{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T10:16:10Z","timestamp":1782814570806,"version":"3.54.5"},"reference-count":55,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub\u2010Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We use data from a mixed\u2010method, cluster randomised controlled trial of the <jats:italic>Ujana Salama<\/jats:italic> cash \u201cplus\u201d intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017\u20132019). The impact evaluation consisted of a parallel mixed\u2010methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the \u201cplus\u201d intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (\u03b2 = 0.003, <jats:italic>p<\/jats:italic> = 0.905).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26038","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T12:15:03Z","timestamp":1669896903000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed\u2010methods study"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5827-343X","authenticated-orcid":false,"given":"Meghna","family":"Ranganathan","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Quinones","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health University at Buffalo  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia","family":"Palermo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health University at Buffalo  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Gilbert","sequence":"additional","affiliation":[{"name":"HIV and AIDS Unit UNICEF Tanzania  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lusajo","family":"Kajula","sequence":"additional","affiliation":[{"name":"UNICEF Office of Research\u2014Innocenti  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Tanzania Cash Plus Evaluation Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203626948"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adolescence.2004.03.004"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32832c7d10"},{"key":"e_1_2_11_5_1","first-page":"1","article-title":"The influence of cash transfers on engagement in transactional sex and partner choice among adolescent girls and young women in Northwest Tanzania","author":"Gichane MW","year":"2020","journal-title":"Cult Health Sex"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780429462818"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2016.09.023"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.02.003"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.20749"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001866"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.4172\/2155-6113.1000158"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.2307\/25549731"},{"issue":"3","key":"e_1_2_11_13_1","first-page":"133","article-title":"Risk factors for transactional sex among young females in post\u2010conflict Liberia","volume":"18","author":"Okigbo CC","year":"2014","journal-title":"Afr J Reprod Health"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1363\/3100605"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-102"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/02533950308628681"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4465.2003.00067.x"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120701294286"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-017-4636-6"},{"issue":"1","key":"e_1_2_11_20_1","first-page":"1","article-title":"Consuming sex: the association between modern goods, lifestyles and sexual behaviour among youth in Madagascar","volume":"9","author":"Stoebenau K","year":"2013","journal-title":"Global Health"},{"key":"e_1_2_11_21_1","volume-title":"Transactional sex and HIV risk: from analysis to action","author":"UNAIDS","year":"2018"},{"key":"e_1_2_11_22_1","volume-title":"The state of social safety nets 2015","author":"Honorati M","year":"2015"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0085473"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.07.024"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0137352"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/wbro\/lky002"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)30253-4"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/19439342.2014.890362"},{"key":"e_1_2_11_29_1","volume-title":"How to make \u2018Cash Plus\u2019 work: linking cash transfers to services and sectors","author":"Roelen K","year":"2017"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/10852351003640849"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1596\/1813-9450-4024"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25316"},{"key":"e_1_2_11_33_1","volume-title":"Research design: qualitative, quantitative, and mixed methods approaches","author":"Creswell JW","year":"2017"},{"key":"e_1_2_11_34_1","unstructured":"Tanzania Cash Plus Evaluation Team. A Cash Plus model for safe transitions to a healthy and productive adulthood: round 3 report.2020."},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0142601"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.20992"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001928"},{"key":"e_1_2_11_38_1","volume-title":"Qualitative research","author":"Denzin N","year":"2000"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.4135\/9781412983488"},{"key":"e_1_2_11_40_1","volume-title":"Summary report on the prevalence of sexual, physical and emotional violence, context of sexual violence, and health and behavioural consequences of violence experienced in childhood","author":"UNICEF Tanzania, US CDC, Muimbili University of Health and Allied Sciences","year":"2011"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001584"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001544"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2017.07.015"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-017-0817-x"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61709-1"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2007.11.008"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303107"},{"key":"e_1_2_11_48_1","unstructured":"Tanzania Cash Plus Evaluation Team. A Cash Plus model for safe transitions to a healthy and productive adulthood: round 3 report.2021."},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61797-9"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2020.07.025"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/sifp.12190"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwac093"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0539-y"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003892"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003837"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2602_03"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26038","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.26038","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26038","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T11:36:02Z","timestamp":1692531362000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26038"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,30]]},"references-count":55,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/jia2.26038"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26038","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,30]]},"assertion":[{"value":"2022-01-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26038"}}