Page 131 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 7 of 9 Original Research

or she becomes vulnerable to being stigmatised. Because of boys. Studies have confirmed that sex with older men is more
this risk, people may avoid self-disclosure and by so doing risky than sex with younger men because HIV prevalence
downplay their personal risk. among older men is significantly higher than younger men.
24
The age differential with older men also introduces a power
A high proportion of black participants reported engaging dynamic into the sexual relationship where younger women
in MSP, followed by mixed race participants as compared to are more vulnerable and less likely to successfully negotiate
the Indian participants. Multiple sexual partnership was condom use. Intergenerational sex is also closely entwined
significantly higher among men than among women. This is with transactional sex – where economic factors push young
consistent with other studies where generally wealthy men girls to engage in various forms of sex in exchange for cash or
in patriarchal societies like SA are expected to have numerous material benefits. 1
partners or wives. This follows the polygamous culture in
19
African countries. Furthermore, women have been found It is not surprising then that transactional sex was also
generally to under-report sexual behaviours. 8,20 This can be associated with MSP. Almost half of the participants reporting
explained by the fact that women want their manner to be both MSP and transactional sex were among those with
viewed favourably by others. MSP in women is often viewed medium socio-economic status. This implies that these
in a derogatory sense. participants were not poor but rather alludes to need for
economic gains or advancements and wealth inequalities as a
The proportion of respondents who had reported not using push factor towards engaging in HIV risk behaviours. The
condoms at last sex was 57%. This was higher among women need for social upward mobility could explain the need for
(62%) than among men (38%). The figure appeared similar to participants to engage in MSP and transactional sex. 3
the findings of the South African National HIV Prevalence,
Incidence and Behaviour Survey, 2012, which reported nCU Increased HIV incidence has been associated with low socio-
2
as 63% in the whole population. Engaging in MSP and economic status in recent studies. 1,20 However, the practice of
having unprotected sex increases HIV risk because of the fact MSP is not untouched by employment status. With regard to
that individuals may be linked through sexual networks and employment status, students recorded a higher prevalence
become more vulnerable to high viral load exposure during of MSP than the unemployed category. This finding is in
the early phases of new HIV infection. 21 contradiction to another study conducted in SA that showed
that nearly half of the participants who engaged in MSP were
Low socio-economic status was predictive of nCU at last sex unemployed and only 10% were students. These differences
24
but there was a significant association with MSP. In this in findings could be because of the differences in how the
study, MSP was frequently reported among those with studies defined unemployed group. This study considered
medium socio-economic status and least reported among informal employment as employed, while the other study
respondents with a high socio-economic status. Similarly, categorised it as unemployed. The geographical coverage of
according to a survey conducted on young men and women the two studies could also explain the different findings. This
in SA in 2004, MSP was reported least among those with high analysis utilised data from a national survey, whereas the
socio-economic status. An explanation of a similar finding other study referred to was only undertaken in two provinces
suggested that if people with lower socio-economic status are in SA. Further research will need to be undertaken to confirm
compared to the ones with a high socio-economic status, these findings.
those with lower socio-economic status may choose to
spend more of their income pursuing various forms of The high prevalence of non-condom use is exacerbated by
relationships. Another possible explanation could be that the consumption of alcohol. 1,9,27 Alcohol has adverse side
2,5
respondents in the high socio-economic group may have effects that include sexual risk behaviours and these have
1
higher educational attainment and better health information; been documented in various different studies in SA. Poor
hence, they reduce risky sexual behaviours. 22,23 judgement and risky sexual behaviours are often exacerbated
as a result of alcohol consumption as it impairs judgement
MSP was prevalent among participants who engaged in and reduces inhibition. These findings emphasise the risks
intergenerational sex. It has been shown in this study and associated with the mix of sexual risk behaviours, MSP,
other studies that intergenerational sex fuels the HIV epidemic transactional sex and alcohol; therefore, interventions better
among the younger generations. 19,24 Research studies argue equipped for the complexities of the behaviour mix need to
that when young women mix with the older generation, their be put in place.
risk for contracting HIV increases. Interventions targeted at
2,25
reducing intergenerational sex could reduce the prevalence of Perceived material, monetary or cognitive benefits were
HIV among younger generations. It is concerning that the strongly associated with nCU and this was furthermore
highest proportion of MSP is among the 20–24-year age groups compounded by the association found between nCU,
where both boys and girls are affected. Age mixing with older engaging in transactional sex and having MSP. While
generations further exacerbates this problem because young perceived benefits could be judged by anticipated rewards,
girls are likely to mix with both older men and young boys. in this study, there was an association with both nCU and
26
In this case, old men infect young girls who then infect young MSP. Among those who did not use condoms at last sex,
28
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