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Background <p>Men engaged in transactional sex (METS) are a critical population for HIV transmission dynamics in Sub-Saharan Africa (SSA). The interplay between multiple sexual partnerships and condom use, two key risk determinants, is complex and not fully understood. This study aimed to assess the prevalence and determinants of these interdependent behaviors among METS across SSA.</p> Methods <p>Cross-sectional data from 26 recent Demographic and Health Surveys (DHS) in SSA were pooled. A sample of 10,128 men who reported providing or receiving money or gifts in exchange for sex was analyzed. A recursive bivariate probit model was use to jointly model the propensity for multiple sexual partnerships and condom use, accounting for their potential correlation. Adjusted coefficients, predicted joint probabilities, and average marginal effects (AME) were reported.</p> Results <p>The weighted prevalence of multiple sexual partnerships was 55.3% (95%CI: 53.8–56.9) and of condom use was 32.9% (95%CI: 31.4–34.4). The model revealed a significant, positive correlation between the two behaviors (rho = 0.447, p &lt; 0.05). Key determinants had compensatory effects: living in a couple was associated with a higher propensity for multiple partnerships (β = 0.39, p &lt; 0.001) but a lower propensity for condom use (β = −&#xa0;0.78, p &lt; 0.001). Higher education was associated with both more multiple partnerships and increased condom use. HIV-related knowledge and testing were strong predictors of condom use but not of multiple partnerships. AME analysis showed that marital status had the largest effect, increasing the probability of the high-risk outcome (multiple partners, no condom) by 25.85 percentage points (p &lt; 0.001). Media exposure and comprehensive HIV knowledge significantly increased the probability of protective behaviors.</p> Conclusion <p>Among METS in SSA, there is evidence of risk compensation, wherein factors associated with multiple sexual partnerships are also associated with increased condom use. However, the alarmingly high prevalence of multiple partnerships coupled with low condom use among married METS represents a critical intervention gap.</p>

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Predictors of multiple sexual partnerships and condom use among men engaged in transactional sex: a recursive bivariate probit analysis of Demographic and Health Surveys from 26 Sub-Saharan African countries

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  • 发表日期：

    2025年12月9日

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  • Issifou Yaya

摘要

Background

Men engaged in transactional sex (METS) are a critical population for HIV transmission dynamics in Sub-Saharan Africa (SSA). The interplay between multiple sexual partnerships and condom use, two key risk determinants, is complex and not fully understood. This study aimed to assess the prevalence and determinants of these interdependent behaviors among METS across SSA.

Methods

Cross-sectional data from 26 recent Demographic and Health Surveys (DHS) in SSA were pooled. A sample of 10,128 men who reported providing or receiving money or gifts in exchange for sex was analyzed. A recursive bivariate probit model was use to jointly model the propensity for multiple sexual partnerships and condom use, accounting for their potential correlation. Adjusted coefficients, predicted joint probabilities, and average marginal effects (AME) were reported.

Results

The weighted prevalence of multiple sexual partnerships was 55.3% (95%CI: 53.8–56.9) and of condom use was 32.9% (95%CI: 31.4–34.4). The model revealed a significant, positive correlation between the two behaviors (rho = 0.447, p < 0.05). Key determinants had compensatory effects: living in a couple was associated with a higher propensity for multiple partnerships (β = 0.39, p < 0.001) but a lower propensity for condom use (β = − 0.78, p < 0.001). Higher education was associated with both more multiple partnerships and increased condom use. HIV-related knowledge and testing were strong predictors of condom use but not of multiple partnerships. AME analysis showed that marital status had the largest effect, increasing the probability of the high-risk outcome (multiple partners, no condom) by 25.85 percentage points (p < 0.001). Media exposure and comprehensive HIV knowledge significantly increased the probability of protective behaviors.

Conclusion

Among METS in SSA, there is evidence of risk compensation, wherein factors associated with multiple sexual partnerships are also associated with increased condom use. However, the alarmingly high prevalence of multiple partnerships coupled with low condom use among married METS represents a critical intervention gap.