Transactional Sex, Risky sexual behaviours, and associated factors and outcomes among young women in Northern Ghana: evidence from a cross-sectional survey

Transactional Sex, Risky sexual behaviours, and associated factors and outcomes among young women in Northern Ghana: evidence from a cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transactional Sex, Risky sexual behaviours, and associated factors and outcomes among young women in Northern Ghana: evidence from a cross-sectional survey Patience Konlan, John Kumuuori Ganle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6434302/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Women's Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background Transactional sex has gained public health attention in recent times because of its contributions to sexually transmitted infections and unwanted pregnacy among young women in sub-Saharan Africa. However, empirical data on the extent of this practice are lacking in Ghana. This study therefore sought to provide baseline information on the prevalence of transactional sex practice and associated factors among young women in Northern Ghana. Methods A quantitative cross-sectional survey was conducted among 340 sexually active young female students in a tertiary institution in northern Ghana. Stratified and simple random sampling techniques were used to sample respondents. Data were collected online using a pretested questionnaire. The prevalence of transactional sex and other essential socio-demographic characteristics were analysed descriptively using frequencies and percentages. A logistic regression model was used to assess the links between transaction sex and risky sexual behaviour as well as determine predictors of transactional sex at a 95% confidence interval. Findings: The prevalence of ever engaging in transactional sex was 23.8%, and 16.8% reported engaging in transactional sex in the past 12 months prior to the study. Nearly 65% of those who reported engaging in transactional sex in the last 12 months have done so at least four times. The odds of engaging in transactional sex were lower among older female respondents (AOR: 0.140, 95%, CI: 0.032–0.605, p = 0.008); but higher for early sexual debut (AOR: 2.745, 95%, CI: 1.068–7.060, p = 0.036), area of residence (i.e. being peri-urban) (AOR: 8.300, 95%, CI: 1.655–41.617, p = 0.010), insufficient family support (AOR: 5.903, 95%, CI: 1.515–23.006, p = 0.011), and frequently using at least two social media applications (AOR: 3.893, 95%, CI: 1.276–11.877, p = 0.017). Respondents who engaged in transactional sex reported higher odds of contracting STIs (AOR: 3.580, CI:1.059–12.099, p 0.040) and having an abortion (AOR: 2.616, CI: 1.037–6.598, p 0.042) in the last 12 months. Conclusion Economic empowerment of young women is critical to preventing and/ or minimising the occurrence of transaction sex among young women. Also, targeted comprehensive sexual and reproductive health and rights education interventions are needed on the campuses of institutions of higher learning to enable young women negotiate safe sex and sexual relationships. In addition, there is urgent need to promote contraceptive (especially those that offer dual protection) use among young women on the campuses of tertiary institutions to minimize STIs infection and unwanted pregnancy. Transactional Sex Risky Sexual Behaviour young women STIs family support Ghana Introduction Transactional sexual relationships refer to non-marital, non-commercial sexual relationships motivated by an implicit assumption that sex will be exchanged for material support or other benefits [ 1 ]. Transactional sex can range from a survival short-term relationship that young women regularly engage in to enable them meet their daily needs and/or those of their family members, to a gift given in long-term relationships as a way of expressing affection but not for marriage [ 2 ]. Transactional sex has gained public health attention in recent times because of its links to sexually transmitted infections (STIs) including HIV infection among young females from sub-Saharan Africa [ 3 , 4 ]. Several studies have posited that transactional sexual relationships are a common phenomenon in sub-Saharan Africa occurring among young adults at different proportions [ 2 , 5 – 7 ]. The range of estimates varies from 2.1% to a high of 72% in African countries [ 8 , 9 ]. A pooled prevalence of transactional sex among women from studies in Sub-Saharan Africa recorded 12.55% (9.59–15.52%) [ 10 ]. Among antenatal women in Soweto, South Africa, transactional sex practice was reported at 21.1% while as high as 72% of young females in Montserrado County, Liberia, engaged in transactional sex [ 11 ]. In Malawi, a quasi-experimental study estimated transactional sex practice at baseline to be 22%, at 6 months to be 15% and at 12 months as 20% among young women [ 12 ]. Though transactional sex appears a common phenomenon of sexual relationships in Sub-Saharan Africa, several studies have associated its with negative outcomes such as increased risk for sexually transmitted infections, unplanned pregnancies, unsafe abortions; and physiological trauma [ 2 , 6 ]. In the context of higer educational institutions in Africa, transactional sexual relationships are frequently intergenerational, leading to the violation of young girls’ sexual and reproductive rights [ 5 ]. These relationships also often perpetuate unequal power dynamics and fail to empower young girls to be able to negotiate safer sexual activity [ 5 ]. While the act of transactional sex per se does not automatically make it risky, transactional sex is problematic because it is often characterised by age-asymmetric relationships, partner violence and individual risky behaviours such as inconsistent condom use and multiple sexual partnerships [ 13 , 14 ]. In Ghana, it is common for young women especially female students to establish sexual networks with local businessmen, politicians and uniformed men, usually older than them in return for money and gifts [ 7 ]. Similarly, female sex work is also very common especially in major cities [ 15 ]. However, because female sex work is illegal and law enforcement agencies regularly clamp down on sex workers, there are suggestions that transactional sex may open new avenues for building new sexual networks [ 16 ]. Nevertheless, the extent of this practice in the population is unclear. Thus far, only a few qualitative studies have been conducted in Ghana. For instance, Sagoe [ 17 ] documented variations in transactional sex practice and the impact it had on female trade apprentices in the Bono regional capital, Sunyani. Amo-Adjei et al. [ 7 ] also explored transactional sex practice among 40 female students at the University of Cape Coast. While these studies have provided useful insights, there is a dearth of prevalence studies on transactional sex in Ghana among young women. For instance, a study among 150 respondents at the Kwame Nkrumah University of Science and Technology reported on the level of awareness about transactional sex but failed to investigate actual practice [ 18 ]. The only exception is a recent cross-sectional survey among female adolescent refugees in Ghana where 71% were engaged in transactional sex in the 12 months leading up to the study [ 16 ]. However, given that this population is very distinct from the general Ghanaian population, one could expect significant differences. Another issue is that previous studies have not investigated the links between transactional sex and risky sexual behaviours. This knowledge gap not only hampers our understanding of the nature and magnitude of transactional sex practice among young women, but it could also limit our ability to develop risk-reduction interventions and promote responsible sexual behaviour. This study therefore aimed to provide baseline information on the prevalence of transactional sex practice and associated factors in Ghana. Methods Study Design A quantitative cross-sectional observational survey was conducted. This design enabled quick but detailed data collection on the frequency, distribution and determinants of transactional sex at a single time point [ 19 ]. Study setting This study was conducted on three campuses of the University for Development Studies in the Northern region. We choose these settings because they provided the largest, easily accessible population of young women, most of whom are sexually active but not married. Another reason for this choice is that previous studies on the topic in Ghana have been conducted in the Southern part of Ghana where sexual norms are quite relaxed partly because of matrilineal culture. The northern region is highly conservative, patriarchal and dominated by the Islamic region. We therefore wanted to understand how this conservative context affects transactional sex practice. Study Population The study population comprised young women who were enrolled in various undergraduate and postgraduate programmes offered across three campuses of a public University in the region. Respondents were aged 18 years and above and were sexually active i.e. have ever engaged in penetrative penile sex. Also, we included only those who were willing to provide written informed consent. We excluded those who met the inclusion criteria above but were indisposed either due to ill health or travel at the time of the study. Sample size and sampling methods Based on a 24.6% prevalence of transactional sex practice reported by a study among female university students in Nigeria[ 20 ], we estimated a minimum sample size of 314 at a confidence level of 95%. However, given that the topic is very sensitive, we adjusted the sample size upward by 100% and approached 628 respondents. As we show below, just a little above the minimum sample size (i.e. 340) young women completed the survey out of the 628 eligible young women who were approached. In terms of sampling methods, we used a combination of stratified and simple random sampling methods. To do this, we stratified the population into three strata, each stratum representing one of the three campuses. We then obtained the female admission registers from the Central registry of the University for each campus, which had information on the date of birth of each female student, their admission year, index number, phone number, email address, and postal address. We screened these registers to exclude those aged less than 18 years. We then calculated a proportionate sample for each stratum depending on the number of females aged 18 and above. Thus, we divided the total number of eligible participants in a particular campus by the sum of the three campuses, multiplied by our estimated sample size of 628. This ensured that the campus with the largest female population had more representation in our study. Following from this, we ordered the eligible participants by their index numbers for each campus according to when they were admitted, fed the data into R software, and use the random number generator function in R to randomly select the required sample for each campus. Following this we contacted each of the 628 selected young women via telephone or email to explain the purpose of the study and how they were selected. We asked one screening question during this initial contact, namely ‘have you ever had penetrative penile sex’. Only 26 out of the 628 participants we approached said they have never had sex and were therefore dropped from the study. We then invited the remining 602 eligible participants to participate in the study. Each eligible participant was given three days to decide on their participation. After the three days, we recontacted each eligible participant. A total of 240 declined participation for various reasons including ‘not interested’, ‘don’t have time’, and ‘does not want to share information about my sexual life’. The remaining 362 eligible participants were sent informed consent forms and a link to the study questionnaire for self-completion. Data collection methods and tools The data were collected online using KoboCollect, a free Android data entry app. Data collection took place between 6th December 2023 and 24th January 2024. A structured, self-reported questionnaire was developed, pre-tested and used for data collection (see supplementary file 1). The questionnaire was structured into three sections. The first section included questions on the background characteristics and other covariates of the respondents such as age, marital status, ethnicity, and age of first sexual debut. The second section included validated questions recommended by STRIVE (2014) on transactional sex practice for inclusion in the Demographic and Health Surveys (DHS) questionnaire for sub-Saharan Africa. The last section included questions on risky sexual behaviours and related health outcomes. The questionnaire was uploaded to KoboCollect, a free Android data entry app. Weblink to the questionnaire was then sent privately to each eligible respondent via WhatsApp or email to self-complete online. Weekly reminders were then sent to each participant to complete the survey. Using the KoboCellect platform for data collection had several advantages. It allowed the data to be collected, saved and transmitted automatically to a cloud server for later download by the research team. This helped minimise the potential for data loss which is common in the context of paper-based questionnaire. Similarly, the automatic saving of the data made it needless for a separate data entry phase commonly present when paper-based questionnaires are used. Description of study variables Outcome variable The primary outcome variable was transactional sex in the last 12 months. While we measured transactional sex as ‘ever’ and ‘within the last 12 months’, we used transactional sex in the last 12 months as it gives a better reflection of current practice. Besides, our decision is in line with recommendations made by STRIVE [ 21 ] to the DHS for the measurement of transactional sex practice, namely a respondent having had sex or become sexually involved with someone (man) because they (man/men) provided them with or expected that they (man/men) would provide them with material support of any kind (e.g. money, gift, favours) in the last 12 months. The responses to this question were dichotomous where ‘YES’ indicated engagement in transactional sex and ‘NO’ indicated otherwise. Independent variables Several independent variables (n = 45), broadly grouped into demographic characteristics (e.g. age, level of education, ethnicity, frequency of listening to radio, frequency of watching television), and sexual behavioural characteristics (e.g. age at first sex, nature of first sexual experience, number of sexual partners, condom use, sex while drunk, abortion, pregnancy history, ever heard of contraceptives, knowledge of where to access contraceptives, exposure to STIs), were defined and measured. Data processing and analysis All data files were downloaded and exported into Stata version 15 for cleaning, coding and possible recoding and analysis. Data cleaning was done by identifying outliers/anomalies and checking for consistency among and across variables. Frequency distributions and cross tabulations were specifically run to aid the data cleaning process. Where there was skewness in the distribution of the data for any variable, the medians with interquartile ranges were used. Basic descriptive statistics (frequencies and percentages) were used to present information on the prevalence of transactional sex. This was followed by using chi square tests of independence and Fishers’ exact test (in cases where cell observations for any variable were less than five) to show statistical differences or association between the independent variables and transactional sex. Finally, two hierarchical models from binary logistic regression were used to show how the independent variables predict transactional sex and the results were presented as adjusted odd ratios. For the chi-square test and binary logistic regression analyses, confidence level was set at 95% and p-value of less than 0.05 was taken as demonstrating statistical significance. Results Characteristics of Study respondents A total of 362 eligible participants received the survey questionnaire. However, only 346 completed the questionnaires. Out of the 346, six questionnaires were incomplete and unusable. Therefore, the analysis involved 340 respondents. Table 1 shows essential socio-demographic characteristics of the 340 respondents. the background characteristics of the study participants. The mean age was 24.94 (SD = ± 4.87). Most of the respondents were single (92.1%). Over two-thirds (69.1%) of the participants belong to the Mole-Dagbani ethnic group. As regards the source of funding for their education, majority (60.0%) reported parents/relatives as their main source. However, 30.0% reported self-funding their education. Financial support from family to pay daily expenses ranged from No Support (14.1%) to Adequate support (34.4%). Table 1 Socio-demographic characteristics of respondents (n = 340) Variable Frequency (n) Percentage (%) Age (Mean = 24.94; SD ± 4.87) < 20 29 8.5 20–24 175 51.5 25–29 74 21.8 30+ 62 18.2 Religious Affiliation Christian 107 31.4 Muslim 223 65.6 Traditional 4 1.3 None 6 1.7 Marital Status Single 313 92.1 Married 24 7.0 Divorce/separated 3 0.9 Number of living children None 284 83.5 1 35 10.3 2–3 17 5.0 4+ 4 1.2 Father’s educational level Below JHS 119 35.0 JHS to SHS 93 27.4 Tertiary 128 37.6 Mother’s educational level Below JHS 299 88.0 JHS to SHS 30 8.8 Tertiary 11 3.2 Area of residence when not in School Urban 162 47.6 Rural 163 48.0 Peri-urban 15 4.4 Ethnicity Mole-Dagbani 235 69.1 Akan 44 12.9 Gurma 42 12.4 Ga-Adangbe 5 1.5 Ewe 3 0.9 Others 11 3.2 Source of funding for education Self-funding 102 30.0 Parents/Relatives 204 60.0 Bursary/Scholarship 3 0.9 Loan 31 9.1 Financial support from family to pay daily expenses No Support 48 14.1 Little Support 56 16.5 Moderate Support 119 35.0 Adequate Support 117 34.4 Number of media applications frequently used (i.e. at least once a day) 1 142 41.8 2 68 20 3 130 38.2 Covered by National Health Insurance Scheme Yes 294 86.6 No 46 13.4 Table 1 HERE Table 2 shows sexual and behavioural characteristics and outcomes of the respondents. Age of sexual debut ranged from less than 16years (16.4%) to 20 years and above (26.6%). As high as 33.8% however reported that their first sexual experience was non-consensual i.e. forced or rape. An over whelming majority (80.6%) have had at least four sexual partners in their life time, whilst about 48% reported having at least four sexual partners in the last 12 months. Also, 35% reported at least one STI infection in the last 12 months, whilst 23.2% had an abortion in the last 12 months before the survey. Table 2 Sexual behavioural characteristics of respondents Variable Frequency (n) Percentage (%) Age at first sex <16 years 56 16.4 16–19 years 194 57.0 20+ 90 26.6 Nature of first sexual experience Consensual 225 66.2 Non-consensual (Forced/Rape) 115 33.8 Whom you had your first sex with Boyfriend 264 77.6 Husband/Partner 12 3.6 Casual Random Partner 60 17.6 Stepdad 4 1.2 Number of sexual partners ever had 1 29 8.5 2–3 37 10.9 4+ 274 80.6 Number of sexual partners in last 12 months 1 57 16.8 2–3 120 35.3 4+ 163 47.9 Ever had sex while drunk Yes 83 24.4 No 257 75.6 Ever received sex education Yes 215 63.2 No 125 36.8 Had unwanted pregnancy in the last 12 months Yes 87 25.6 No 253 74.4 Had abortion in the last 12 months Yes 79 23.2 No 261 76.8 Ever heard of contraceptives Yes 284 83.5 No 56 16.5 Knows where to access contraceptives (n = 284) Yes 214 75.4 No 70 24.6 Modern contraceptive (condom) use during last sex (n = 284) Yes 45 15.8 No 239 84.2 Had STI infection in the last 12 months Yes 119 35.0 No 221 65.0 Ever smoked any substance in the last 12months Yes 42 12.4 No 298 87.6 Ever had sex transactional sex Yes 81 23.8 No 259 76.2 Had transactional sex in the last 12 months (n = 81) Yes 57 16.8 No 24 83.2 Number of transactional sex encounters in the last 12 months (n = 57) 1 6 10.5 2–3 14 24.6 4+ 37 64.9 Overall, 23.8% reported ever engaging in transactional sex. Among this population, 16.8% said they engaged in transactional sex in the past 12 months, and majority of those who engaged in transactional sex in the last 12 months reported at least four encounters Table 2 HERE Factors influencing engagement in transactional sex To identify factors that are statistically associated with transactional sex, we chi square and fisher’s exact test analysis were performed on a total of 45 independent variables. Only six variables showed statistical association and were therefore further examined using logistic regression analysis. The results are shown in Table 3 . As illustrated in Table 3 , the final model (Model II) is a full model with demographic characteristics and sexual behavioural characteristics. It was that the odds of engaging in transactional sex among female students aged 20–24 were significantly lower (aOR: 0.140, 95%, CI: 0.032–0.605, p = 0.008) compared to those aged < 20 (reference age category). However, the odds of engaging in transactional sex among respondents whose age of sexual debut was < 18 years is almost three times (aOR: 2.745, 95%, CI: 1.068–7.060, p = 0.036) those whose age of sexual debut was 18 years or higher (reference category). Similarly, the odds of engaging in transactional sex among those whose area of residence when not in school is Peri-urban is over eight times higher (aOR: 8.300, 95%, CI: 1.655–41.617, p = 0.010) than those who reside in rural areas (reference category). Also, the odds of engaging in transactional sex among those who reported receiving ‘Insufficient financial support from family to pay daily expenses’ is almost six times higher (aOR: 5.903, 95%, CI: 1.515–23.006, p = 0.011) compared to those receiving ‘Adequate support’ (reference category). Furthermore, the odds of engaging in transactional sex among those who frequently used two social media applications is almost four times higher (aOR: 3.893, 95%, CI: 1.276–11.877, p = 0.017) compared to those who frequently use only one social media application. Table 3 Multivariable hierarchical logistic regression results by predictors of transaction sex Variable Model I Model II aOR (95% CI) p-value aOR (95% CI) p-value Age (years) < 20 1 (Ref) 1 (Ref) 20–24 0.288 (0.119–0.695) 0.006** 0.140 (0.032–0.605) 0.008** 25–29 0.230 (0.080–0.665) 0.007** 0.406 (0.100- 1.655) 0.209 30+ 0.661 (0.255–1.715) 0.395 0.556 (0.150–2.066) 0.381 Age of sexual debut >/=18 Years 1 (Ref) 1 (Ref) < 18 Years 0.132 (0.070–0.248) 0.000*** 2.745 (1.068–7.060) 0.036* Father’s Educational level Below JHS 1 (Ref) 1 (Ref) JHS to SHS 0.263 (0.122–0.568) 0.001** 1.477 (0.519–4.205) 0.465 Tertiary 0.745 (0.384–1.446) 0.384 2.800 (0.917–8.551) 0.071 Area of Residence Rural 1 (Ref) 1 (Ref) Peri-urban 8.280 (2.709–5.311) 0.000*** 8.300 (1.655–41.617) 0.010** Urban 0.913 (0.495–1.687) 0.772 1.386 (0.602–3.192) 0.443 Financial support from family to pay daily expenses Adequate support 1 (Ref) 1 (Ref) Moderate Support 1.390 (0.610–3.167) 0.433 2.093 (0.743- 5.900) 0.162 Little support 3.525 (1.496–8.310) 0.004** 5.903 (1.515–23.006) 0.011* No Support 4.818 (2.032–11.426) 0.000*** 3.192 (0.944–10.799) 0.062 No. of Social Media Apps frequently use 1 1 (Ref) 1 (Ref) 2 5.181 (2.376–11.298) 0.000*** 3.893 (1.276–11.877) 0.017* 3+ 2.329 (1.107–4.897) 0.026* 1.957 (0.751–5.101) 0.170 Exponentiated coefficients; 95% confidence intervals in brackets; aOR adjusted Odds Ratios CI; Confidence Interval. * p ≤0.05, ** p ≤0.01, *** p ≤0.001 Model I adjusted for demographic characteristics only Model II adjusted for demographic and sexual behavioural characteristics Table 3 HERE Association between transactional sex and other risky sexual behaviours and outcomes Table 4 presents the crude and adjusted odd ratios from the logistic regression analysis investigating the relationship between engaging in transactional sex in the past 12 months and two other risky sexual behaviours and two health outcomes. The results show that respondents who reported having engaged in transactional sex have over three times higher odds of contracting STIs in the last 12 months (aOR: 3.580, CI:1.059–12.099, p 0.040) and two and half times higher odds of having an abortion in the last 12 months (aOR: 2.616, CI: 1.037–6.598, p 0.042) compared to those who did not engage in transactional sex. However, while both condom use during last sex and drunk sex during the last 12 months showed statistical association at the crude level, the association disappeared in both cases after other covariates were controlled for in the adjusted model. Table 4 Association between transactional Sex and other risky sexual behaviours Variable cOR (95% CI) p-value aOR (95% CI) p-value Transactional Sex in the past 12months’ Modern Contraceptive (condom) use during last sex No 1 (ref) 1 (ref) Yes 1.868 (1.050–3.323) 0.034 1.809 (0.762–4.292) 0.179 Transactional Sex in the past 12 months Had sex while drunk in the last 12 months No 1 (ref) 1 (ref) Yes 1.52 (0.950–1.521) 0.049 1.326 (0.562–7.220) 0.390 Transactional Sex in the past 12 months Had STI during the last 12 months No 1 (ref) 1 (ref) Yes 1.649 (0.820–3.316) 0.161 3.580 (1.059–12.099) 0.040 Transactional Sex in the past 12 months Abortion in the last 12 months No 1 (ref) 1 (ref) Yes 3.900 (2.158–7.048) 0.000 2.616 (1.037–6.598) 0.042 A Logistic model controlling for background characteristics, cOR = Crude Odd Ratio, aOR = Adjusted Odd Ratio, p-value = significant at 0.05, TS = Transactional Sex, CI = Confident Interval Table 4 HERE Discussions This study is one of the few to have simultaneously estimated the prevalence of transactional sex and examined its association with other risky sexual behaviours and outcomes. The study reported a relatively high prevalence (23.8%) of ever engaging in transactional sex practice. The prevalence of transactional sex in the last 12 months prior to the study was equally relatively high (16.8%), with nearly 65% of those who reported engaging in transactional sex in the last 12 months indicating at least four encounters. Given the highly conservative, patriarchal and Moslem dominated nature of our study context, we are very surprised that the overall prevalence reported in this study is consistent with studies from other contexts that may not be very conservative. For instance, a cross-sectional survey conducted at two Universities in North Central Nigeria showed that 23.7% of males and 24% of females reported ever engaging in transactional sex [ 20 ]. The overall prevalence in our study is however lower than a study in Uganda which reported a prevalence of 15.2% among female university students [ 6 ]. The prevalence of transactional sex in the last 12 months (16.8%) in this study is also lower when compared with a study in Obafemi Awolowo University in Nigeria where female students reported a 23.85% prevalence of ‘transactional sex in the past 12 months’ [ 5 ]. Outside of the higher education context, our findings bear parallels with other studies in other African countries. For instance, in Soweto, South Africa, 21.1% of women attending antenatal clinics reported ever engaging in transactional sex [ 22 ]. Similarly, commercial farm workers (women) in South Africa, who have ever practised transactional sex were found to be 19% (Durojaiye et al., 2020). Again, in Tanzania, 26% of unmarried adolescent girls and young women reported ever engaging in transactional sex [ 23 ]. Together with previous findings, the foregoing discussion reiterates transactional sex as a growing but problematic sexual and reproductive health and rights issue that must be addressed. Whilst one could view transactional sex as manifesting some form of female sexual agency, its links with both risky sexual behaviours and adverse sexual and reproductive health outcomes makes the practice concerning. Indeed, transactional sex has been associated with risky sexual behaviours including varying levels of condom use, having sex while drunk, multiple sexual partnship as well as negative outcomes such as unintended pregnancies, unsafe abortions and STIs [ 23 ]. Whilst the findings from this study showed no statistically significant association between transactional sex in the past 12 months and four risky sexual behaviours measured (i.e. condom use during last sex, drunk sex, and multiple sexual partnership), the results indicate that those who engaged in transactional sex reported lower condom use during last sex, and higher likelihood of having drunk sex and multiple sexual partners. In terms of adverse outcomes, this study clearly showed that those who reported engaging in transactional sex were more likely to contract STIs in the last 12 months compared with those who did not engage in transactional sex. This finding is consistent with a recent study in Portland, Oregon, where transactional sex practice was characterised by increased condomless sex, sexual violence, bacterial STIs and hepatitis C [ 24 ]. Again, the study showed that female students who engaged in transactional sex in the last 12 months were significantly more likely to have had an abortion in the last 12 months compared to those who did not. Similar findings have been reported by other studies in African Countries [ 2 , 6 ]. . That transactional sex could increase the chances of engaging in risky sexual behaviours is not surprising. As noted earlier, most of these sexual encounters are framed by age and power asymmetries, gender-based violence and vulnerability. In these contexts, the financial rewards associated with transactional sex could influence young women to compromise on safer sexual practices hence increasing their risk of contracting STIs. This is more likely in the context of this study where a large proportion of respondents said they were self-financing their education and that the financial support they received from family to cater for their daily expenses was either not existent or very little. Our findings here suggest a need for both public education on the dangers of transaction sex and economic empowerment opportunities for young girls. For instance, part-time employment opportunities especially online work, could enabled many young women earn some income while pursuing higher, independent education. As regards the factors influencing transactional sex practice, we found that age, age of sexual debut, area of residence, family support, and frequent social media exposure were significant predictors. From this study, the odds of engaging in transactional sex decrease as the participant age increases though inconsistently. This is contrary to a study among students in a Nigerian University where ageing increases the odds of participants engaging in transactional sex [ 5 ]. Similarly, ageing was associated with higher odds of engaging in transactional sex among adolescent girls and young women in rural Tanzania [ 23 ]. However, a similar study in Liberia reported no association between participants’ age and transactional sex [ 25 ]. It is not clear why older respondents in our study reported lower odds of engaging in transaction sex. We think that it could be related to the fact that older respondents are more likely to be pursuing postgraduate studies or are married or are employed and therefore are relatively financially stable. Another explanation could be that older respondents may have over time build a large social network of friends and support systems, which are accessed for sustenance rather than engaging in transactional sex as a survival strategy. Whatever the explanation, our study suggests that ageing is protective of transactional sex, and therefore interventional programmes toward eliminating transactional sex should be targeted at adolescents and younger women. From our study, transaction sex seems to increase with increasing urbanization, albeit respondents whose resided in peri-urban were the most likely to practice transactional sex. A similar study in Liberia reported no significant association between area of residence and transactional sex practice [ 25 ]. Peri-urban represents a transition zone between rural and urban areas. This transition usually comes with several exposures to different lifestyles. When some of these exposures are not properly controlled, they could plunge the vulnerable especially young females into undesirable lifestyles including transactional sex. From our study, early sexual debut (< 18 years) increases the likelihood of engaging in transactional sex. This result is congruent with findings from a Liberian study where early sexual debut increased the odds of engaging in transactional sex [ 11 ]. In another study in Rural Soweto, delayed first coitus among antenatal women decreases their odds of engaging in Transactional sex [ 22 ]. Again, students of Obafemi Awolowo University in Nigeria who had their first intercourse at age 18 or later were less likely to experience transactional sex compared to those who had first intercourse at younger ages [ 5 ]. The finding from this study therefore suggests that being sexually active at a younger age is a risk factor for transactional sex. Being sexually active at a younger age could also increase the risk of teenage pregnancy, early childbearing and STI infection due to ignorance or lack of sex education. Therefore, comprehensive sexuality education for both in-school and out of school adolescent girls could be critical to helping them make informed sexual and reproductive health decisions. Furthermore, we found that perceived insufficient family support generally increases the likelihood of engaging in transactional sex compared with those receiving adequate family support. This finding is similar to a previous study where the odds of receiving money, gifts or favour for sex were lower in individuals who receive adequate support from their parents compared to those who receive no or insufficient support [ 20 ]. These findings suggest that young women with limited financial support and economic opportunities may use transactional sex both as a copying mechanism and to elevate their status in youth cultures that prioritise sexual success and conspicuous consumption [26]. A novel fining from our study is that frequent use of at least two social media applications increases the likelihood of engaging in transactional sex though not consistent. With advancements in technology, there is no doubt that people are more networked and interact more than before. In particular, social media platforms like Facebook, Instagram, Twitter and even WhatsApp as well as dating applications are used not just for finding sexual partners but also for distributing sexually explicit context. This new trend has the potential to lead many users of these applications to risky sexual behaviours including transactional sex. Therefore, there is need for some education on responsible use of these social media flatforms. Also, there is need for some content regulation to ensure that children and young girls are not exposed to harmful sexual content. Whilst this study has added new knowledge on transactional sex practice among young women in Ghana, the study has limitations. First, the study was carried out in a university context. While the context provided access to suitable and easily accessible respondents, findings may not be applicable to non-university context where pressure to pay fees and cater to other life essentials maybe relatively less. Second, the use of cross-sectional study design did not allow for causal inferences. Third, this study considered transactional sex practice from only young women’s perspective and did not also explore detailed reasons underlying the practice. Future studies could therefore include males as well as use qualitative research methods to deepen understanding of the intersectional factors that drive transaction sex. These limitations notwithstanding, the findings reported in this study offer useful starting points for policy, research and programmatic interventions. Conclusion This study has provided baseline data on the magnitude of transactional sex among young women in a university context. In particular, the study has added empirical data on the linkages between transactional sex and risky sexual behavours and adverse sexual and reproductive health outcomes. Together, the findings offer useful pointers for initiating targeted remedial interventions. To this end, we recommend that Ghanaian Institutions of Higher Learning liaise with the Ghana Health Service and University-based Health Services to organise periodic comprehensive sexuality education to young students that will offer accurate and comprehensive information while building skills for negotiating safer sexual behaviours. The government of Ghana should institute deliberate interventions that are aimed at the economic empowerment of young females even as they go through their higher education. This could include deliberate cash transfers to identifiable impoverished households to support young women through higher education; scholarships and grant opportunities for young women; and discounted fees for young women pursuing higher education. Early sexual debut increases the odds of transactional sex practice. This probably means the practice is even more prevalent in second-cycle institutions. School authorities and the Government through the Ministry of Gender, Children and Social Protection should roll out more comprehensive sexuality education programmes to inform young people about the dangers of early sex and the risk for STIs infections while encouraging safer sexual practices. Transactional sex practice increases the probability of participants contracting STIs and having abortions. This association between transactional sex and STIs therefore lends support to the evidence that transactional sex practice creates a fertile ground for the transmission of HIV infections. It is recommended that the University Health Services should incorporate School-based STI (HIV) prevention Programmes into their routine outreach activities to educate students on appropriate sexual behaviours. Finally, further qualitative studies that will describe the nature, forms and drivers of transactional sexual relationships among young women are needed. Abbreviations AIDS Acquired Immunodeficiency Syndrome AOR Adjusted Odd Ratio CI Confidence Interval DHS Demographic and Health Survey HIV Human Immunodeficiency Virus JHS Junior High School NGOs Non-Governmental Organizations OR Odd Ratio SD Standard Deviation SSA Sub-Saharan Africa SSS Senior High School STIs Sexually Transmitted Infections STRIVE Strengthening Resilience to Violent Extremism UNAIDS Joint United Nations Programme on HIV/AIDS Declarations Acknowledgments The authors would like to thank the participants who shared their experiences in this study. Availability of Data No/Not applicable (this manuscript does not report data generation or analysis). Funding The authors received no specific funding for this work. Authors’ Contribution Study conception and design was by Authors PK and JKG. Recruitment and Data collection was done by Author PK. Data analysis and interpretation was done by Authors PK AND JKG, Manuscript drafting was by author PK. All Authors reviewed the results and approved the final version of the manuscript. Ethics approval and consent to participate The protocol for this study was reviewed and approved by the Navrongo Health Research Centre Institutional Review Board with ethical approval ID: NHRCIB553. Administrative approval was obtained from the Management of University in which this study was conducted. The study was conducted in accordance with the terms of the Helsinki Declaration. Informed consent was obtained form every participant prior to completing the study. Consent for publication Not applicable. Competing interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article References Wamoyi J, Heise L, Meiksin R, Kyegombe N, Nyato D, Buller AM. Is transactional sex exploitative? A social norms perspective, with implications for interventions with adolescent girls and young women in Tanzania. PLoS ONE. 2019;14(4). https://doi.org/10.1371/journal.pone.0214366 . Hundie T, Mohammed E, Mannekulih E. Transactional sex and associated factors among female students of Adama Science and Technology University, Oromia, Ethiopia. Int J Sch Res Reviews. 2022;1(1):017–21. https://doi.org/10.56781/ijsrr.1.1.0023 . Oyeoku EK, Ibezim NE, Agwu PC, Okoye UO, Oyeoku EK, Ibezim NE, Agwu PC. Transactional Sex in Nigerian Universities among Female Students: Drivers and Safety Concerns. J Int Women’s Stud. 2022;24:5. Stoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of transactional sex in sub-Saharan Africa: A review and synthesis of the literature. Soc Sci Med. 2016;168:186–97. https://doi.org/https://doi.org/10.1016/j.socscimed.2016.09.023 . Ige OS, Solanke BL. Drivers of transactional sexual relationships among students in a Nigerian University: implications for elimination of reproductive rights violation. Int J Reprod Contracept Obstet Gynecol. 2020;10(1):55. https://doi.org/10.18203/2320-1770.ijrcog20205754 . Choudhry V, Östergren PO, Ambresin AE, Kyagaba E, Agardh A. Giving or receiving sex something: A cross-sectional study of transactional sex among Ugandan University students. PLoS ONE. 2014;9(11). https://doi.org/10.1371/journal.pone.0112431 . Amo-Adjei J, Kumi-Kyereme A, Tuoyire DA. Transactional sex among female university students in Ghana: Implications for HIV education. Health Educ. 2014;114(6):473–86. https://doi.org/10.1108/HE-02-2014-0013 . Steffenson AE, Pettifor AE, Seage GR, Rees HV, Cleary PD. Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth. Sex Transm Dis. 2011;38(6):459–66. https://doi.org/10.1097/OLQ.0b013e3182080860 . Juma M, Alaii J, Bartholomew LK, Askew I, Van den Borne B. Risky Sexual Behavior Among Orphan and Non-Orphan Adolescents in Nyanza Province, Western Kenya. AIDS Behav. 2013;17(3):951–60. https://doi.org/10.1007/s10461-012-0336-5 . Mihretie GN, Kassa BG, Ayele AD, Liyeh TM, Belay HG, Miskr AD, Minuye B, Azanaw MM, Worke MD. Transactional sex among women in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS ONE. 2023;18(6 June). https://doi.org/10.1371/journal.pone.0286850 . Okigbo CC, Mccarraher DR, Chen M, Pack A. (2014). Transactional sex in post-conflict Liberia African Journal of Reproductive Health. In African Journal of Reproductive Health , 2014; 18: 3. Gichane MW, Moracco KE, Pettifor AE, Zimmer C, Maman S, Phanga T, Nthani T, Rosenberg NE. Socioeconomic Predictors of Transactional Sex in a Cohort of Adolescent Girls and Young Women in Malawi: A Longitudinal Analysis. AIDS Behav. 2020;24(12):3376–84. https://doi.org/10.1007/s10461-020-02910-5 . Jewkes R, Dunkle K, Nduna M, Shai NJ. Transactional sex and HIV incidence in a cohort of young women in the stepping stones trial. J AIDS Clin Res. 2012;3(5):7. https://doi.org/10.4172/2155-6113.1000158 . Ott MQ, Bärnighausen T, Tanser F, Lurie MN, Newell ML. Age-gaps in sexual partnerships: Seeing beyond sugar daddies. AIDS. 2011;25(6):861–3. https://doi.org/10.1097/QAD.0b013e32834344c9 . Gbagbo YF, Gbagbo AJ. Commercial sex work among university students: a case study of four public universities in Ghana. BMC Women’s Health. 2021;21:103. https://doi.org/10.1186/s12905-021-01251-2 . Ganle JK, Amoako D, Baatiema L, Ibrahim M. Risky sexual behaviour and contraceptive use in contexts of displacement: Insights from a cross-sectional survey of female adolescent refugees in Ghana. Int J Equity Health. 2019;18(1). https://doi.org/10.1186/s12939-019-1031-1 . Sagoe G. The Prevalence of Transactional Sex and Its Implications for Female Trade Apprentices in The Bono Region-A Case Study of The Sunyani Metropolis. UniMAC-GIJ, 2021. https://repository.gij.edu.gh/handle/123456789/358 Azumah DF, Krampah S, Onzaberigu NJ. Transactional Sex And Its Health Implications: A Case Study Of Kwame Kwame Nkrumah University of Science and Technology. Res J Public Health. 2018;4:8. . Durojaiye I, Obisie-Nmehielle N, Ibisomi L. Transactional sex and HIV infection among commercial farm workers in South Africa. J Public Health Afr. 2020;11(2):86–91. https://doi.org/10.4081/jphia.2020.1229 . Ajayi AI, Somefun OD. Transactional sex among Nigerian university students: The role of family structure and family support. PLoS ONE. 2019;14(1). https://doi.org/10.1371/journal.pone.0210349 . STRIVE. Subject: Capturing Transactional Sex . http://strive.lshtm.ac.uk/ , 2014. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92. https://doi.org/https://doi.org/10.1016/j.socscimed.2004.02.003 . Ranganathan M, Quinones S, Palermo T, Gilbert U, Kajula L. Transactional sex among adolescent girls and young women enrolled in cash plus intervention in rural Tanzania: a mixed-methods study. J Int AIDS Soc. 2022;26038. https://doi.org/10.1002/jia2.26038/full . Menza TW, Lipira L, Bhattarai A, Leon VC, Orellana ER. Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, Oregon. BMC Women’s Health. 2020;20(1). https://doi.org/10.1186/s12905-020-01088-1 . Stoebenau K, Nair RC, Rambeloson V, Rakotoarison PG, Razafintsalama V, Labonté R. Consuming sex: The association between modern goods, lifestyles and sexual behaviour among youth in Madagascar. Globalization Health. 2013;9(1). https://doi.org/10.1186/1744-8603-9-13 . Additional Declarations No competing interests reported. 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Transactional sex can range from a survival short-term relationship that young women regularly engage in to enable them meet their daily needs and/or those of their family members, to a gift given in long-term relationships as a way of expressing affection but not for marriage [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Transactional sex has gained public health attention in recent times because of its links to sexually transmitted infections (STIs) including HIV infection among young females from sub-Saharan Africa [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have posited that transactional sexual relationships are a common phenomenon in sub-Saharan Africa occurring among young adults at different proportions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The range of estimates varies from 2.1% to a high of 72% in African countries [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A pooled prevalence of transactional sex among women from studies in Sub-Saharan Africa recorded 12.55% (9.59\u0026ndash;15.52%) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Among antenatal women in Soweto, South Africa, transactional sex practice was reported at 21.1% while as high as 72% of young females in Montserrado County, Liberia, engaged in transactional sex [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In Malawi, a quasi-experimental study estimated transactional sex practice at baseline to be 22%, at 6 months to be 15% and at 12 months as 20% among young women [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThough transactional sex appears a common phenomenon of sexual relationships in Sub-Saharan Africa, several studies have associated its with negative outcomes such as increased risk for sexually transmitted infections, unplanned pregnancies, unsafe abortions; and physiological trauma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In the context of higer educational institutions in Africa, transactional sexual relationships are frequently intergenerational, leading to the violation of young girls\u0026rsquo; sexual and reproductive rights [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These relationships also often perpetuate unequal power dynamics and fail to empower young girls to be able to negotiate safer sexual activity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While the act of transactional sex per se does not automatically make it risky, transactional sex is problematic because it is often characterised by age-asymmetric relationships, partner violence and individual risky behaviours such as inconsistent condom use and multiple sexual partnerships [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ghana, it is common for young women especially female students to establish sexual networks with local businessmen, politicians and uniformed men, usually older than them in return for money and gifts [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Similarly, female sex work is also very common especially in major cities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, because female sex work is illegal and law enforcement agencies regularly clamp down on sex workers, there are suggestions that transactional sex may open new avenues for building new sexual networks [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Nevertheless, the extent of this practice in the population is unclear. Thus far, only a few qualitative studies have been conducted in Ghana. For instance, Sagoe [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] documented variations in transactional sex practice and the impact it had on female trade apprentices in the Bono regional capital, Sunyani. Amo-Adjei et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] also explored transactional sex practice among 40 female students at the University of Cape Coast. While these studies have provided useful insights, there is a dearth of prevalence studies on transactional sex in Ghana among young women. For instance, a study among 150 respondents at the Kwame Nkrumah University of Science and Technology reported on the level of awareness about transactional sex but failed to investigate actual practice [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The only exception is a recent cross-sectional survey among female adolescent refugees in Ghana where 71% were engaged in transactional sex in the 12 months leading up to the study [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, given that this population is very distinct from the general Ghanaian population, one could expect significant differences. Another issue is that previous studies have not investigated the links between transactional sex and risky sexual behaviours. This knowledge gap not only hampers our understanding of the nature and magnitude of transactional sex practice among young women, but it could also limit our ability to develop risk-reduction interventions and promote responsible sexual behaviour. This study therefore aimed to provide baseline information on the prevalence of transactional sex practice and associated factors in Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA quantitative cross-sectional observational survey was conducted. This design enabled quick but detailed data collection on the frequency, distribution and determinants of transactional sex at a single time point [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003eThis study was conducted on three campuses of the University for Development Studies in the Northern region. We choose these settings because they provided the largest, easily accessible population of young women, most of whom are sexually active but not married. Another reason for this choice is that previous studies on the topic in Ghana have been conducted in the Southern part of Ghana where sexual norms are quite relaxed partly because of matrilineal culture. The northern region is highly conservative, patriarchal and dominated by the Islamic region. We therefore wanted to understand how this conservative context affects transactional sex practice.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population comprised young women who were enrolled in various undergraduate and postgraduate programmes offered across three campuses of a public University in the region. Respondents were aged 18 years and above and were sexually active i.e. have ever engaged in penetrative penile sex. Also, we included only those who were willing to provide written informed consent. We excluded those who met the inclusion criteria above but were indisposed either due to ill health or travel at the time of the study.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling methods\u003c/h3\u003e\n\u003cp\u003eBased on a 24.6% prevalence of transactional sex practice reported by a study among female university students in Nigeria[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], we estimated a minimum sample size of 314 at a confidence level of 95%. However, given that the topic is very sensitive, we adjusted the sample size upward by 100% and approached 628 respondents. As we show below, just a little above the minimum sample size (i.e. 340) young women completed the survey out of the 628 eligible young women who were approached.\u003c/p\u003e \u003cp\u003eIn terms of sampling methods, we used a combination of stratified and simple random sampling methods. To do this, we stratified the population into three strata, each stratum representing one of the three campuses. We then obtained the female admission registers from the Central registry of the University for each campus, which had information on the date of birth of each female student, their admission year, index number, phone number, email address, and postal address. We screened these registers to exclude those aged less than 18 years. We then calculated a proportionate sample for each stratum depending on the number of females aged 18 and above. Thus, we divided the total number of eligible participants in a particular campus by the sum of the three campuses, multiplied by our estimated sample size of 628. This ensured that the campus with the largest female population had more representation in our study. Following from this, we ordered the eligible participants by their index numbers for each campus according to when they were admitted, fed the data into R software, and use the random number generator function in R to randomly select the required sample for each campus. Following this we contacted each of the 628 selected young women via telephone or email to explain the purpose of the study and how they were selected. We asked one screening question during this initial contact, namely \u0026lsquo;have you ever had penetrative penile sex\u0026rsquo;. Only 26 out of the 628 participants we approached said they have never had sex and were therefore dropped from the study. We then invited the remining 602 eligible participants to participate in the study. Each eligible participant was given three days to decide on their participation. After the three days, we recontacted each eligible participant. A total of 240 declined participation for various reasons including \u0026lsquo;not interested\u0026rsquo;, \u0026lsquo;don\u0026rsquo;t have time\u0026rsquo;, and \u0026lsquo;does not want to share information about my sexual life\u0026rsquo;. The remaining 362 eligible participants were sent informed consent forms and a link to the study questionnaire for self-completion.\u003c/p\u003e\n\u003ch3\u003eData collection methods and tools\u003c/h3\u003e\n\u003cp\u003eThe data were collected online using KoboCollect, a free Android data entry app. Data collection took place between 6th December 2023 and 24th January 2024. A structured, self-reported questionnaire was developed, pre-tested and used for data collection (see supplementary file 1). The questionnaire was structured into three sections. The first section included questions on the background characteristics and other covariates of the respondents such as age, marital status, ethnicity, and age of first sexual debut. The second section included validated questions recommended by STRIVE (2014) on transactional sex practice for inclusion in the Demographic and Health Surveys (DHS) questionnaire for sub-Saharan Africa. The last section included questions on risky sexual behaviours and related health outcomes.\u003c/p\u003e \u003cp\u003eThe questionnaire was uploaded to KoboCollect, a free Android data entry app. Weblink to the questionnaire was then sent privately to each eligible respondent via WhatsApp or email to self-complete online. Weekly reminders were then sent to each participant to complete the survey. Using the KoboCellect platform for data collection had several advantages. It allowed the data to be collected, saved and transmitted automatically to a cloud server for later download by the research team. This helped minimise the potential for data loss which is common in the context of paper-based questionnaire. Similarly, the automatic saving of the data made it needless for a separate data entry phase commonly present when paper-based questionnaires are used.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDescription of study variables\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eOutcome variable\u003c/h2\u003e \u003cp\u003eThe primary outcome variable was transactional sex in the last 12 months. While we measured transactional sex as \u0026lsquo;ever\u0026rsquo; and \u0026lsquo;within the last 12 months\u0026rsquo;, we used transactional sex in the last 12 months as it gives a better reflection of current practice. Besides, our decision is in line with recommendations made by STRIVE [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] to the DHS for the measurement of transactional sex practice, namely a respondent having had sex or become sexually involved with someone (man) because they (man/men) provided them with or expected that they (man/men) would provide them with material support of any kind (e.g. money, gift, favours) in the last 12 months. The responses to this question were dichotomous where \u0026lsquo;YES\u0026rsquo; indicated engagement in transactional sex and \u0026lsquo;NO\u0026rsquo; indicated otherwise.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eIndependent variables\u003c/h3\u003e\n\u003cp\u003eSeveral independent variables (n\u0026thinsp;=\u0026thinsp;45), broadly grouped into demographic characteristics (e.g. age, level of education, ethnicity, frequency of listening to radio, frequency of watching television), and sexual behavioural characteristics (e.g. age at first sex, nature of first sexual experience, number of sexual partners, condom use, sex while drunk, abortion, pregnancy history, ever heard of contraceptives, knowledge of where to access contraceptives, exposure to STIs), were defined and measured.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eAll data files were downloaded and exported into Stata version 15 for cleaning, coding and possible recoding and analysis. Data cleaning was done by identifying outliers/anomalies and checking for consistency among and across variables. Frequency distributions and cross tabulations were specifically run to aid the data cleaning process. Where there was skewness in the distribution of the data for any variable, the medians with interquartile ranges were used.\u003c/p\u003e \u003cp\u003eBasic descriptive statistics (frequencies and percentages) were used to present information on the prevalence of transactional sex. This was followed by using chi square tests of independence and Fishers\u0026rsquo; exact test (in cases where cell observations for any variable were less than five) to show statistical differences or association between the independent variables and transactional sex. Finally, two hierarchical models from binary logistic regression were used to show how the independent variables predict transactional sex and the results were presented as adjusted odd ratios. For the chi-square test and binary logistic regression analyses, confidence level was set at 95% and p-value of less than 0.05 was taken as demonstrating statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of Study respondents\u003c/h2\u003e \u003cp\u003eA total of 362 eligible participants received the survey questionnaire. However, only 346 completed the questionnaires. Out of the 346, six questionnaires were incomplete and unusable. Therefore, the analysis involved 340 respondents.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows essential socio-demographic characteristics of the 340 respondents. the background characteristics of the study participants. The mean age was 24.94 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87). Most of the respondents were single (92.1%). Over two-thirds (69.1%) of the participants belong to the Mole-Dagbani ethnic group. As regards the source of funding for their education, majority (60.0%) reported parents/relatives as their main source. However, 30.0% reported self-funding their education. Financial support from family to pay daily expenses ranged from No Support (14.1%) to Adequate support (34.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of respondents (n\u0026thinsp;=\u0026thinsp;340)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (Mean\u0026thinsp;=\u0026thinsp;24.94; SD\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligious Affiliation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorce/separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of living children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow JHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHS to SHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow JHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHS to SHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArea of residence when not in School\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeri-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMole-Dagbani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAkan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGurma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGa-Adangbe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource of funding for education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-funding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents/Relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBursary/Scholarship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancial support from family to pay daily expenses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of media applications frequently used (i.e. at least once a day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCovered by National Health Insurance Scheme\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows sexual and behavioural characteristics and outcomes of the respondents. Age of sexual debut ranged from less than 16years (16.4%) to 20 years and above (26.6%). As high as 33.8% however reported that their first sexual experience was non-consensual i.e. forced or rape. An over whelming majority (80.6%) have had at least four sexual partners in their life time, whilst about 48% reported having at least four sexual partners in the last 12 months. Also, 35% reported at least one STI infection in the last 12 months, whilst 23.2% had an abortion in the last 12 months before the survey.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSexual behavioural characteristics of respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge at first sex\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;16 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;19 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNature of first sexual experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsensual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-consensual (Forced/Rape)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhom you had your first sex with\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoyfriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHusband/Partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCasual Random Partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStepdad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of sexual partners ever had\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of sexual partners in last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver had sex while drunk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver received sex education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHad unwanted pregnancy in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHad abortion in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver heard of contraceptives\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnows where to access contraceptives (n\u0026thinsp;=\u0026thinsp;284)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModern contraceptive (condom) use during last sex (n\u0026thinsp;=\u0026thinsp;284)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHad STI infection in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver smoked any substance in the last 12months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver had sex transactional sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e23.8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHad transactional sex in the last 12 months (n\u0026thinsp;=\u0026thinsp;81)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e16.8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of transactional sex encounters in the last 12 months (n\u0026thinsp;=\u0026thinsp;57)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4+\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOverall, 23.8% reported ever engaging in transactional sex. Among this population, 16.8% said they engaged in transactional sex in the past 12 months, and majority of those who engaged in transactional sex in the last 12 months reported at least four encounters\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors influencing engagement in transactional sex\u003c/h2\u003e \u003cp\u003eTo identify factors that are statistically associated with transactional sex, we chi square and fisher\u0026rsquo;s exact test analysis were performed on a total of 45 independent variables. Only six variables showed statistical association and were therefore further examined using logistic regression analysis. The results are shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. As illustrated in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the final model (Model II) is a full model with demographic characteristics and sexual behavioural characteristics. It was that the odds of engaging in transactional sex among female students aged 20\u0026ndash;24 were significantly lower (aOR: 0.140, 95%, CI: 0.032\u0026ndash;0.605, p\u0026thinsp;=\u0026thinsp;0.008) compared to those aged\u0026thinsp;\u0026lt;\u0026thinsp;20 (reference age category). However, the odds of engaging in transactional sex among respondents whose age of sexual debut was \u0026lt;\u0026thinsp;18 years is almost three times (aOR: 2.745, 95%, CI: 1.068\u0026ndash;7.060, p\u0026thinsp;=\u0026thinsp;0.036) those whose age of sexual debut was 18 years or higher (reference category). Similarly, the odds of engaging in transactional sex among those whose area of residence when not in school is Peri-urban is over eight times higher (aOR: 8.300, 95%, CI: 1.655\u0026ndash;41.617, p\u0026thinsp;=\u0026thinsp;0.010) than those who reside in rural areas (reference category). Also, the odds of engaging in transactional sex among those who reported receiving \u0026lsquo;Insufficient \u003cb\u003efinancial support from family to pay daily expenses\u0026rsquo;\u003c/b\u003e is almost six times higher (aOR: 5.903, 95%, CI: 1.515\u0026ndash;23.006, p\u0026thinsp;=\u0026thinsp;0.011) compared to those receiving \u0026lsquo;Adequate support\u0026rsquo; (reference category). Furthermore, the odds of engaging in transactional sex among those who frequently used two social media applications is almost four times higher (aOR: 3.893, 95%, CI: 1.276\u0026ndash;11.877, p\u0026thinsp;=\u0026thinsp;0.017) compared to those who frequently use only one social media application.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable hierarchical logistic regression results by predictors of transaction sex\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eModel I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eModel II\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eaOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eaOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.288 (0.119\u0026ndash;0.695)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.006**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.140 (0.032\u0026ndash;0.605)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.008**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.230 (0.080\u0026ndash;0.665)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.007**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.406 (0.100- 1.655)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.661 (0.255\u0026ndash;1.715)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.556 (0.150\u0026ndash;2.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of sexual debut\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;/=18 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.132 (0.070\u0026ndash;0.248)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.745 (1.068\u0026ndash;7.060)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.036*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s Educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow JHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHS to SHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.263 (0.122\u0026ndash;0.568)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.477 (0.519\u0026ndash;4.205)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.745 (0.384\u0026ndash;1.446)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.800 (0.917\u0026ndash;8.551)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArea of Residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeri-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.280 (2.709\u0026ndash;5.311)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8.300 (1.655\u0026ndash;41.617)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.010**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.913 (0.495\u0026ndash;1.687)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.386 (0.602\u0026ndash;3.192)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancial support from family to pay daily expenses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.390 (0.610\u0026ndash;3.167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.093 (0.743- 5.900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.525 (1.496\u0026ndash;8.310)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.004**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.903 (1.515\u0026ndash;23.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.818 (2.032\u0026ndash;11.426)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.192 (0.944\u0026ndash;10.799)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo. of Social Media Apps frequently use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.181 (2.376\u0026ndash;11.298)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.893 (1.276\u0026ndash;11.877)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.017*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.329 (1.107\u0026ndash;4.897)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.026*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.957 (0.751\u0026ndash;5.101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eExponentiated coefficients; 95% confidence intervals in brackets; aOR adjusted Odds Ratios CI; Confidence Interval. \u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026le;0.05, \u003csup\u003e**\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e\u0026le;0.01, \u003csup\u003e***\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e\u0026le;0.001\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eModel I adjusted for demographic characteristics only\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eModel II adjusted for demographic and sexual behavioural characteristics\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between transactional sex and other risky sexual behaviours and outcomes\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the crude and adjusted odd ratios from the logistic regression analysis investigating the relationship between engaging in transactional sex in the past 12 months and two other risky sexual behaviours and two health outcomes. The results show that respondents who reported having engaged in transactional sex have over three times higher odds of contracting STIs in the last 12 months (aOR: 3.580, CI:1.059\u0026ndash;12.099, p 0.040) and two and half times higher odds of having an abortion in the last 12 months (aOR: 2.616, CI: 1.037\u0026ndash;6.598, p 0.042) compared to those who did not engage in transactional sex. However, while both condom use during last sex and drunk sex during the last 12 months showed statistical association at the crude level, the association disappeared in both cases after other covariates were controlled for in the adjusted model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between transactional Sex and other risky sexual behaviours\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransactional Sex in the past 12months\u0026rsquo;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eModern Contraceptive (condom) use during last sex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.868 (1.050\u0026ndash;3.323)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.809 (0.762\u0026ndash;4.292)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransactional Sex in the past 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHad sex while drunk in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.52 (0.950\u0026ndash;1.521)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.326 (0.562\u0026ndash;7.220)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransactional Sex in the past 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHad STI during the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.649 (0.820\u0026ndash;3.316)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.580 (1.059\u0026ndash;12.099)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransactional Sex in the past 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAbortion in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.900 (2.158\u0026ndash;7.048)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.616 (1.037\u0026ndash;6.598)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eA Logistic model controlling for background characteristics, cOR\u0026thinsp;=\u0026thinsp;Crude Odd Ratio, aOR\u0026thinsp;=\u0026thinsp;Adjusted Odd Ratio, p-value\u0026thinsp;=\u0026thinsp;significant at 0.05, TS\u0026thinsp;=\u0026thinsp;Transactional Sex, CI\u0026thinsp;=\u0026thinsp;Confident Interval\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis study is one of the few to have simultaneously estimated the prevalence of transactional sex and examined its association with other risky sexual behaviours and outcomes. The study reported a relatively high prevalence (23.8%) of ever engaging in transactional sex practice. The prevalence of transactional sex in the last 12 months prior to the study was equally relatively high (16.8%), with nearly 65% of those who reported engaging in transactional sex in the last 12 months indicating at least four encounters.\u003c/p\u003e \u003cp\u003eGiven the highly conservative, patriarchal and Moslem dominated nature of our study context, we are very surprised that the overall prevalence reported in this study is consistent with studies from other contexts that may not be very conservative. For instance, a cross-sectional survey conducted at two Universities in North Central Nigeria showed that 23.7% of males and 24% of females reported ever engaging in transactional sex [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The overall prevalence in our study is however lower than a study in Uganda which reported a prevalence of 15.2% among female university students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The prevalence of transactional sex in the last 12 months (16.8%) in this study is also lower when compared with a study in Obafemi Awolowo University in Nigeria where female students reported a 23.85% prevalence of \u0026lsquo;transactional sex in the past 12 months\u0026rsquo; [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Outside of the higher education context, our findings bear parallels with other studies in other African countries. For instance, in Soweto, South Africa, 21.1% of women attending antenatal clinics reported ever engaging in transactional sex [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, commercial farm workers (women) in South Africa, who have ever practised transactional sex were found to be 19% (Durojaiye et al., 2020). Again, in Tanzania, 26% of unmarried adolescent girls and young women reported ever engaging in transactional sex [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTogether with previous findings, the foregoing discussion reiterates transactional sex as a growing but problematic sexual and reproductive health and rights issue that must be addressed. Whilst one could view transactional sex as manifesting some form of female sexual agency, its links with both risky sexual behaviours and adverse sexual and reproductive health outcomes makes the practice concerning. Indeed, transactional sex has been associated with risky sexual behaviours including varying levels of condom use, having sex while drunk, multiple sexual partnship as well as negative outcomes such as unintended pregnancies, unsafe abortions and STIs [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Whilst the findings from this study showed no statistically significant association between transactional sex in the past 12 months and four risky sexual behaviours measured (i.e. condom use during last sex, drunk sex, and multiple sexual partnership), the results indicate that those who engaged in transactional sex reported lower condom use during last sex, and higher likelihood of having drunk sex and multiple sexual partners. In terms of adverse outcomes, this study clearly showed that those who reported engaging in transactional sex were more likely to contract STIs in the last 12 months compared with those who did not engage in transactional sex. This finding is consistent with a recent study in Portland, Oregon, where transactional sex practice was characterised by increased condomless sex, sexual violence, bacterial STIs and hepatitis C [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Again, the study showed that female students who engaged in transactional sex in the last 12 months were significantly more likely to have had an abortion in the last 12 months compared to those who did not. Similar findings have been reported by other studies in African Countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. .\u003c/p\u003e \u003cp\u003eThat transactional sex could increase the chances of engaging in risky sexual behaviours is not surprising. As noted earlier, most of these sexual encounters are framed by age and power asymmetries, gender-based violence and vulnerability. In these contexts, the financial rewards associated with transactional sex could influence young women to compromise on safer sexual practices hence increasing their risk of contracting STIs. This is more likely in the context of this study where a large proportion of respondents said they were self-financing their education and that the financial support they received from family to cater for their daily expenses was either not existent or very little. Our findings here suggest a need for both public education on the dangers of transaction sex and economic empowerment opportunities for young girls. For instance, part-time employment opportunities especially online work, could enabled many young women earn some income while pursuing higher, independent education.\u003c/p\u003e \u003cp\u003eAs regards the factors influencing transactional sex practice, we found that age, age of sexual debut, area of residence, family support, and frequent social media exposure were significant predictors. From this study, the odds of engaging in transactional sex decrease as the participant age increases though inconsistently. This is contrary to a study among students in a Nigerian University where ageing increases the odds of participants engaging in transactional sex [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similarly, ageing was associated with higher odds of engaging in transactional sex among adolescent girls and young women in rural Tanzania [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, a similar study in Liberia reported no association between participants\u0026rsquo; age and transactional sex [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is not clear why older respondents in our study reported lower odds of engaging in transaction sex. We think that it could be related to the fact that older respondents are more likely to be pursuing postgraduate studies or are married or are employed and therefore are relatively financially stable. Another explanation could be that older respondents may have over time build a large social network of friends and support systems, which are accessed for sustenance rather than engaging in transactional sex as a survival strategy. Whatever the explanation, our study suggests that ageing is protective of transactional sex, and therefore interventional programmes toward eliminating transactional sex should be targeted at adolescents and younger women.\u003c/p\u003e \u003cp\u003eFrom our study, transaction sex seems to increase with increasing urbanization, albeit respondents whose resided in peri-urban were the most likely to practice transactional sex. A similar study in Liberia reported no significant association between area of residence and transactional sex practice [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Peri-urban represents a transition zone between rural and urban areas. This transition usually comes with several exposures to different lifestyles. When some of these exposures are not properly controlled, they could plunge the vulnerable especially young females into undesirable lifestyles including transactional sex.\u003c/p\u003e \u003cp\u003eFrom our study, early sexual debut (\u0026lt;\u0026thinsp;18 years) increases the likelihood of engaging in transactional sex. This result is congruent with findings from a Liberian study where early sexual debut increased the odds of engaging in transactional sex [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In another study in Rural Soweto, delayed first coitus among antenatal women decreases their odds of engaging in Transactional sex [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Again, students of Obafemi Awolowo University in Nigeria who had their first intercourse at age 18 or later were less likely to experience transactional sex compared to those who had first intercourse at younger ages [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The finding from this study therefore suggests that being sexually active at a younger age is a risk factor for transactional sex. Being sexually active at a younger age could also increase the risk of teenage pregnancy, early childbearing and STI infection due to ignorance or lack of sex education. Therefore, comprehensive sexuality education for both in-school and out of school adolescent girls could be critical to helping them make informed sexual and reproductive health decisions.\u003c/p\u003e \u003cp\u003eFurthermore, we found that perceived insufficient family support generally increases the likelihood of engaging in transactional sex compared with those receiving adequate family support. This finding is similar to a previous study where the odds of receiving money, gifts or favour for sex were lower in individuals who receive adequate support from their parents compared to those who receive no or insufficient support [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These findings suggest that young women with limited financial support and economic opportunities may use transactional sex both as a copying mechanism and to elevate their status in youth cultures that prioritise sexual success and conspicuous consumption [26].\u003c/p\u003e \u003cp\u003eA novel fining from our study is that frequent use of at least two social media applications increases the likelihood of engaging in transactional sex though not consistent. With advancements in technology, there is no doubt that people are more networked and interact more than before. In particular, social media platforms like Facebook, Instagram, Twitter and even WhatsApp as well as dating applications are used not just for finding sexual partners but also for distributing sexually explicit context. This new trend has the potential to lead many users of these applications to risky sexual behaviours including transactional sex. Therefore, there is need for some education on responsible use of these social media flatforms. Also, there is need for some content regulation to ensure that children and young girls are not exposed to harmful sexual content.\u003c/p\u003e \u003cp\u003eWhilst this study has added new knowledge on transactional sex practice among young women in Ghana, the study has limitations. First, the study was carried out in a university context. While the context provided access to suitable and easily accessible respondents, findings may not be applicable to non-university context where pressure to pay fees and cater to other life essentials maybe relatively less. Second, the use of cross-sectional study design did not allow for causal inferences. Third, this study considered transactional sex practice from only young women\u0026rsquo;s perspective and did not also explore detailed reasons underlying the practice. Future studies could therefore include males as well as use qualitative research methods to deepen understanding of the intersectional factors that drive transaction sex. These limitations notwithstanding, the findings reported in this study offer useful starting points for policy, research and programmatic interventions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study has provided baseline data on the magnitude of transactional sex among young women in a university context. In particular, the study has added empirical data on the linkages between transactional sex and risky sexual behavours and adverse sexual and reproductive health outcomes. Together, the findings offer useful pointers for initiating targeted remedial interventions. To this end, we recommend that Ghanaian Institutions of Higher Learning liaise with the Ghana Health Service and University-based Health Services to organise periodic comprehensive sexuality education to young students that will offer accurate and comprehensive information while building skills for negotiating safer sexual behaviours. The government of Ghana should institute deliberate interventions that are aimed at the economic empowerment of young females even as they go through their higher education. This could include deliberate cash transfers to identifiable impoverished households to support young women through higher education; scholarships and grant opportunities for young women; and discounted fees for young women pursuing higher education. Early sexual debut increases the odds of transactional sex practice. This probably means the practice is even more prevalent in second-cycle institutions. School authorities and the Government through the Ministry of Gender, Children and Social Protection should roll out more comprehensive sexuality education programmes to inform young people about the dangers of early sex and the risk for STIs infections while encouraging safer sexual practices. Transactional sex practice increases the probability of participants contracting STIs and having abortions. This association between transactional sex and STIs therefore lends support to the evidence that transactional sex practice creates a fertile ground for the transmission of HIV infections. It is recommended that the University Health Services should incorporate School-based STI (HIV) prevention Programmes into their routine outreach activities to educate students on appropriate sexual behaviours. Finally, further qualitative studies that will describe the nature, forms and drivers of transactional sexual relationships among young women are needed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAIDS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDHS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDemographic and Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eJHS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNGOs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-Governmental Organizations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSSS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSenior High School\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSTIs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually Transmitted Infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSTRIVE\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStrengthening Resilience to Violent Extremism\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUNAIDS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoint United Nations Programme on HIV/AIDS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank the participants who shared their experiences in this study.\u003c/p\u003e\n\u003ch2\u003eAvailability of Data\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNo/Not applicable (this manuscript does not report data generation or analysis).\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eStudy conception and design was by Authors PK and JKG. Recruitment and Data collection was done by Author PK. Data analysis and interpretation was done by Authors PK AND JKG, Manuscript drafting was by author PK. All Authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2 id=\"_Toc163399636\"\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe protocol for this study was reviewed and approved by the Navrongo Health Research Centre Institutional Review Board with ethical approval ID: NHRCIB553. Administrative approval was obtained from the Management of University in which this study was conducted. The study was conducted in accordance with the terms of the Helsinki Declaration. Informed consent was obtained form every participant prior to completing the study.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCompeting interest\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWamoyi J, Heise L, Meiksin R, Kyegombe N, Nyato D, Buller AM. Is transactional sex exploitative? A social norms perspective, with implications for interventions with adolescent girls and young women in Tanzania. 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Soc Sci Med. 2004;59(8):1581\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/10.1016/j.socscimed.2004.02.003\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2004.02.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRanganathan M, Quinones S, Palermo T, Gilbert U, Kajula L. Transactional sex among adolescent girls and young women enrolled in cash plus intervention in rural Tanzania: a mixed-methods study. J Int AIDS Soc. 2022;26038. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jia2.26038/full\u003c/span\u003e\u003cspan address=\"10.1002/jia2.26038/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenza TW, Lipira L, Bhattarai A, Leon VC, Orellana ER. Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, Oregon. BMC Women\u0026rsquo;s Health. 2020;20(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-020-01088-1\u003c/span\u003e\u003cspan address=\"10.1186/s12905-020-01088-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoebenau K, Nair RC, Rambeloson V, Rakotoarison PG, Razafintsalama V, Labont\u0026eacute; R. Consuming sex: The association between modern goods, lifestyles and sexual behaviour among youth in Madagascar. Globalization Health. 2013;9(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1744-8603-9-13\u003c/span\u003e\u003cspan address=\"10.1186/1744-8603-9-13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Transactional Sex, Risky Sexual Behaviour, young women, STIs, family support, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-6434302/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6434302/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTransactional sex has gained public health attention in recent times because of its contributions to sexually transmitted infections and unwanted pregnacy among young women in sub-Saharan Africa. However, empirical data on the extent of this practice are lacking in Ghana. This study therefore sought to provide baseline information on the prevalence of transactional sex practice and associated factors among young women in Northern Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quantitative cross-sectional survey was conducted among 340 sexually active young female students in a tertiary institution in northern Ghana. Stratified and simple random sampling techniques were used to sample respondents. Data were collected online using a pretested questionnaire. The prevalence of transactional sex and other essential socio-demographic characteristics were analysed descriptively using frequencies and percentages. A logistic regression model was used to assess the links between transaction sex and risky sexual behaviour as well as determine predictors of transactional sex at a 95% confidence interval.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eThe prevalence of ever engaging in transactional sex was 23.8%, and 16.8% reported engaging in transactional sex in the past 12 months prior to the study. Nearly 65% of those who reported engaging in transactional sex in the last 12 months have done so at least four times. The odds of engaging in transactional sex were lower among older female respondents (AOR: 0.140, 95%, CI: 0.032\u0026ndash;0.605, p\u0026thinsp;=\u0026thinsp;0.008); but higher for early sexual debut (AOR: 2.745, 95%, CI: 1.068\u0026ndash;7.060, p\u0026thinsp;=\u0026thinsp;0.036), area of residence (i.e. being peri-urban) (AOR: 8.300, 95%, CI: 1.655\u0026ndash;41.617, p\u0026thinsp;=\u0026thinsp;0.010), insufficient family support (AOR: 5.903, 95%, CI: 1.515\u0026ndash;23.006, p\u0026thinsp;=\u0026thinsp;0.011), and frequently using at least two social media applications (AOR: 3.893, 95%, CI: 1.276\u0026ndash;11.877, p\u0026thinsp;=\u0026thinsp;0.017). Respondents who engaged in transactional sex reported higher odds of contracting STIs (AOR: 3.580, CI:1.059\u0026ndash;12.099, p 0.040) and having an abortion (AOR: 2.616, CI: 1.037\u0026ndash;6.598, p 0.042) in the last 12 months.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEconomic empowerment of young women is critical to preventing and/ or minimising the occurrence of transaction sex among young women. Also, targeted comprehensive sexual and reproductive health and rights education interventions are needed on the campuses of institutions of higher learning to enable young women negotiate safe sex and sexual relationships. In addition, there is urgent need to promote contraceptive (especially those that offer dual protection) use among young women on the campuses of tertiary institutions to minimize STIs infection and unwanted pregnancy.\u003c/p\u003e","manuscriptTitle":"Transactional Sex, Risky sexual behaviours, and associated factors and outcomes among young women in Northern Ghana: evidence from a cross-sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 16:39:18","doi":"10.21203/rs.3.rs-6434302/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-27T12:04:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T09:57:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280506155797289961394215194582978887191","date":"2025-05-16T09:28:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T09:01:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320020537240152880326511609949694932744","date":"2025-05-11T08:29:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T17:02:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T09:48:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-15T12:57:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-14T18:25:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-04-14T18:24:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1cc17f9-fc79-45e1-9992-31df8aa8aaa1","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:09:35+00:00","versionOfRecord":{"articleIdentity":"rs-6434302","link":"https://doi.org/10.1186/s12905-025-03845-6","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-07-03 15:57:29","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2025-05-08 16:39:18","video":"","vorDoi":"10.1186/s12905-025-03845-6","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03845-6","workflowStages":[]},"version":"v1","identity":"rs-6434302","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6434302","identity":"rs-6434302","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}