African Journal of Reproductive Health, Vol. 11, No. 3, December, 2007, pp. :44-61
Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa
Ann M. Moore1, Ann E. Biddlecom1, and Eliya M. Zulu2
1Guttmacher Institute, New York, New York, United
Code Number: rh07034
Using national survey data collected in 2004 in Burkina Faso, Ghana, Malawi, and Uganda with 12-19 year olds, we examine the prevalence of sex in exchange for money or gifts in the 12 months prior to the survey and its association with adolescents' social and economic vulnerability and condom use. Receiving something in exchange for sex is very common among sexually active, unmarried female adolescents and there are no significant differences by household economic status, orphan status, level of schooling completed or age difference between partners. Condom use at last sex in the 12 months prior to the survey is not associated with receiving gifts or money. Qualitative data based on focus group discussions and in-depth interviews collected in 2003 with adolescents suggest that receiving money or gifts for sex is not necessarily a coercive force, but rather can be a routine aspect of dating.
Prévalence et significations de l'échange d'argent ou de cadeaux pour l'acte sexuel dans les rapports sexuels des adolescents célibataires en Afrique subsaharienne A l'aide des données recuellies d'une enquête nationale en 2004 au Burkina-Faso, au Ghana, au Malawi et en Ouganda auprès des adolescents âgés de 12-19 ans, nous avons étudié la prévalence du sexe dans l'échange pour l'argent ou des cadeaux au cours de 12 mois précédant l'enquête et son association avec la vulnérablité sociale et économique des adolescents et l'utilisation des préservatifs. Le fait de recevoir quelque chose en échange pour le sexe est très commun parmi les adolescents célibataires et sexuellement actifs et il n'y a pas de différences significatives par rapport à la situation économique de la maison, la situation d'orphelin, le niveau d'instruction achevée ou la différence d'âge entre des partenaires. L'utilisation des préservatifs au cours de douze derniers mois avant l'enquête n'est pas liée à la reception des cadeaux ou de l'argent. Des données qualitatives basées sur des discussions à groupe cible et les interviews en profondeur qui ont été recueillies en 2003 auprès des adolescents, montrent que l'acceptation de l'argent ou des cadeaux pour le sexe n'est pas nécessairement une force coercitive, mais pourrait être plutôt un aspect de routine de fixer un rendez-vous entre petits amis.
Key Words: transactional sex, adolescents, condom use
The HIV/AIDS epidemic in sub-Saharan Africa has motivated, in large part, studies of the role of money and material gifts in sexual relationships because these exchanges may pressure young women, in particular, into sexual relationships with risky partners and into having sex without condoms.1 Statistics on the course of the AIDS epidemic provide persuasive justification for a focus on young women's sexual relationships in Africa. In 2006, 40 percent of new HIV infections worldwide among adults aged 15 years and older were estimated to be among young people (15 to 24 years old), nearly two-thirds (63 percent) of HIV-positive people were living in sub-Saharan Africa and 59 percent of HIV-positive people in sub-Saharan Africa (across all age groups) were female.2 Unprotected sex also puts women at risk of pregnancy and young women make up a large fraction of those who experience unsafe abortions. More than one-quarter of the estimated 4.2 million unsafe abortions in Africa were experienced by 15-19 year olds.3
This paper focuses on sex in exchange for money or material support among young, unmarried women, be that support for basics such as food or clothes or for luxury goods such as jewelry or cosmetics. Using qualitative and quantitative data collected in 2003-2004 in four sub-Saharan African countries, we examine:
Having sex for money or gifts has been found to be a common occurrence among girls in many parts of sub-Saharan Africa.4-9 "Gifts have become a symbol of the girl's worth and a man's interest, and girls feel offended if they do not receive something."4, pg. 21 Studies show wide variation across the region in reported levels of receiving money or gifts in exchange for sex. An analysis of national level Demographic and Health Survey data found that among sexually-active 15-19 year old girls, the percentage who had engaged in transactional sex in the last 12 months ranged from 2 percent in Niger to 14 percent in Benin among the nine West African countries examined and was 14 percent and 27 percent among sexually-active girls in Kenya and Zambia, respectively.8 In Uganda, 31 percent of 15-19 year old adolescents reported that they received money or gifts in exchange for sex at their last sexual encounter.4;7 A review of studies based mainly on sub-national data or specific population groups (e.g., secondary school students) found five percent of girls 12-17 years old in Cameroon; about two-thirds of 10-18 year old girls in Malawi and 85-90 percent of rural girls 12-20 years old in Uganda reported ever engaging in sexual relations in exchange for money or gifts.10-12
As can be seen from the Ugandan statistics presented above, big discrepancies across surveys in the same country suggest that measuring the receipt of money or gifts for sex may be highly sensitive to the wording of the question or it may be more prevalent in some sub-populations than others within the same country. Furthermore, some argue that even at the levels transactional sex is being reported, it is an underestimate because of the narrow definition of transactional sex used in survey questions (frequently only asking about gifts and money given proximally to the sex act) and because of the disincentive to report exchange behaviors due to the universally high level of social stigma attached to prostitution.4
The practice of receiving money and gifts for sex has generally been perceived to be a consequence of women's poverty.13 Yet research on transactional sex has found that engaging in sex for money or gifts does not appear to be mostly for economic survival.8;14;15 (Data on men's perceptions of this belief are available elsewhere.16) Luke and Kurz divide women's financial interests in engaging in transactional sex into three categories: economic survival, to increase longer-term life chances, and to increase status among one's peers. Economic survival includes being pressured (actively or passively) by parents to secure needed goods for the household (as noted in other studies8;12;14;15;17-21). Improving long-term life chances generally means getting school fees from ones' partner or using a partner to help one socially climb (which can also increase one's status among one's peers).22 Lastly, increasing one's status among one's peers includes the presence of boyfriends which can serve to show that one is attractive and sexually-active and has money to spend.4;19;23-25 Of these various reasons, economic survival is the most coercive reason to have sexthe greater the financial dependence on the resources one's partner provides, the more coercive the sex.26
Having sex for money or gifts has frequently been conflated with having sex with older partners. Yet contrary to the image of "sugar daddies" paying teenage partners for sex, comparatively few girls have sexual partners who are more than 10 years older than themselves. Previous research has found that less than a quarter of girls have partners who are 10 or more years older than them and that in fact the average age difference between girls and their partners is six years.4;11;16;27-31
Receiving money or gifts in exchange for sex is not necessarily disempowering. It may be a way for young women to obtain validation of their worth from their partner.5;12;23 Existing evidence suggests that gifts and money may not mean the same thing to both members of the couple. In rural Tanzania, while males perceived women to be largely motivated to engage in sex for gifts, women interpreted the gifts as a demonstration of their partner's love and commitment.9 Another study in Tanzania found that the price/gifts women demand for sex are a demonstration of self-respect and how much they perceive they are valued by their partner: accepting too low of a price for sex is a threat to a woman's sexual respectability.19 In an analysis of the relationship between the value of the gift and condom use among the Luo in Kenya, Luke's study of an economic threshold for engaging in sex without a condom is evidence that girls are active agents in this sexual negotiation.32 In a further testament to girls' voluntary participation in unions that provide gifts and money, girls have been found to terminate the relationship if gift-giving ends.5;12,33;34
Evidence also shows that receiving a gift does not guarantee a man sexual access. Nyanzi et al. (2001) found that girls in Uganda are able to delay relations and thereby increase the size and frequency of gifts, possibly never coming through with the expected sexual intercourse.12 "Detoothing" is a Ugandan term used by girls to mean getting as much financial reward from a man while successfully eluding sex.12;35 Yet detoothing can end badly: Some studies have found that adolescents, including girls, felt that rape is an acceptable response by men to having been detoothed.12;36
Another theory posited more recently about transactional sex is that the transactional element creates meaningful social ties. The sexual relationship can be significant in its own right, and the transfer of financial resources should not be assumed to alter the meaning of the sexual interaction but rather the financial transaction can add another layer of meaning.37;38 Meekers and Calves (1997) found that sexual connections are a strategy women use in Cameroon to increase their access to resources.39 Analyzing the meaning of gifts and money for sex in Malawi, Swidlerand Watkins (2006) argue that redistribution and reciprocity in a society wrought with uncertainties and inequalities is a way of life where gifts or money for sex is only one manifestation of this system-wide phenomenon.22 Evidence to support this argument was found in Tanzania where transactional sex has been characterized as a modification of bride wealth. Bride wealth was a way that gifts or money for sexual access changed hands in traditional African cultures, and with the disassociation of sex from marriage, even when sex occurs surreptitiously, gifts or money for sex may be the modern version of the financial validation of women's sexual, and perhaps, personal worth.19
Receiving gifts and money in exchange for sex has been studied in relation to condom use. Luke and Kurz (2002) found that as in many relationships, within transactional relationships, girls lack power to negotiate condom use or to control the use of violence. Yet reasons for this were not limited to the transaction but included gender norms of male dominance and female subservience, the condom's continued association with infidelity, women's economic dependence on men, and lack of information about HIV, pregnancy risk and contraception.4;36;40 Kaufman and Stavrou (2004) found in South Africa that the 14-22 year olds in their study felt that accepting a gift meant agreeing to the man's right to demand sex. The study also found racial differences in the interpretation of the gift whereby white males said that if a gift was given and sex was to follow they would not tolerate condom use, while black males said that a gift would not be meant to dissuade their partner from condom use.23 However, while most white females indicated that they would not be persuaded to forego condoms if gifts were offered, black females said that if a girl was to accept a gift just before sex, she denied herself the right to ask for a condom.23 These findings are consistent with results from Kenya, Tanzania and Malawi that gifts or money can be a barrier to condom use.32;41;42 Luke and Kurz conclude that for many young women engaging in sex for gifts or money, financial rewards take precedence over fears of pregnancy or infection with STIs including HIV.
Drawing on new nationally representative survey data of male and female adolescents that include the experience of very young adolescents (aged 12-14), we examine the prevalence of receiving gifts and money for sex, the social and economic correlates of receiving gifts or money for sex and the degree to which it places unmarried girls at risk for HIV and unintended pregnancy by lowering the likelihood of using condoms. The qualitative data provide further insights into the meaning adolescents attach to the giving and receiving of gifts and money in sexual relationships and the implications that money and gifts have on their sexual behavior.
Data for the study come from three sources: national surveys, focus group discussions (FGDs) and in-depth interviews (IDIs) carried out with adolescents 12-19 years of age. (The focus groups were conducted with youth 14-19 years of age.) The data were collected in four countries in sub-Saharan AfricaBurkina Faso, Ghana, Malawi and Ugandawith the objective of collecting information that would contribute to our understanding of factors that either place young people at risk or protect them from HIV and unintended pregnancy.
Nationally Representative Survey
A nationally-representative household survey on adolescent sexual and reproductive health was conducted with both female and male 12-19 year olds in each of the study countries in 2004. The final sample sizes were 5,955 in Burkina Faso, 4,430 in Ghana, 4,031 in Malawi, and 5,112 in Uganda. A two-stage stratified, cluster sample design was used. All 12-19 year old de facto residents in selected households were eligible for participation. The instrument was translated into the appropriate languages for each of the four countries. Informed consent was sought first from the parent of each eligible adolescent 12-17 years of age, and then from the adolescent him/herself. Adolescents 18-19 years of age were directly approached for consent. Further details on the survey content and methodology are available elsewhere.43-46
The main outcome measure of interest is whether gifts or money were received in exchange for sex with a partner in the last 12 months among unmarried adolescents. When the term "sex" is used in this paper, it refers to vaginal/penile intercourse. In calculating overall prevalence, data are summarized across up to three sex partners in the 12 months prior to the survey interview. When examining the association between relationship-specific characteristics and receipt of money or gifts, information is with respect to the most recent sex partner in the last 12 months. The second outcome of interest is whether condoms were used at last sex with the most recent sex partner in the last 12 months (yes/no). Measures of the social and economic vulnerabilities of adolescent girls are household wealth (lowest quintile, second and third quintiles and fourth and highest quintiles); being an orphan (yes if biological mother or father died); completed 6+ years of schooling (which approximates completing primary school across the four countries; yes/no); and age difference with partner (partner is similar in age or respondent doesn't know partner's age/partner is 5+ years older). Other variables used in the analysis include age at time of interview; having had two or more sex partners in the last 12 months (yes/no); and duration of sexual relationship in which last sex occurred (less than one year/one year or more).
Aside from the measures of sexual activity and receiving gifts or money for sex for unmarried males and females presented in Table 1, the analysis is restricted to unmarried 12-19 year old girls who had sex in the last 12 months. The data are for unmarried females since married females were not asked about having received gifts or money for sex. Chi-square statistics are shown for the association between individual and relationship characteristics and receiving money or gifts in exchange for sex, and the multivariate analysis predicting having received money or gifts in the last 12 months and condom use at last sex is conducted using logistic regression. SPSS 13.0 (SPSS Inc., Chicago, USA) was used for analysis.
A total of 55 focus group discussions (FGDs) were conducted from January through March 2003 with 14-19 year olds: 16 in both Burkina Faso and Ghana, 11 in Malawi and 12 in Uganda. In each country, one or two urban and one or two rural locations were selected in which to conduct the focus groups with in- and out-of-school youth, and married and unmarried adolescents (in Malawi and Burkina Faso). FGD recruitment was similar across countries: a facility-based recruitment approach, where respondents were recruited in specified facilities such as community halls and youth centers, was used in urban areas and a community-based approach was used in rural areas. Consent was obtained from all the young people before they participated in the discussions and parental or guardian consent was also obtained for adolescents younger than 18. Each country team used the same discussion guideline translated into the appropriate language. Focus groups had 8_12 participants and lasted an average of 2_2.5 hours. The discussions were tape-recorded, transcribed and translated from local languages into English and, in the case of Burkina Faso, into French.
Approximately 102 in-depth interviews were conducted with males and females aged 12-19 in each of the four countries and consisted of the same sub-groups as the FGDs: in- and out-of-school adolescents from urban and rural locations. In addition, interviews were conducted among young people who belonged to specific groups that were considered to be at higher than average sexual risk: young married women, women with children, refugees (Ghana and Uganda), street children and petty traders. The discussion of transactionsmoney or gifts within the context of a relationship and for sexemerged spontaneously in the qualitative data. Interviews lasted between 30 minutes and 2.5 hours. Just as with the focus groups, the interviews were tape-recorded, transcribed and translated from local languages into English and, in Burkina Faso, into French.
The FGD and IDI transcripts were coded with N6 qualitative software (QSR International, Doncaster, Australia) using, in both cases, a pre-established node structure based on the discussion or interview guide. Each focus group was treated as a unit of analysis for the FGD component of the study and the individual was treated as a unit of analysis for the IDIs. Experiences of receiving money or gifts for sex were not limited to a specific time frame (i.e. 12 months prior to the interview). Analysis took place via summary matrices of substantive themes by gender of the study participants for each country. Quotes presented represent relevant themes which emerged on the topic of analysis. For consistency purposes, only qualitative data on unmarried transactional relationships are presented. While the quantitative data speak to prevalence and association, the qualitative data speak to expectations and meanings of gifts in relationships. By drawing on these multiple data sources, a fuller picture emerges of the role of money and gifts in sexual relationships in the four countries analyzed in the paper.
Table 1 shows that about one in ten unmarried 12-19 year old girls and a wider range, from 6 percent in Ghana to 26 percent in Malawi, of unmarried boys report having had sex in the 12 months prior to the survey interview. Among those who had sex, at least three-fourths of girls in Ghana, Malawi and Uganda received money or material goods in exchange for sex with recent sex partners. Burkina Faso is an outlier: 36 percent of unmarried girls received gifts or money for sex with recent sex partners. The proportion overall for male adolescents is much lower than it is for female adolescents with exchanging gifts or money for sex in the last 12 months being most common among male adolescents in Uganda (35 percent), followed by Ghana (33 percent), Malawi (9 percent) and Burkina Faso (5 percent). Yet the data on males should be interpreted with caution as some of the male respondents may have interpreted the question to mean whether they had given gifts, in which case these numbers might overstate gift-receiving among males. That not withstanding, since receiving money or gifts for sex occurs much less frequently for boys, the rest of the analysis focuses on girls.
The items identified by girls that they received in exchange for sex were not temporally specifiedthat is, the items may have been given directly before or after sex or quite some time before or after sex occurred. The most common item to receive in exchange for sex was money (93 percent or more across all four countries) followed by clothes (ranging from 33 percent to 63 percent) (Table 2). Clothes could be necessities (e.g., school uniforms) or luxuries. The third most common type of gift received by girls in Burkina Faso, Malawi and Uganda was jewelry and cosmetics. Only in Ghana did more girls report receiving food than jewelry and cosmetics. The type of food (unspecified in our study) that is exchanged for sex could indicate whether sex is being used for survival, for example, if it is salt; or a luxury good, for example, if it is a soda.
Characteristics associated with receiving money or gifts for sex
Table 3 shows characteristics hypothesized to be associated with receiving gifts or money in sexual relationships. In Burkina Faso, age is negatively associated with receiving gifts and money for sex, while in Uganda it is positively associated (i.e., older girls who are sexually active are more likely to have received gifts in the last 12 months than younger one girls who are sexually active). Age makes little difference in Malawi and Ghana. It is remarkable to note that for 18-19 year old girls in Malawi and Uganda, over 80 percent reported having received gifts or money in the last 12 months for sexual intercourse.
There is no consistent pattern in the relationship between household wealth and whether the respondent received gifts or money for sex and none of the associations are statistically significant. Being an orphan is not significantly associated with engaging in sex for money or gifts. Level of schooling is negatively associated with getting things in exchange for sex only in Burkina Faso and not significant in the other three countries. Having sex for money or gifts is associated with having more sex partners in Uganda where 96 percent of girls with two or more partners received gifts or money compared to 72 percent of girls with only one recent sex partner. In Ghana, however, having more sex partners is, in fact, significantly negatively associated with receiving gifts or money for sex. Neither age difference with the partner nor duration of the relationship are significantly associated with engaging in sex for money or gifts. Lastly, only in Uganda is receiving money or gifts for sex significantly associated with condom use, but in the opposite direction one would expect: Among unmarried young women who did use a condom at last sex, 81 percent received money or gifts in the last year compared to 68 percent of those who did not use a condom.
Odds ratios from the multivariate logistic regression models in Table 4 show the likelihood of receiving money or gifts in exchange for sex with the most recent sex partner in the last 12 months. In Burkina Faso age is negatively associated with engaging in sex for money or gifts and in Uganda having two or more sex partners in the last 12 months is positively associated with having engaged in sex for money or gifts. This finding should be interpreted with caution, though, due to the small number of girls who had two or more sexual partners in the last 12 months. The rest of the variables were not significantly associated with receiving gifts or money in exchange for sex.
Table 5 shows whether receiving money or gifts in exchange for sex compromises the use of condoms. Contrary to what has been found by a number of studies, the results show that having received gifts or money in the 12 months prior to the survey is not significantly associated with condom use at last sex in any of the four countries. Being an orphan in Malawi increases the probability of having used a condom at last sex and in all four countries having six or more years of education increases the probability of having used a condom. In Uganda, young women with two or more partners in the last 12 months were significantly more likely to have used a condom at last sex. (Again, for the reason stated above, this finding should be interpreted with caution.) Urban residence increases the probability of condom use in Burkina Faso while it decreases the probability of condom use in Malawi. In short, while there are other significant correlates of condom use in some countries, receiving gifts or money in exchange for sex is not one of them.
Context and motivations for receiving gifts and money in exchange for sex
A transactional element in sexual interactions was discussed as present both with older partners as well as with age-mates. In all four countries, cross-generational relationships which included money or material goods were described in generally negative terms with economic need a motivation, though not exclusively so. In some of the female discussion groups, the influence of peers (whether external, i.e. direct pressure, or internal, i.e. adolescents just wanting to be like others) was mentioned as a reason for engaging in sex for gifts or money. A common way external pressure occurred was when girls with boyfriends complained to their single friends that they were tired of buying treats for those without boyfriends. The explicit message was that the girl without money should go out and get a boyfriend so she no longer needs to be supported by her friends.
In Uganda, where discussions about transactional sex were on the whole more extensive, girls were described in both the female and male groups as being strategic about sex and money in the relationships they entered into with both older men and age-mates although love was understood to obfuscate an interest in money.
Participant 1: There are girls who like money a lot in their life. So if a man gives you UGS10,000 [about US$5.50], you do not mind [having sex with him], even old men.
Participant 2: If you have one [boyfriend] who gives you UGS2,000 and another who gives you UGS10,000, you split with one of UGS2,000 and settle with one of UGS10,000.
Participant 1: Big daddy, if one gives me UGS10,000, I would go there for fun and the money but remain with the other one too. You keep both: you may be liking [the] first one genuinely but want only money from [the] second one. So you keep both.
Participant 4: Some girls do not want money but they go in for real love. Even if they get no money from the boyfriend, they just go in for love.
Urban females, out of school, Uganda
In this data set of over 200 in-depth interviews with girls, only one respondent described a traditional sugar daddy relationship. There was a 15 year age difference between her and her partner:
He would pick me from home secretly and take me for film shows in town. I would always lie to my mother that I had gone to my Auntie's place and would spend nights with him. [ ] At the end of it all he asked me to show him that I loved him by having sex with him and I complied. I could not refuse because I was ashamed of all the things he had done for me.
Rural female, out of school, 17 year old, Uganda
The descriptions of money and gifts in relationships with age-mates encompassed money or gifts being used simply to indicate an interest in someone; as part of the courting process that might lead to having sex; as one further step on the path towards marriage; and in quid pro quo terms: something was given and so the gift must be repaid. In Burkina Faso, discussions focused on boys giving gifts and money to "flatter" girls, sometimes just to indicate their interest in becoming close and sometimes with the underlying intention of having sex. The gift itself may indicate a boy's romantic intentionsthus blurring the girl's motivations for engaging in sex:
Participant 1: Sometimes boys can be wanting to just spoil girls. He can persuade you and you know us girls-small things like these [holding a packet of biscuits] can persuade us. He spoils you then you miss your education and sometimes your life just because of such petty things.
Participant 2: He persuades and deceives you that he is going to marry you and gives you something like this [holding a packet of biscuits]. You play sex, you find he has a sexually transmitted infection or sometimes he spoils you and impregnates you and you fall in a deep pit.
Rural females, in-school, Uganda
Money played a very clear role in bringing about sexual intercourse for some young men.
Moderator: Is it possible for the girl to refuse sexual intercourse if the male proposes to her?
Participant 1: If she refuses, you can flatter her and give her lots of money for her to accept [to have sex].
Participant 2: The girl can refuse if she wants to.
Moderator: But if she refuses, do you think that the boy can force her?
Participant 2: It's possible. If you take her out to eat and drink and she refuses to have sex with you, you can force her because it's not for nothing that you spent your money.
Participant 3: For example, if a boy pays for a girl at every party, afterwards she can't refuse to have sex with him. Or else if the boy pays for something to eat, she can't [refuse].
Urban males, out of school, Burkina Faso
Boys from Uganda described that it is not only the girl who is bound by the financial expectations that come with accepting a gift. The boy is too:
Moderator: What else leads one into indulging in sexual activities?
Participant 1: She comes to you and asks why you can't talk. You find the girl going too far and wanting you to give her money. Then if she takes anything from you, you get forced to follow it up and demand for sex.
Moderator: How does she take money from you?
Participant 2: She asks you, "Can't you give me something to eat?" So you give her [something to eat] and [thereby] lay the groundwork for demanding sex.
Rural males, out of school, Uganda
In analyzing the sexual narratives outside of marriage in the in-depth interviews (IDIs), boys related being asked for money by their partners while girls talked about being presented with the money yet it is unclear if they were asking for it.
Girls related receiving money to buy themselves food, soap or clothes.
In Uganda and Malawi, receiving gifts or money were described as one aspect of romantic relationships that involved sex but that the gifts or money did not necessarily connote pressure. As a Ugandan girl described the exchange in her relationship: "We were friends, he would give me money and we also had sex" (rural, out of school 18 year old female). A rural, out-of-school 16 year old Malawian boy said that he knew that if he had no money his girlfriend would refuse to have sex with him. He talked about how he spent all week assembling the money so that he could have sex with her once a week.
Yet from the narratives it is not always clear whether money or gifts played a coercive role. A number of rural, out of school Ugandan girls described sexual experiences that involved obtaining money or gifts to engage in sexual intercourse where the role that money played in bringing about the sex was explicit but whether the money and gifts were coercive remains unclear: "When we reached his place, he told me he was going to have sex with me but he would not tear me [damage my private parts] and that he's not a bad person. So I believed him and had sex with him, then he gave me 300 shillings" (rural, out of school, 15 year old, Uganda); and "He approached me tactfully and he promised some dress and some sunglasses and I gave in" (rural, out of school, 16 year old, Uganda).
On the other hand, some of the sexual narratives that included an exchange of money were more explicit about the coercive force exerted by that money. "The man told me that `If I have sex with you I will use a condom and nothing will happen to you, I will also give you 2000 shillings' so I accepted because I needed the money" (rural, out of school, 15 year old, Uganda); and "He would give me money and would say that I should show him that I love him by playing sex with him" (rural, out of school, 16 year old, Uganda). In Burkina Faso, where gifts were described as more directly tied to having sex, one Burkinabé girl described how she was lured by gifts to put herself in a situation where explicit sexual coercion occurred. The boy in the narrative below had invited the respondent to go to a video club to watch a movie.
Respondent: He charmed me and then we had sex. It was my first time. [ ] He encouraged me to go with him to the bedroom so that he could give me a gift; when we went into the bedroom, he shut the door.
Interviewer: But when he shut the door, did you try to scream?
Respondent: No, I wanted to scream and he told me not to cry and I shut up.
Urban female, urban, out of school, 19 year old, Burkina Faso
The respondent had not spoken to the boy since that day. She recounts at the end of this narrative that she has not had sex again because she is scared of boys. Gifts and money did not come up in the sexual narratives in Ghana.
Using these unique data from four sub-Saharan African countries provides nationally represen-tative prevalence numbers and correlates for sex in exchange for money or gifts for adolescents 12-19 years old. The qualitative data inform the meaning and expectations associated with gift giving and getting in romantic relationships. The data show that money and gifts do not increase the probability that girls' last sex experiences are unprotected and that getting gifts or money for sex can be coercive but it can also be a non-coercive part of romantic relationships in which girls can exercise agency through romantic preferences and demanding gifts.
The quantitative data show that receiving gifts, primarily money and clothes, to engage in sex is a common practice within adolescent sexual relationships in the four countries of this study as over two-thirds of young women Ghana, Malawi and Uganda and one-third of young men in Ghana and Uganda said they had received gifts from a recent sex partner to have sexual intercourse. Getting money or material goods in exchange for sex occurs most commonly in relationships with age-mates, is taking place across the socio-economic spectrum and is not associated with less condom use. Since household wealth status is not associated with having engaged in sex for money or gifts, it appears that what is being observed is not primarily survival sex but frequently gift-giving in the context of romantic relationships, which is not to say that it is not coercive. The results on condom use do not speak to prior findings that the size of the transfer is negatively related to condom use since in this study there are no data on the value of the gift (or amount of money received) or the frequency that gifts or money were exchanged for sexual intercourse.32 Additionally, the limited number of cases means that smaller effect sizes will not be detectable. It should be noted that while there is no statistically significant association between educational attainment (having six or more years of schooling) and receiving money or gifts for sex in both the bivariate and multivariate analyses, educational attainment has a strong and positive association across all four countries with condom use at last sex.
While the qualitative data demonstrate that gift-giving is part of what takes place in unmarried adolescents' sexual relationships, in many cases, it remains unclear if money or gifts were the critical incentive to have sexual intercourse. Offering basic necessities for sex might be a coercive tactic if a young woman is in dire need, yet it is hard to make that same argument when gifts such as jewelry and cosmetics are the items received.
Peer pressure can influence girls to enter into transactional sexual relationships. While this might be deemed coercive, the coercion is not being perpetrated by the sex partner. Girls can be strategic about the sexual arrangements they make using money as a reason to have sex when love is not present, as was discussed by girls in Uganda. This finding is consistent with the work of Meekers and Calves' (1997) in Cameroon. Girls' agency is further demonstrated through asking for gifts sometimes to get the relationship started (as was discussed among Ugandan youth) as well as rejecting sex partners for not giving enough (Malawi).
Accepting gifts can lead to forced sex: Burkinabé boys stated that spending money on a girl entitles them to sex whether or not their partner is willing. Yet the expectation of sex tied to gifts can bind either of the partners to an unwanted sexual situation as evidenced by Ugandan boys stating that girls coerce them into having sex through asking for gifts. While Ghanaian youth did not talk about obtaining gifts or money for sex, the quantitative evidence demonstrates that gifts and money are given for sex there as well. Perhaps the behavior is more stigmatized in Ghana and that was the reason it was not discussed.
Norms about girls and sexuality may make it more advantageous for girls to report engaging in sexual intercourse for money rather than for desire. It is not socially acceptable for unmarried girls to initiate sex or be demonstrably enthusiastic about engaging in sex. Therefore, just as it is difficult to get an accurate assessment of coercive sex for girls47, it is not possible from these narratives to tease apart the girls' willingness to engage in sex in the absence of money or material items given in the context of the relationship.
Many of the studies on "transactional sex" have been carried out in sub-Saharan Africa. Perhaps the issue is studied so infrequently in the general adolescent population outside of sub-Saharan Africa because there is interest in "transactional sex" only in the context of high HIV prevalence rates and the particular vulnerabilities to HIV that young women face. For point of comparison it is useful to note the role of money and gifts in adolescents' romantic relationships in the United States, although virtually no studies examine connections to sexual activity. For example, a descriptive study based on the National Longitudinal Study of Adolescent Health (adolescents in grades 7 through 12 in 1994-95) showed that 62 percent of adolescents in romantic relationships gave each other presents; more girls than boys report gift-giving behavior, and as adolescents age they report more gift-giving in their romantic relationships (though even among 15 year old females and males, more than half reported gift-giving).48 An in-depth study of
vi Romatic relationships were either self-reported or categorized as such based on separate questions about whether the adolescent had held hands with kissed and said they liked or loved the person. Girls tended to have male partners that were on average a couple years older than them, while boys tended to have older partners only up until they were 18 or 19 years old,
college-aged young women highlighted women's use of money and gifts in exchange for sex in order to feel in control of their relationships with men.49
Transactional sex has caused enough concern as a social problem that a number of interventions have been designed, but they address cross-generational sex and not transactional sex in general. For example, a randomized information campaign intervention in 2004 in Kenyan primary schools (called the "Sugar Daddy Awareness Campaign") was meant to decrease cross-generational sexual relationships by presenting specific information to primary school pupils about HIV prevalence rates by gender and age group. An evaluation of the program found that the program led to a 65 percent decrease in the incidence of pregnancies by older partners among teenage girls in the program, and, interestingly, reported sexual activity and condom use with age-mates increased but pregnancy incidence in those relationships did not increase.50
Limitations of the present study include that the only measures on the survey that capture a transaction are whether the respondent was given gifts or money to have sex in the last 12 months (up to three partners) and the type of gift that was received. We do not know how often gifts were given in the relationship; what the value of the gifts were; if the gift-giving was mutual in the relationship, i.e. the male partner also received money/gifts from his girlfriend; whether the respondent would have had sexual intercourse for a smaller gift; and the role that money or gifts played in the decision to use or not use a condom. The timing of when the gift or money was given likely influenced whether a respondent identified having engaged in sex for money or gifts. It is possible that the longer the time period between receiving money or gifts and sex, the less likely adolescents might have been to state that they received money or gifts for sex, even when the long-term expectation of money or gifts for sex may have played a part in the decision to have sex. Another limitation is that the data are not detailed enough to distinguish between survival sex and sex for gifts and money for other reasonsthough there was no association between household economic well-being and the likelihood of receiving something in exchange for sex. Since what is needed for survival is subjective, it is extremely difficult to gain an accurate measure of this. A third limitation is that the type of item given may determine whether the young woman perceives the support to be a gift or money for sex. Luke and Kurz posit that lifts to school, sodas or rent may not been seen as gifts.4 In addition, overt exchanges may be viewed as prostitution in many settings and therefore may lead to underreporting of transactional behavior.23 It is also possible that the data gathered on exchange of money for sex would have been different if the IDI and FGD study instrument had included direct questions on the topic, especially in Ghana where the adolescents did not discuss the issue at all. Lastly, this study only speaks to experiences of exchanging sex for money or gifts outside of marriage. Understanding the exchange of gifts or money for sex in extramarital relationships (and possibly within marriage) cannot be addressed by the data in this study.
This research has shown that across the four study countries, there are not clearly identifiable high risk groups more likely to engage in sexual intercourse for money or gifts and that transactions are not predictive of condom use. Gifts can have multiple meanings within any given relationship that can serve to blur the line between romantic intentions and more transactional sexual exchange. While the research presented here brings us closer to understanding the role that money and gifts play with respect to sexual intercourse, much more research is needed. To gain a better understanding of transactional sex will require more research on what the coercive threshold is for engaging in unwanted sexual intercourse or sexual intercourse without a condom using nationally representative data and/or data that include women older than the sample captured in these data. Assessing this would be extremely challenging as it no doubt varies from person to person and most likely over time for the same person as well. More research is also needed on the prevalence of survival sex, males' expectations associated with different types of gifts or amounts of money given, and how expectations of sexual intercourse and contraceptive use associated with gift giving vary according to relationship duration. Lastly, exploring young men's experiences with receiving gifts or money for sex is also warranted given the high proportion of males in Ghana and Uganda who said that they had received gifts or money for sex.
The authors would like to thank Beth Fredrick as well as two anonymous reviewers for comments on an earlier draft of this paper. This research was supported by The Bill and Melinda Gates Foundation, The Rockefeller Foundation and the National Institute of Child Health and Human Development (Grant#5 R24 HD043610).
© Copyright 2007 - Women's Health and Action Research Centre
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