Background: Transactional sex, or informal sexual exchange relationships, are an important determinant of adolescent girls'' and young women''s (AGYWs) disproportionate HIV risk in sub-Saharan Africa. Transactional sex relationships are structured by both social and economic gender inequalities, suggesting economic intervention strategies alone may not be adequate. In this study we explored the less examined social norm influences on transactional sex. We describe findings from a pilot study that developed innovative experimental vignettes to identify and assess gender norms stemming from the shared expectation that men should provide financial support to their partners.
Methods: We developed vignettes in the Kampala and Masaka districts of Uganda with 15 to 24 year old women between February, 2017 and January, 2018. The three phases of primary data collection included
1) 10 focus-group discussions (FGDs) to identify gender norms,
2) two rounds of 16 cognitive interviews to refine vignettes, and
3) the administration of a pilot survey experiment to 108 sexually-active unmarried AGYW (general population (n=78) and high-risk venues (n=30)).
Respondents were randomly assigned to one of two versions of each of three vignettes (short stories) which presented different levels of male provision.
Results: The vignettes examined whether the amount a man provided changed perceived approval of men''s authority in relationships, men''s sexual decision-making power, and women having multiple partners. We find an increase in the value a man provides significantly raises perceived levels of community approval for his sexual decision-making power (p< .001), and significantly lowers perceived peer approval of AGYW''s seeking a second partner (p< .05). Finally, we find women who practiced transactional sex in the last 12 months (51%) were more likely to approve of women who sought multiple partners when their primary partner did not provide.
Conclusions: Our findings suggest that approval of men''s sexual decision-making power increases when they provide more and that women are less socially sanctioned, or more approved of by their friends, when they seek a second partner in the event their first cannot provide. These findings highlight normative drivers of HIV risk associated with transactional sex that should be addressed by HIV intervention efforts working with AGYW.