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Objectives.Toexaminetherelationshipbetweensexualviolenceandtransactional sex and assess the impact of social support on this relationship among female transnational migrants in Cape Town, South Africa.
Methods. In 2012 we administered a behavioral risk factor survey using respondent-driven sampling to transnational migrant women aged between 16 and 39 years, born outside South Africa, living in Cape Town, and speaking English, Shona, Swahili, Lingala, Kirundi, Kinyarwanda, French, or Somali.
Results. Controlling for study covariates, travel-phase sexual violence was positively associated with engagement in transactional sex (adjusted prevalence ratio [APR]=1.38;95%confidenceinterval[CI]=1.07,1.77),andsocialsupportwasshown tobeaprotectivefactor(APR=0.84;95%CI=0.75,0.95).Theinteractionofexpe-rienced sexual violence during migration and social support score was APR=0.85 (95%CI=0.66,1.10).Inthestratifiedanalysis,wefoundanincreasedriskoftransactional sexamongthelowsocialsupportgroup(APR=1.56;95%CI=1.22,2.00).Thisrelationship wasnotstatisticallysignificantamongthemoderateorhighsocialsupportgroup(APR=1.04; 95% CI=0.58,1.87).
Conclusions. Programs designed to strengthen social support may reduce transactional sex among migrant women after they have settled in their receiving communities. (Am J Public Health. 2016;106:1123-1129. doi:10.2105/AJPH.2016.303107)
Population mobility has been shown to be associated with sexual risk in resource-poor populations around the world,1 and these risks are likely contributing to the high rates of sexually transmitted infections and HIV/AIDS documented in many migrant populations.2,3 Evidence also suggests that female migrants shoulder a higher burden of sexually transmitted infections and HIV/ AIDS than do their male counterparts.4 Although the exact mechanisms that shape disparities in negative sexual health outcomes among migrant populations are unclear, gendered experiences of sexual risk factors, in particular migrant women's experience of transactional sex and sexual violence, may be driving this increased burden among female migrants.
Transactional sex and sexual violence can be defined in several ways. We used an informal conceptualization of transactional sex, in which sex can be exchanged for money and goods and services. Women who engage in this form of transactional sex may be less likely to be viewed as sex workers.5 We defined sexual violence as sexual activity in which consent is not obtained or freely given (also referred to as rape or forced sex). Transactional sex and sexual violence can result in numerous negative sexual health outcomes; both are frequently typified by low rates of condom use in South Africa,6,7 which can result in unwanted pregnancies, unsafe abortions, and HIV and sexually transmitted infections. Sexual abuse and violence have also been found to be associated with future engagement in riskier sexual activity.8,9 Furthermore, there is some evidence to suggest a link between sexual violence...