reasons.23 In this study, boys were inclined to seek sexual services from prostitutes or to trade sexual favours for economic survival with sugar mamas, because they could afford to maintain a girlfriend or because they wanted to avoid long-term commitment. Girls reported the need to have several lovers to help fulfil their economic needs (daily expenses, costs of education, and expenses for clothing and cosmetics, etc). Several girls even had one or two `sponsors' or `sugar daddies' as well as their regular boyfriend who was usually a fellow student. Kaptue23 also found that young boys were often coerced into homosexual relationships with a wealthy foreign older man in exchange for tuition, clothing and other living expenses. He stressed that his clinical experience suggests that many young boys who are HIV positive in sub-Saharan Africa and Cameroon in particular have been infected through such relationships.

A number of studies have noted that one of the attractive features of older men or women who are sugar daddies or mommies for young boys and girls is their social influence and the opportunities they can offer to them in terms of pursuing their studies and securing a good job upon graduation. Such observations have come primarily from reports in focus group discussions with university students in urban areas in developing countries.3,4,26 Adolescents, especially girls, are usually seen as victims of (often older and married) men's sexual exploitation. Yet, a qualitative study by Silberschmidt and Rasch25 of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam (Tanzania) found that these girls are not only victims but they also take advantage of their relationships with sugar daddies. They are active social agents engaging in high-risk sexual and health behaviours in order to secure financial and material benefits from them. In another research conducted by the International Labour Organization in Jamaica,12 sugar daddy girls, some below 12 years, were sexually exploited by older men in exchange for economic benefits and basic needs (e.g., education, food, clothing, shelter and financial support) that sometimes included support for their families. Teenage schoolboys called chapses in Jamaica, like the sugar daddy girls, were having sexual relationships with sugar mummies in exchange for economic support. These older women were usually affluent and well off and kept the boys primarily to have sexual relationships with them at their convenience. This they do in exchange for economic support, access to education and higher standard of living, taking them on outings, treats and holidays and providing them with presents, clothing and money.

Is Sugar Daddy or Sugar Mama mainly an Urban Practice?

The practice associated with the notions of sugar daddy or sugar mummy have been described in many parts of the world but focusing primarily on cities.22,23,25,26,29,33,44,45,47,56,57 There is only limited evidence from rural areas that properly controls for migration effects.24,25,48,54,58 The practice has also been noted in other areas of the developing3,26 and developed countries.11 Thus, the extent to which the practice is more prevalent in urban than rural areas as well as its magnitude between and within countries remains largely a matter of conjecture. Furthermore, existing findings cannot even be generalised to the urban areas in most countries due to shortcomings inherent in the methods of inquiry, sample selection bias and units of analysis or observation of the practice. But the changing contexts and family dynamics of many urban settings may render the situation of urban youths quite susceptible to those sugar daddy/mummy relationships. There are two broad categories of these youths in many countries worldwide, namely, street children and young people living in single parent households. Street children tend to strive to ensure that their basic needs are satisfied and this may mean resorting to sexual relationships with older individuals as a survival strategy. Moreover, the rate of female-headed households tend to be higher in urban than rural areas, so that it is now not unusual for families with adolescents to be headed by a single mother. Many adolescents' time in such families may be unstructured, unsupervised and consequently expose them to unsafe sexual behaviour under these settings. Much of this time occurs after school hours when adolescents are frequently alone. Studies in Africa and US indicate that female headed households experience greater poverty due to a variety of factors, including pay inequities faced by women and lack of paternal financial support, which may affect the sexual behaviour of adolescents in those households.18

Our observations in many countries in Africa, Asia and Latin America tend to suggest that there are movements in and out of urban and rural areas and a great degree of fluidity in terms of where older people have their relationships with younger people. The economic crisis in many African countries, for example, has made many girls in rural areas very vulnerable especially those living with their grandparents, given in part the increase in orphanage triggered by the AIDS epidemic. These girls are often the prime target of older and affluent people living in towns who go on weekends in their home towns in rural areas where they have built luxurious houses and where they get these girls to come and receive presents, money and favours for themselves and their families in exchange for sexual relationships. Furthermore, because such transactional sexual relationships are expected to be cheaper in rural than urban areas, given the differential in level of expectations and demands between urban and rural dwellers, rural adolescents may be particularly at risk of sexual exploitation by older people coming from town and travellers. The suggestion that the rural environment and its mode of life may increase the vulnerability of adolescents, and mainly girls, to sexual relationships with their peers or older people is consistent with one study in rural Uganda, which noted that girls reported that the risk of being approached for sex increased on their way to or from school, on their way to the well and on their way to the market.59

Parental Care, Living Arrangement, Commitment to Marriage and Type of Union

Increasingly in developing countries, just as it is the case for developed countries for some time now, today adolescents and youths are growing up in families that are diverse with respect to size, shape and structure.20 They range from families characterised as traditional with two parents and a stay-at-home mother (including polygamous families for a number of developing countries especially in Africa), to dual career families, single parent families and other forms of family structures. The promise of marriage is often the underlying argument given by sugar daddies to entertain relationships with young girls. In those circumstances, sexual intercourse essentially occurs without protection from pregnancy or STIs and may expose young girls to reproductive health problems including HIV/AIDS. The role of parental and family/household level influences on young people's relationships to sugar daddies or mummies is a perspective that has been recognised in the few studies that exist on sugar daddies and mummies. It is certainly not the case that all adolescents growing up in poor or divorced families are destined to problems and failure. There is extensive literature that suggests that adolescents and young people living in families and households experiencing economic hardship, divorce or both are at increased risk for a range of reproductive health, psychosocial and behavioural problems. These include unintended pregnancies and sexually transmitted infections and HIV/AIDS. However, the effects of these challenges can be moderated by parents' behaviours.

A number of studies have found that parents warn or allow their girls to engage in sexual relationships with well-off older people to the extent that such relationships may increase their marriage prospect with the older people or that their daughters and her offspring will be well taken care of should a pregnancy occur.47,60,61 This is especially the case for adolescents entering polygamous unions. In fact, one of the most notorious features of marriage in Africa is the practice of polygamy. In this practice, as men grow older they seek younger and reproducing wives (often with the help of their first wife) such that the marriage realised in several stages can take several years and may be initiated back during early adolescence for girls. Until marriage is socially acknowledged, the first phases of old men's relationships with younger women in urban areas may be quite similar in description to those involving the sugar daddies. Existing studies in Africa have not delineated the link between polygamy and the practice of sugar daddy or sugar mama. In contrast, parents may disapprove such relationships if the (older) man is not envisioning marriage to their daughter.19,24

On the other hand, the practice of `sugar daddy' and `sugar mummy' may often please young people who are engaging in sexual relationships with older people for whom there is no prospect or intention for marriage from both parties as documented in a variety of urban settings including Accra in Ghana,44 Dar es Salaam in Tanzania25 and Yaounde in Cameroon.33 This may happen especially among girls in transition to adulthood who need `piggy-back' support from sugar daddies to live comfortably without the expectation of possible marriage. In those cases, they purposively look for a married sugar daddy who can support them.

One of the features of the relationships between young people and sugar daddies and mummies is that young people do not live with their sexual partner. Because they are involved with men or women who are sometimes twice or more as old as themselves, they are not in a position to negotiate for living together. In some cases, their sugar daddies and mummies will pay their rent and even ensure that their residence is a secured, comfortable and respectable environment where they can feel a sense of privacy whenever they are with them. Indeed, sugar daddies and mummies are generally married men and women and they may even have children who are older than their young sexual partner. These older men and women often hold leadership positions in the society or are businessmen and women or wives of businessmen (especially in polygamous unions), as such they fear for their reputation and as a result keep their relationships with the young people secret. Studies in Tanzania have confirmed that as much as half of the young girls' sugar daddy partners were already married or said they were.25,29

Economic Vulnerability, Unequal Economic Opportunities and Peer Pressure

Sexual relationships of young people with sugar daddies and mummies are often linked to the financial status of parents, poverty and peer pressure. Evidence from many societies shows that young people enter into arrangements with older men (sugar daddies) or older women (sugar mummies), in which they exchange sexual relationship, however casual, for money or resources to remain in school. The greater the degree of financial dependence for survival,3,4,12,13,36,62 the less scope girls and boys have to protect themselves.21,22,48 Crossgenerational sexual relationships can take many forms and offering economic rewards is one form. This is classically seen in the practice of older men securing girlfriends who are very much younager than they by buying them presents. Although young women may readily consent to these relationships in exchange for presents or money, which would otherwise be beyond their reach, it is also a form of exploitation and coercion. It places women who are involved in such relationships at considerable risk of HIV, STIs and pregnancy, with subsequent abandonment. Poverty is a major reason for girls exchanging sex at an early age. Survival strategies often involve sexual favour in exchange for money, food, shelter, clothing, protection, affection, job and other livelihood opportunities. "I love him because he gives me money" is a common statement among young girls as they recount their relationships with sugar daddies. Poverty increases the likelihood of women engaging in sex work or more subtle forms of transactional sex, for example, trading sex for beer in bars.63 Similar forms of relationship are also found for older women engaging in sexual intercourse with young boys in exchange for gifts and money. Thus, the challenge of the practice of sugar daddy and sugar mummy cannot be addressed outside the context of poverty prevailing within and across countries.

Perhaps the best way to characterise this challenge is illustrated by the so-called "sex for survival", whereby young people may engage in sexual relationships with older persons over a period of time as a currency in exchange for money and/or gifts or for satisfaction of their basic needs in food, clothing and shelter.35 Unequal economic opportunities and access to education may promote a dependence on male partners or commercial sex. Schoolchildren in Africa, for example, often resort to sex with older sugar daddies to help pay school fees, and the fact that many sugar daddies may have multiple partners or practice unsafe sex does not seem to prove a deterrent.64 It is quite clear in discourses of most of those young people that they do not engage in sexual relationships with older men or women because of sexual pleasure, especially for girls. In Dar es Salaam, for instance, contrary to boys who often refer to their `lust' and regard sex as the most pleasant activity, most girls did not consider sexual intercourse with a sugar daddy or buzi as an activity by which their own sexual needs would be met. They saw sex as something that they provided in return for financial or material benefits. As one of them said, "I only engage a minimum with this buzi. I enjoy sex more with other partners."65 Here, a buzi or sugar daddy appears to be a good source of income that most girls do not want to loose, and sexual pleasure is less important.

However, poverty cannot be treated as the main reason that young people engage in sexual relationships with older people. Non-monetary reasons abound as well to explain the practice of sugar daddy and sugar mommy. Most studies on the practice of sugar daddy and sugar mummy are based on populations of urban youths from the middle class to higher class families, high school pupils and university students in Nairobi (Kenya),32 Yaounde (Cameroon),33 Dar es Salaam,25 Kisumu (Kenya), Ndola (Zambia),66 Maputo (Mozambique),56 Durban (South Africa),36 Tanzania,13 Mumbai City (India),37 Quezon City in the Philippines38 and Korea.39 These youths are least likely to engage in sexual relationships for financial or material favours as a result of sub-standard socio-economic and living conditions or (extreme) poverty. In fact, contrary to common perception, sugar daddy girls are not necessarily poor, since they sometimes just like to look fashioned and privileged among their peers or pride themselves in sleeping with the most influential (financially or administratively) men of their communities, and may not make some of the associated requests to their parents, no matter how wealthy they may be. This view is consistent with findings from large scale studies, which have shown that young people's sexual relationships with older men and women are often for sexual self-determination and other motives than for securing their basic financial and material needs.1,11,14 These explain why I use purposely the term `economic vulnerability' instead of `poverty' as used in most studies on transactional and/or cross-generational sexual relationships. Clearly, adolescents from both poor and middle class families are found in various societies to be sugar daddy girls or sugar mommy boys. Indeed, the original concept of the sugar daddy came from a middle class and has been applied primarily in specific groups of young people during focus group discussions. Hence, while there are obviously poor adolescents (especially girls) in urban ghettos for whom transactional sex with sugar daddies/mommies may be the only way to get support for themselves and their family members, most young people engage in such sexual behaviour for other motives.

Another factor influencing the sexual behaviour and motives for engaging in sexual relationships with affluent older people is that adolescents want to be in conformity and fashion with peers. The girl may not be considered if she does not wear the fashioned shoes, clothes or other external makeup found among her peers or available in the market. For example, in Dar es Salaam, several girls said they had been forced by another adolescent, a houseboy or a schoolteacher, to have sex mainly for the first time.25 In her subsequent research in Dar es Salaam, Silberschmidt65 found that even if it may not be socially acceptable to have a mshikaji, the girls in her sample were proud of having a mshikaji wa muda or a buzi as their `financial resource' and were quite flattered by older men's interest in them. Other studies have documented that a buzi (sugar daddy) gives prestige among peers since a girl's status within this group is often dependent on having nice clothes and other material possessions. Such things are achieved most easily by entering into sexual relationship with a man who is willing to provide these items. Moreover, not many girls or women would enter into premarital sexual relationship without the potential for material recompense. In such conditions, sexual services are considered commodities that should be paid for and only women with no self-respect would give such services free. In exchange for financial compensation, men gain sexual access and control over young women, a relationship that acts as a booster to their virility and self-esteem.67

Multiple Sexual Partners

There is substantial evidence around the world from existing studies that young people engage in sexual relationships with other young people as well as with older people either sequentially or simultaneously. They do this for a variety of reasons including the financial and material support they expect and receive from sugar daddies and mummies.3,11-13,22 They also do it as a fulfilment of their desire for love, affection, companionship and eventually marriage with their peer main sexual partner.3,26,48,68 From the standpoint of young people as sugar daddy girls and sugar mummy boys, or from the perspective of older and wealthier sugar daddies or mummies, there is an implicit recognition and/or alright knowledge that the young partner or the older lover is married or may have one or several other sexual partners. This is because as long as the proper attention and financial responsibilities are assumed by the sugar daddy or sugar mommy, the conditions are usually met for perpetuating the relationship.22,25 In this respect, a number of studies have suggested that adolescents take advantage of their relationships with their older partners who can invest in their human capital in order to enhance their opportunities in the educational and employment structures. They also help to achieve their goals of high socio-economic status, secure financial situation and social mobility for leisure, which may not be at the reach of (or a priority for) these adolescents' parents,22,36,54,56,61 despite their knowledge of the risk for STI/HIV infections, unintended pregnancies and their consequ-ences.25,48,62,69

There is evidence from a number of studies that even girls who said they loved their partner would not continue the relationship without material benefits. In their qualitative study of 51 adolescents in Dar es Salaam, Silberschmidt and Rasch25 found that 25% of girls had more than one sexual partner at the time they became pregnant, and many planned to have an illegally induced abortion if they got pregnant. Some of them were actually planning to find one more partner in order to increase their financial resources.65 The majority of girls in Dar es Salaam claimed to have had an average of 2.7 sexual partners since their sexual debut. A similar finding was reported from Northern Tanzania.45 In these circumstances, these young girls are seeking more partners by targeting individuals who are capable and willing to pay for sexual favour, and sugar daddies occupy a prominent position. There is a suggestion that in Tanzania, many parents are perfectly aware of their daughters' escapades, but they choose to close their eyes because it relieves them of their financial responsibilities.

Power Differentials and Sexual Exploitation of Young People by Sugar Daddies and Mummies

There is evidence throughout the world that both young boys and girls experience forced sexual relationships, even if there is substantial knowledge about coerced sexual relationships endured by girls.26,63,70,71 Forced or coerced sex has been a widely neglected issue in reproductive health research worldwide and especially in developing countries, despite its deleterious consequences on women's health. It makes women unable to protect themselves against unintended pregnancy, abortions and sexually transmitted infections including HIV/AIDS. The epidemiology of non-consensual sex, which is often associated with the sugar papas and sugar mamas practice deserves attention, given its considerable public health importance. In all societies worldwide, there is overwhelming evidence that gender power differentials tend to play an important role in male- female sexual relationships and that both boys and girls experience sexual relationships in the context of power imbalance with older partners.22,26,35,46 Unequal power relations in young people's relationships with older sugar daddies and sugar mamas has been suggested in literature with conjectures that adolescent girls and boys involved in such relationships with older men are quite powerless to discuss or negotiate safe sexual practices or to control sexual violence and exploitation.3,25,26,68,72 In such relationships of dependency, adolescents and young people find it very difficult to protect themselves from sexual exploitation and very often have to tolerate abuse. Disparities in power result in girls often lacking the confidence to negotiate. Therefore, reproductive and health problems including HIV/AIDS affect men and women differently. This arises from the differential infection rates and learned cultural values and norms, including early marriage stereotypes, gender roles and power relations, that impose a disproportionate burden of care and nurturing on women.

Some studies of age mixing in sexual relationships consider the practice of sugar daddy and sugar mommy as an indirect indicator of sexual coercion, to the extent that a refusal of money and/or gift offered by the older person in exchange for sex leads to severe consequences experienced by the young person. Indeed, that practice has been reported by adolescent girls in a number of studies as a reason for engaging in sexual intercourse against their will with sugar daddies. This has been reported in settings as diverse as in Selibe Phikwe, Mahalapye and Kang (Botswana), Dar es Salaam (Tanzania), Republic of Korea, where studies report that perpetrators were often in position of authority such as work place supervisors, or in Botswana and Tanzania where sugar daddies were reported to be sometimes older male teachers, policemen, priests and relatives.3 Similarly, this practice has also been reported by boys in five settings where coercive relationships between adolescent males and older females have been examined such as in Dumaguete City in the Philippines.3

Recently, Straight Talk, a free monthly magazine targeted at adolescents in Uganda, indicates that girls fall easy prey to sugar daddies because they have no bargaining power.73 It has been found that one of the reasons older men choose young girls for sex is to avoid having to pay for it. A social worker with Slums Information Development and Resource Centres in Nairobi (Kenya) notes that the young girls might be satisfied with sweets while a regular sex worker could charge anything from 100 Kenyan shillings or US$0.80, and oral sex could cost half that sum.74 Such sexual exploitation within the context of young girls' relationships with sugar daddies is by no means comparable to or associated with prostitution. In Dar es Salaam, for instance, Silberschmidt65 documents that while the girls in her study were involved overtly in transactional sex, they did not see it as prostituting themselves. Indeed, most women in a Tanzanian or East African context with any self-respect would be very reluctant to engage in sexual relationship with a man without any material benefits. Men who are unable to provide such benefits are met with contempt. It was also obvious to these adolescent girls in her study that no man would give them money or other material benefits unless they received something in return. Sexual services were all that these girls could bargain with and they were willing to offer their services not as a means of survival, but as a means to get access to small `luxuries', schooling amenities and prestige from peers, among other benefits.65

Misconceptions and Beliefs

In a number of societies in Africa, it has been reported that men believe younger women are less likely to be HIV positive and, therefore, men are choosing younger sex partners. Furthermore, a myth persists among some men that having sex with a virgin can cure AIDS. In this context, some teenage girls choose older men or sugar daddies as sex partners to get gifts or money for school.

A number of researchers have stressed that this increase is closely associated with the sugar daddy and sugar mummy practice, partly because older people fearing HIV infection increasingly seek sexual favours from adolescent males and females who they believe are most likely to be HIV free.21,35,48 It is a known fact that most young adolescents are very unlikely to carry a sexually transmitted infection, and this fact has been used by some older people as a motive to have sexual intercourse with these adolescents either because they consider them as a `safe zone' for sexual activity or because of the prevailing myth that having sex with virgins offers a sure cure for HIV/AIDS. Several such worrisome misconceptions about HIV/AIDS have spread among populations in many countries. At the same time, many young people hold the common perception that clean, well-dressed and good-looking people are not and cannot be infected with HIV. In Nairobi, it was found that many older men (sugar daddies) choose young girls for sex in the belief that they couldn't possibly be infected with HIV.74

Internet and Young People's Relationships with Sugar Daddies and Sugar Mamas

The availability of new technologies for communication, and particularly the internet, has also served the purpose of facilitating contacts and follow-up sexual relationships across local and national boundaries. There is increasing evidence to establish a link between the internet universe and the spread and prevention of STI/HIV infections among adolescents.75 The internet has had such a profound impact on the way contacts, friendships and sexual relationships are initiated in less technologically internet-driven societies of Latin America and Africa as well as in many parts around the world. This is because internet is a media through which one can communicate one's desires directly and entirely anonymous.

For example, while some sites that promote sexual encounters are designed for adults, some sites are explicitly targeting relationships involving sugar daddies and sugar mamas. For example, the purpose of the website http://www.sugar-daddies-and-sugar-mamas.com/ is to provide a place where sugar daddies, sugar mamas and the young adult men and women seeking them can post their personals and photos. Hence, with the increased influence of globalisation and inter-national migration, a number of young boys and girls in many developing countries may prefer to engage in sexual relationships with a foreign older Western European or North American man or woman as a boyfriend or girlfriend or even husband. This is to promote his/her status among peers and often to secure better living conditions including travelling and living abroad for his/herself, family members and relatives at least for the duration of the relationship. Hence, the role of internet accessibility and utilisation on young people's relationships with well-off older men and women both within and across national boundaries deserves investigation.

Legal Vacuum

There is a diversity of legal meaning and criminal code regarding sexual relationships between men and women and across ages. In many or all countries where the practice of sugar daddy and sugar mummy has been reported, there is no legislation adopted and/or enforced to address the issues of sexual exploitation of all forms of children.

What is needed are legislations protecting children as specified by international conventions and as it is the case in most developed countries where there are minimal legal age for sexual intercourse and legal provisions protecting children until they can exercise their right to sexual self-determination. Laws against "seduction" of minors should also be adopted and enforced, because even in many countries where such law exists it is hardly ever enforced.14 Finally, sexual relationships with juveniles in relationships of authority should be outlawed. For example, in Russia, it is an offence (irrespective of age) to practise upon a financial or other dependency to gain sexual contact. In Poland and Spain, there is a general law against the abuse of dependency for sexual purposes regardless of the age of the partners.14

Consequences of Young People's Relationships with Sugar Daddies and Mummies

Many studies of age mixing in sexual relationships and those dealing with the issue of sugar daddies and sugar mummies in particular have suggested that such practice inevitably bring the boys and girls into contact with the high-risk segments of the population for sexually transmitted infections (STI) and of human immunodeficiency virus (HIV). The quantitative basis and clinical evidence substantiating the link between that practice and the incidence rate of HIV among adolescents remain limited48 and deserve further investigation. For girls, there is the additional risk of unintended pregnancy and abortions. Other consequences on these boys and girls, their families and their communities exist, including the physical, economic, educational, social, and health-related short and long-term consequences. However, I focus on unwanted pregnancies, abortions, STI and HIV given their public and reproductive health implications and the fact that they are amenable to comprehensive interventions.

Studies carried out in the developed and developing countries have often reported that a substantial proportion of girls overlook the possibility of becoming pregnant.19,18,76 This is also true when they are involved in relationships with sugar daddies. As reported in a study in Dar es Salaam (Tanzania), a few girls thought they were too young to get pregnant.25 This study found that one of the consequences of sexual relations between young girls and sugar daddies was voluntary abortions in case of pregnancy at the request and expense of their sugar daddy partner. Some sugar daddies even offer assistance in dealing with the problem of pregnancy. This study also found that 73% of the 15-19-year-olds admitted to hospital for `incomplete' abortion reported that their sexual partner was 30 years or older. In general, these older men do not want to have children with the young girls, but keep and use them for their sexual enjoyment. Thus, abortion often takes place in these relationships when the sugar daddy partner does not accept the paternity.

Sexual relationships between young people and their sugar daddies and mummies also have potentially deleterious health consequences on both the young person and his/her sugar daddy or mummy. First, exploitative intergenerational sexual relationships may be implicated in HIV transmission. Unequal power relations often make it difficult for females to negotiate condom use. Recent estimates from Africa show that HIV transmission rate peaks among girls aged 15-20 years, and that about 60% of all new HIV infections occur among the 15-24-year-olds.17 Second, studies have shown that women are about three times more likely than men to be infected through sexual intercourse, because vaginal wall is prone to sores and abrasion, and the viral load in semen is higher than that in vaginal fluid. High rates of STI or HIV infection can therefore be attributed to a combination of biological and social factors.

One of the few studies linking age gap differentials with HIV infection was carried out in rural eastern Zimbabwe with blood for HIV testing provided by all male and female respondents aged 15-54 years. The study concluded that sexual relationships with older men or women put young people (particularly girls) at high risk of HIV infection.48 In descriptive analyses, the risk of HIV infection among 17-24-year-old women increased with the cumulative number of partners and number of years by which women were younger than their most recent partner. Similarly for men, HIV risk increased with cumulative number of partners and age difference with the most recent partner. In multivariate analyses, HIV infection risk also increased with each year by which the respondents were younger than their most recent partner (1.04 for both men and women). For instance, Silberschmidt and Rasch25 suggest that with increasing awareness of HIV/AIDS, older men considered as sugar daddies are increasingly blamed for luring young girls into high-risk sexual relations by promising them some sort of financial or material support. On the other hand, while the sugar daddies trust that they are having safe sex with their young girlfriends, they may in fact be jeopardising their own health, that of their wife and other partners. Indeed, several studies have reported misconceptions about STI protective behaviour for older people, adults, young boys and especially girls.77-80 The relationship of these misconceptions to abstinence, condom use and STI/HIV incidence is well established in literature.78,79

Some studies have suggested that sugar daddy and sugar mummy practices have dire consequences with respect to HIV/AIDS. For instance, Peter Piot, executive director of UNAIDS, recently noted that there are teenage girls whose only way of staying on at school is to barter sex with teachers or sugar daddies, who will pay for books, uniforms and fees.21 Ugandan officials also consider that one of the big challenges remains the reduction of the comparatively high prevalence of HIV among girls aged 15-19 years. The acting programme manager of the Ugandan AIDS Control Programme noted that girls are six times more likely to be infected with HIV than boys the same age. He attributed this to the sugar daddy syndrome, referring to older relatively wealthy men who engage adolescents in sexual relationships.73 But the evidence from literature remains inconclusive, and more rigorous cross- national research on representative community-based samples of adolescents and girls in particular is needed. For instance, Gregson and colleagues48 found in rural Zimbabwe that a one-year increase in age difference is associated with a 4% increase in HIV infection risk, with most recent non-marital sexual partner on HIV infection for young people aged 17-24 years. In contrast, Glynn and collaborators66 found in two urban settings in Kenya and Zambia that there is no effect of age of the older partner on HIV infection risk for unmarried girls.

Implications for Research and Inter-ventions Targeting Adolescents and Young People

Over the past two decades or so, researchers have made substantial progress in describing sexual relationships between adolescents and older people that are associated with the practice of having these relationships in exchange for money, presents, favours and other material benefits that adolescents receive. At the same time, there are indications that these relationships increase the risk and prevalence of STI and HIV infections among adolescents and young people. Just as evidence is mounting about this practice and its associated factors, it appears that in studies of the young people's relationships with sugar daddies or mummies, the connection between these behaviours and the individual, familial, community characteristics which perpetuate them in combination with partners' attributes are little investigated. There is also little attention to the psychological worlds of young people and the ways teenagers and young people construct and interpret the developmental changes they are experiencing and, therefore, how the influence of social settings is mediated by psychological and cognitive processes as they experience these relationships. These unmeasured factors are part of the randomness in the content and contexts of young people's interactions with older men and women, and the extent to which sexual activity is traded for some material or financial favours.

This paper has raised a series of metho-dological challenges in defining and measuring this practice and the difficulties in understanding and comparing research in diverse contexts and countries due to potential differences in culture, language, education, wealth, living environment and local economy in the context of globalisation. Thus, more in-depth research combining quan-titative and qualitative methodologies, particularly cross-culturally, on meanings of different forms and contents of sexual relationships between young people and older individuals is of paramount importance if progress is to be made in addressing the many ways in which young people are sexually exploited and coerced as well as the scope of the short, medium and long-term consequences. Such cross-cultural endeavour is essential in understanding young and older people's risky sexual behaviours and their needs as victims or perpetrators and priorities for intervention and policy formulation.

Future Research and Data Needs

As regards the estimates of the prevalence/extent of sexual relationships of young people with sugar daddies and sugar mamas, in the absence of substantial evidence based on several datasets, disagreement about the magnitude of the practice of sugar daddy or sugar mama in any setting is a matter of fact. There is an urgent need to do comparable qualitative and quantitative studies on the epidemiology of this practice so that its specificity, sensitivity, various aspects and risk/protective factors measured at the individual, family and community levels can be determined. Most studies in this area are based on focus group discussions, which tend to capture general perceptions, local moral or normative beliefs, and sensational stories for the media, anecdotal evidence and often rumours, not truly individual experiences.

The lack of an agreed definition and specificity of the practice of sugar daddy and sugar mummy and the paucity of data describing the nature and extent of the problem worldwide have contributed to its lack of visibility on the agenda of policymakers and donors. There is a need for substantial further research on almost every aspect of individual adolescent males and females experiencing sexual relationships with older men and women in exchange for money, presents and favourable treatments within the framework of the sugar daddy and sugar mummy practice. This should include (i) the incidence and prevalence of the practice in a range of settings across and within countries using a standard research tool for capturing the practice; (ii) the risk and protective factors for being a victim or a perpetrator of such practice; (iii) the emotional, psychological, health and social consequences in the short, medium and long-term of different forms of this practice; and (iv) the social contexts of different forms of such practice.

The trustworthiness of self-reported sexual behaviour data retrieved from either qualitative or quantitative research methodologies have been questioned repeatedly since the early studies.81 Self-reports of sexual relationships between younger and older people as they relate to the practice of sugar daddy and sugar mummy reviewed here are even more questionable due to data limitations and methodological shortcomings inherent in existing studies. To address a number of outstanding issues related to young people's sexual relationships with older people, two large scale community surveys conducted in several urban and rural areas of Cameroon by the author of this paper have sought information from young people and older men and women. The preliminary evidence suggests that the picture is a complex one. Hence, it is important to collect information from young people and older men and women within the same study site on (i) the type of relationship; (ii) whether a pregnancy occurred; (iii) partner's age; (iv) marital status; (v) number of children; (vi) socio-economic standing of the partner (education, employment, etc); (vii) age of partners at onset and duration of the sexual relationships; (viii) frequency of sexual encounters; (ix) material and immaterial exchanges between the young and the older person; (x) partner's attitude to use of contraception; (xi) partner's reaction if there was a pregnancy; (xii) prospect for the relationship with the partner; and (xiii) raison d'être and motives of the relationship and whether either the young person or the old man or woman has any long-term goals for the relationship including marriage. Because of the continued importance of marriage in many developing countries, most girls continue to believe that the need to find a suitable husband and build a family is more important than pursuing schooling or professional goals. Indeed, it was once noted that in parts of Africa, deliberately becoming pregnant is often a strategy for securing a husband and attaining a certain social status.

More research is also needed to determine the magnitude of the practice of sugar daddy and sugar mummy around the world including its salient features in urban versus rural areas. Such research should also explore the physical, psychological, emotional and health impact of these relationships on the health, education, life options and opportunities, living arrangements and morals of the boys and girls involved.

Legal and Public Health Implications of this Review

The prevention and policy responses to young people's sexual relationships with older people need to be based on an understanding of the problem, its causes and the circumstances in which it occurs. In all studies to date around the world on age mixing, cross-generational and/or transactional sexual relationships, the practice of sugar daddy and sugar mummy is not adequately addressed in legislation. Studies conducted on the practice have not been very illuminating in terms of making it a public health issue, given its quantitative importance. In addition, this practice is frequently not treated as an offence to minors in the sense that it involves transaction for sexual favours, which are criminal offences in most legal systems in the developed world. Unfortunately, in most developing countries and in sub-Saharan Africa where the majority of studies on cross-generational transactional sexual relationships have been conducted, there is much to be done before the practice of sugar daddies and sugar mommies are properly acknowledged and addressed as a reprehensible sexual behaviour of older people against adolescent males and females, who are the victims the society, legal and judiciary systems need to protect. Such a necessary step will enable more comprehensive prevention measures and better support for the adolescent victims. It will also allow an integrated youth prevention programme for both male and female adolescents to the extent that the practice becomes a social and public health problem encompassing both genders.

Because sex laws are dealing with the most intimate and private aspect of human existence, and sexual intercourse remains the main mode of transmission of HIV/AIDS in sub-Saharan Africa where the practice of sugar daddy and sugar mummy has been most explored, sex laws protecting minors and juveniles under 18 years against this practice and other forms of child sexual abuse and exploitation should be developed, adopted and enforced, whether sex was consensual or not. The complexity of such laws is evident from the 17 variations on sexual conduct examined in the case of the United States by Posner and Silbaugh,15 including bestiality, necrophilia, sodomy, incest, public nudity and age of consent.

A Call for Action

An integrated effort at all levels of leadership is needed to counter the practice of sugar daddy girls or sugar mummy boys and to avoid its further spread. Serious political commitment and adequate resource allocation are essential elements to save the lives of millions of persons and the economic viability of the societies involved. In addition, a more complete knowledge of the complex interactions of the various factors affecting the spread of the epidemic is urgently needed in order to develop appropriate prevention initiatives. Many international organisations are now aware of the reproductive health risks orchestrated by young people's relationships with older men and women and some of them have developed non-formal education approaches to HIV/AIDS prevention in this context. For instance, UNESCO has recently produced materials covering a range of pertinent subjects including two booklets dealing with the issue of sugar daddies, one booklet from urban rich girls' perspectives and the other from the point of view of poor rural parents.21 These materials are designed to help people change their behaviour towards practicing safe sex in relationships between women and men and the cultural practices influencing such relationships. These materials are targeted at both poor rural people and particularly women and girls who are most at risk in any society as well as men who have been singled out as the most important actors in bringing about successful HIV/AIDS prevention.

Acknowledgements

A preliminary version of this article was presented at the International Conference on Non-Consensual Sexual Experiences of Young People in Developing Countries held in New Delhi (India), 22-25 September 2003. It was co-organised by the Population Council, World Health Organization and Family Health International. This work was carried out as part of the research programme of the Population Health and Nutrition Research Laboratory (PRONUSTIC) at the University of Montreal and was supported in part by a grant from the Rockefeller (New York, USA) to Professor Kuate-Defo.

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