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Associations between individual and partner-level mobility, household food insecurity and women's transactional sex behavior: an analysis from six African countries

Title
Associations between individual and partner-level mobility, household food insecurity and women's transactional sex behavior: an analysis from six African countries
Presenter
Aleya Khalifa
Authors
A. Khalifa * (1,2), S. Findley (3), A. Hakim (4), G. Hrusa (2), E. Gummerson (2), S. Hong (5), W.L. Kirungi (6), L. Maile (7), L.A. Miller (5), N.M. Mutenda (8), A. Saadani Hassani (9), A. Schwitters (10), J. Ward (11), S. Farley (2), N. Philip (2), A. Low (2)
Institutions
(1) Columbia University, Department of Epidemiology, New York, United States, (2) ICAP at Columbia University, New York, United States, (3) Columbia University, Population & Family Health Department, New York, United States, (4) US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, United States, (5) US Centers for Disease Control and Prevention, Windhoek, Namibia, (6) Ministry of Health, Kampala, Uganda, (7) Ministry of Health, Maseru, Lesotho, (8) Ministry of Health and Social Services, Windhoek, Namibia, (9) US Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, United States, (10) US Centers for Disease Control and Prevention, The National Institute for Occupational Safety and Health, Atlanta, United States, (11) US Centers for Disease Control and Prevention, Kampala, Uganda

BACKGROUND: Women experiencing food insecurity demonstrate higher rates of migration and HIV infection in sub-Saharan Africa, as they may travel to seek economic opportunity and may have sex in exchange for material support. We assessed the relationship between mobility, food insecurity and transactional sex (TS) to understand mechanisms of HIV risk.
METHODS: Data were pooled from 2016-2017 Population-based HIV Impact Assessments (PHIAs) in Eswatini, Lesotho, Namibia, Tanzania, Uganda and Zambia. Overall, 27,378 women were linked to their cohabitating or marital male partner using respondent ID and reported marital status. Survey-weighted logistic regressions evaluated the association between women's or their partner's mobility (away from home for one month or more in the past year) and TS (selling sex or exchanging sex for material support in the past year). Models were adjusted for individual (age, education, employment), partner-level (age) and household (food insecurity, wealth, economic support, household head gender, urban) variables. Results were stratified by food insecurity (hunger, lack of food or missing meals in the past month).
RESULTS: Prevalence of TS was 8.0% (95% CI: 7.4 ' 8.6%) among women linked to partners. Women were mobile in 8.8% (8.3 ' 9.4%) of partnerships, while male partners were mobile in 12.6% (11.8 ' 13.3%), and both partners were mobile in 2.3% (2.0 ' 2.6%) of partnerships. Both mobile women with (aOR = 1.36 [0.94 ' 1.97]) and without (aOR = 1.34 [1.07 ' 1.67]) mobile partners were more likely to have TS compared to non-mobile women with non-mobile partners. Non-mobile women with mobile partners were not more likely to engage in TS (aOR = 0.91 [0.74 ' 1.12] 1.12 [0.91 ' 1.38]). Food insecurity, experienced by 18.2% (17.2 ' 19.3%) of households, was associated with women's TS (aOR = 1.31 [1.11 ' 1.53]). However, mobile women without mobile partners in food insecure households were not more likely to engage in TS compared to non-mobile counterparts (aOR = 0.90 [0.50 ' 1.64]).
CONCLUSIONS: Women's mobility, but not their partner's, is associated with TS. Food insecurity is associated with TS irrespective of mobility. Multilevel interventions promoting gender-equitable food access and economic resilience are needed to address food insecurity and its consequences on mobility, TS and HIV risk.