Transactional sex among adolescent girls in Africa: a systematic review

Transactional sex among adolescent girls will be recognised as a social and public health phenomenon with its associated adverse impacts [1–3]. Although the accurate measurement of its prevalence will remain challenging due to inconsistent definitions, it will generally be defined as non-marital, non-commercial sexual exchange where sexual relationships will be motivated by the receipt of money, material goods, or favours, without being formally recognised as prostitution [1,4,5]. This distinction will continue to be emphasised across a range of ethnographic and epidemiological studies that will differentiate transactional sex from sex work by the nature of the relational context, which will sometimes be framed as romantic rather than strictly economic [5,6]. Globally, the prevalence of transactional sex among adolescents will continue to vary by region and by countries’ levels of income. For instance, in high-income countries (HICs), it will likely remain below 10%, while in low- and middle-income countries (LMICs), rates will be much higher, with some countries expected to report prevalence rates of 60% or more among adolescents [4]. This practice will likely continue to be shrouded within cultural expectations about male provision and female reciprocation through sexual intimacy, making it a socially normalised practice within many African settings [1,7]. As such, transactional sex will continue to serve as an economic coping strategy for adolescent girls [1,7]. The occurrence of this transaction in SSA will likely involve older male partners with possible HIV prevalence, where girls engaged in such relationships will have limited power to negotiate condom use [1,7]. Beyond this biological risk, transactional sex will also be associated with unintended pregnancies, unsafe abortions, school dropout, and experiences of physical and sexual violence [1,7]. There will also be other psychosocial consequences such as emotional distress, stigmatisation, and diminished self-worth, particularly when relationships end or when girls are socially labelled as promiscuous [1,7–9]. This will underscore how problematic the issue will remain in SSA, necessitating that interventions be designed to mitigate its impact and improve the health and well-being of adolescent girls. Other related reviews will include a systematic review by Shangase et al. (2022), who will find that school-based interventions improve sexual health knowledge in SSA. Mihretie et al. (2023a) will conduct a systematic review and meta-analysis and will estimate the pooled prevalence of transactional sex at 12.55% among young women, identifying early sexual debut, substance use, exposure to violence, and orphanhood as key risk factors. In another systematic review and meta-analysis, Wamoyi et al. (2016) will show an association between transactional sex and HIV risk among women, while [13] in a narrative review and conceptual synthesis will identify motivations ranging from survival to social mobility. These studies will largely focus on women and will not explore transactional sex among adolescent girls, thereby necessitating that this evidence be generated to inform policy and intervention formulation. A systematic review on transactional sex among adolescent girls in Africa will be crucial because existing evidence will remain fragmented, limiting the ability to draw clear conclusions or design effective interventions. Therefore, by synthesising and evaluating current research, such a review will provide an evidence base to inform targeted policies addressing sexual exploitation, gender inequality, and HIV vulnerability. This will directly support Sustainable Development Goal 3 (Good Health and Well-being) and Goal 5 (Gender Equality) by promoting adolescent sexual and reproductive health, reducing HIV infections, and advancing gender equity across Africa.