If you are interested in HIV prevention, at some point you are likely to have heard “transactional sex” discussed as one of the issues. However, I find this discussion to usually be awkward and confused, especially among Western audiences: the user is feeling somewhat uncomfortable using the term and the audience is having trouble understanding what it is she exactly means. The frameworks we have in the U.S. are dating on one end and commercial sex work on the other. So, when one tries to describe transactional sex, the audience gets a sense that this falls somewhere in between, which leads to the oft-used “sugar daddy” term to pop up (as it is the only other framework people have), and the discussion goes downhill from there…
So, I thought it would be useful to describe what is meant by transactional sex, so that if you hear it mentioned in the future, you can have a better idea of what is being discussed. The understanding of transactional sex does have implications for HIV prevention strategies and should be taken seriously.
1. At least some sexual activity does happen as a result of economic circumstances: There is little disagreement here among researchers who study the topic. Anthropologists, demographers, sociologists, and economists agree: “…direct need for material support plays a role in poor women’s decisions to readily accept sexual proposals from men…” (Verheijen, 2011 ). Most of this literature is from Sub-Saharan Africa, but the concept does extend to other settings, including the U.S. In a piece titled “What Really Fuels the HIV/AIDS Epidemic in Black America? ,” (The Body, Feb. 6, 2012) survival sex is mentioned as a coping strategy for economically disadvantaged women, “so that they and their families can survive.” This paper  in the Journal of Human Resources (also 2011) shows that when young, single women in Florida win ($25,000-$50,000) the lottery, they delay marriage. Much smaller regular monthly cash transfers  did the same for marriage and childbearing in Malawi. When we asked never married sexually active young women in Malawi why they started their sexual relationship, about 25% said that they needed his money or wanted his gifts. I could carry on with more citations, but the bottom line is economic circumstances play a role in sexual behavior.
2. But, depicting sexually active women who are supported by their partners as “powerless victims” is too simplistic: If you don’t believe me, you should read Michelle Poulin (2007) , Ann Swidler and Susan Watkins (2007) , and Janneke Verheijen (2011) . Poulin’s piece is particularly helpful in understanding that gift giving and providing support are part and parcel of the dating scene in rural Malawi (and elsewhere in the region) and that transfers of money or gifts are “as much about the expression of love and commitment as they are about meeting the financial needs of women or the acquisition of sex for men.” She argues convincingly that the material exchanges are not quid pro quo for sexual acts, but rather support with multiple meanings. Both Swidler and Watkins (2007) and Verheijen (2011) agree that women are often far from helpless victims in their relationships, and sometimes actively manipulate. The latter also argues that sexual relationships for young single women are a form of insurance – by reducing the likelihood of social exclusion so that she can depend on other forms of community support in tough times.
3. “Sugar daddies” do not fit the usual stereotype: The audiences I face have an image of a rich guy in his 30s or 40s, waiting in front of a high school to pick up his girlfriend in a fancy car. That guy may exist, but he is not likely to be a significant part of the problem. Nancy Luke (2005)  argues that sugar daddy relationships are not “as pervasive as generally assumed:” a small percentage of relationships of a sample of men she examined in Western Kenya were characterized by large transfers and an age difference of at least 10 years. Most relationships do have age and economic asymmetries between men and women (with the former being older and richer), but we are talking about, say, an 18 year-old girl and a 23-24 year-old guy. This is confirmed in our study in Malawi, where the average age gap between school-age girls and their sexual partners is 2-3 years, with variation: about 20% in the control group had a boyfriend 25 or older. The variance is important: 15-19 year-old boys in Malawi are not infected with HIV, while about 17% of men 25 or older are. So, you might get pregnant if you have unprotected sex with a teenage boy, but you’re unlikely to contract HIV.
A more nuanced understanding of sexual relationships of young people in Sub-Saharan Africa will lead to HIV prevention programs that are better designed. There is good research across multiple disciplines that we can all learn from and use. Telling people to abstain, be faithful, or always use condoms without addressing the underlying socioeconomic and cultural issues are unlikely to succeed.
On the other hand, while it is important to understand the complexities of transactional sex, it remains a fact that women having their own income and access to reliable social safety nets will likely make a difference on the path of the epidemic wherever these changes can happen. Safe jobs for women, cash transfers targeted towards poor, young women, and other forms of insurance and safety nets are likely to reduce their economic dependence on men and perhaps change the course of the HIV epidemic by changing the dynamic of relationships between men and women.
Update (2/23/2012; 11:42 AM): After posting, I got tweeted this link  to AIDSTAR-One's website (by USAID and PEPFAR), which has much more on transactional sex.