1. ‘ Women’s bodies are shops’- beliefs about transactional sex and implications for understanding gender power and HIV prevention J. Wamoyi 1,2, A. Fenwick 1, M. Urassa 2, W. Stones 1 1 University of Southampton, UK 2 National Institute for Medical Research, Tanzania

2. 2 Transactional sex What do I mean by this? Exchange of sex for material support including money & gifts Not sex work Heterosexual encounters Transactional sex is common in many sexual relationships

3. 3 Why is it important? Transactional sex linked to increased risk of HIV: Encourages partner change Makes particular people attractive as sexual partners who given the current distribution of HIV, are more risky e.g. older partners Creates uneven power relationship which makes it difficult to negotiate for condom use

4. 4 AIM To explore unmarried young people’s motivations for, and beliefs about transactional sex in rural Tanzania

5. 5 Study setting Study site Source: NIMR, report of Kisesa open cohort, Dec 2005

6. 6 Methods Qualitative fieldwork conducted in 2007: 46 In-depth interviews 25 women (14 young women, 11 female parents) 21 Men (12 young men, 9 male parents) 17 focus group discussions 8 women (5 young women, 3 female parents) 9 men (6 young men, 3 male parents) Thematic analysis using NVIVO 7 software

7. 7 Findings: Male perspectives on the practice (1) Sex is never free & should never be free Men equated sexual exchange as like getting meat from a butcher: You can’t stop them because you can’t get meat from a butcher for free…You know that is a butcher’s shop…I mean, those private parts…you have to give money to get meat. [FGD, Male parents].

8. 8 Male perspectives on the practice (2) Young men described it as a good way to get a woman to satisfy their sexual desires & to prove their masculinity: Sexual exchange means the easiest way to get a partner…it means that girls usually have lust for things which are out of their ability/means. [FGD, out of school young men].

9. 9 Female perspectives on sex without exchange (1) Demeaning Equal to Prostitution Stupid Lack of ‘attractive power’

10. 10 Illustrative quotes What are people’s reactions to a girl who has sex without being given anything? She is a prostitute…they call her a prostitute. [FGD, Primary school girls]. Do some people have sex without being given anything? …they are not there…may be those who are cheated. [IDI, 20 years old, out of school woman].

11. 11 Female perspectives on sex without exchange Mothers views about sex without exchange were similar: If you have sex with him [without exchange], he can go & tell others, that that girl is free of charge…you just have sex with her, you don’t even have to ask her…she is like a sheep, you just go & take her & she follows you without asking for anything [money]. [FGD, female parents]

12. 12 Transactional sex and gender power (1) Men interpret women’s demands for money/gift before sex as a sign of their power Could take exchange but still refuse to engage in sex Women have power to choose partners Women were powerful at the beginning of the relationship then power shifted to males

13. 13 Transactional sex and gender power (2) Young women perceived themselves as clever & lucky to be created women: Could exploit their sexuality The female body perceived as a useful ‘shop’ Young women perceived men as being cheated for paying for goods that they could not take away

14. 14 Illustrative quote …he can buy for you a dress worth Tsh 30,000 [$25], he comes and you both enjoy, he leaves you with your thing [vagina]. In addition, you get a profit out of it and then you go and sell it to someone else [have sex in exchange for money/gifts with a different man]. [FGD, out of school young women]

15. 15 Illustrative quotes Others say those are ‘shops’. [female private parts]…you go to sleep with a man, he must give you money…you can even bargain in advance… so isn’t that a shop? Us women are so developed/empowered…I mean he gives you money and then he leaves you with your thing & yet you both get the pleasure…to me, I see them as cheated. I think, men just get a loss. [FGD, out of school young women].

16. 16 Transactional sex and gender power (3) Women believed that sex without transaction was not mutual A mother said: You cannot have sex with a man without a gift...why should you give him and he does not give you, he must also give. [IDI, 46 year old mother].

17. 17 Awareness of risk Young women were aware of the risks that came as a result of the exploitation of the ‘female body’ e.g. unintended pregnancy, STIs & HIV infection Referred to the occurrence of this as bad luck & God’s plan

18. 18 Illustrative quote Interviewer: But are women happy that they benefit? P1: Yes, but now when you happen to become pregnant, and then the man leaves you, that is where the loss is P2: The losses are may be when you get sexually transmitted disease or when you get our big disease AIDS. That is when it becomes difficult P 3: Apart from that, it is very beneficial. That is when you say God I am so grateful to be a woman [FGD, out of school young women]

19. 19 Conclusions (1): Implications for gender power Although transactional sex is easily linked to poverty, there are other underlying factors that make it thrive despite the known risks: The feeling of autonomy on the part of the women to exploit their sexuality One of the rare opportunities where women feel powerful to face men Feeling of pride & sense of value to be created women Equalises power in sexual relationships

20. 20 Conclusions (2): Implications for HIV/AIDS interventions Interventions aimed at tackling transactional sex for women’s empowerment & as a HIV prevention strategy, need to be approached with caution: They need to take into account gender and power issues Need to be aware of the beliefs associated with the practice that make it thrive regardless of the awareness of the sexual & reproductive health risks

21. 21 So… How can we make use of this power & powerlessness? Interventions might train young women to explicitly incorporate safer sex into negotiation for gifts/money by encouraging them to make use of their power

22. 22 Acknowledgements Magu DSS study participants The Tanzania National Institute for Medical Research University of Southampton- School of Medicine & Centre for Global Health, Population, Poverty and Policy