Assessing risk factors and health impacts across different forms of exchange sex among young women in informal settlements in South Africa: A cross-sectional study.

Autor: Stoebenau K; University of Maryland School of Public Health, Department of Behavioral and Community Health, 4200 Valley Drive, College Park, MD, USA. Electronic address: kstoeben@umd.edu., Dunkle K; Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa., Willan S; Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa., Shai N; Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa., Gibbs A; Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Psychology, University of Exeter, Exeter, UK; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2023 Feb; Vol. 318, pp. 115637. Date of Electronic Publication: 2023 Jan 02.
DOI: 10.1016/j.socscimed.2022.115637
Abstrakt: For women in South Africa, engaging in exchange sex, including transactional sex (TS), or sex work (SW), is associated with several shared poor health outcomes; yet the practices themselves differ in meaningful ways. SW is a form of commodity exchange, while TS is grounded in gendered relationship expectations of male provision and aspects of emotional intimacy. Additionally, exchange sex types could be imagined on a "continuum of instrumentality" from relationships that do not include material support; to those characterized, but not driven by support; to those primarily motivated by material support. We use cross-sectional data from 644 women ages 18-30 enrolled in a trial addressing intimate partner violence in urban KwaZulu-Natal, South Africa to assess whether these conceptualizations may also map onto different types or levels of risk. Using self-reports, we developed four exchange sex relationship categories corresponding to a continuum of instrumentality: no exchange-based relationship; TS with a main partner only; TS with a casual partner; and SW. Using tests of association and adjusted logistic regression models, we compared socio-economic and behavioural risk factors, and health outcomes across reported forms of exchange sex. We find little difference between women who report no exchange sex and those who report TS only with a main partner. By contrast, as compared to women not in exchange sex, women in casual TS and SW were poorer, and significantly more likely to report problematic alcohol use, past drug use, prior non-partner sexual violence, and PTSD; with aOR higher for women in SW for many outcomes. When comparing casual TS to SW, we find women in SW held more gender equitable attitudes and were more likely to report modern contraceptive use. We discuss the implications for distinguishing between TS and SW, and use of the continuum of instrumentality conceptualization for research and programming.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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