Developmental Trajectories of Transactional Sex and Age-Disparate Relationships During Adolescence: An HPTN 068 Analysis.
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Takeaways Social norms—particularly inequitable gender norms—play a central role in shaping adolescents’ engagement in transactional sex and age-disparate relationships. These norms influence power dynamics, expectations of male provision, and girls’ ability to negotiate safer relationships. The study highlights that early exposure to inequitable norms and structural vulnerabilities (e.g., poverty, IPV) reinforces sustained engagement in risky behaviors, underscoring the importance of intervening early to shift norms and reduce HIV risk.
Objectives This study aimed to characterize how transactional sex and age-disparate relationships develop over time among adolescent girls and young women (AGYW) in South Africa, and to assess how these behaviors co-evolve and contribute to HIV risk.
Methods The study used longitudinal data from the HPTN 068 randomized controlled trial, including 1,191 AGYW followed over approximately five years. Group-based trajectory modeling identified patterns of engagement in transactional sex and age-disparate relationships, while dual-trajectory analysis assessed their co-evolution. Social norms were measured indirectly using the Gender Equitable Men’s Scale (GEMS), which captures attitudes toward gender roles, alongside related psychosocial and structural factors (e.g., IPV, depression).
Results Two trajectories were identified for both behaviors: “low” and “increasing.” While most participants remained in low-risk groups, a significant minority showed increasing engagement over time (18.1% for transactional sex; 8.3% for age-disparate relationships). Notably, 28% of participants exhibited increasing trajectories for both behaviors. Early sexual debut, depression, IPV, prior pregnancy, and inequitable gender norms were associated with higher-risk trajectories. Girls in these trajectories were more likely to engage in other HIV-related risk behaviors, including condomless sex and multiple partnerships.
Conclusions The study concludes that transactional sex and age-disparate relationships often co-develop during adolescence and are sustained over time, increasing HIV vulnerability. These behaviors are shaped by intersecting social norms and structural inequalities that limit girls’ agency. Early, targeted interventions that address gender norms and relationship power dynamics are critical to reducing long-term HIV risk.
Norms Addressed
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