This study provides insights into the factors driving engagement in transactional sex among MSM in Ghana. In addition to identifying predictors of transactional sex, we also examined its association with HIV and syphilis. Although TS was not independently associated with HIV or syphilis, it clustered with multiple behavioral and structural vulnerabilities that heighten overall risk. The findings underscore the need for targeted interventions that address the unique contexts in which TS occurs.<\/p>\n
Transactional sex was most prevalent among adolescents aged 18\u201319\u00a0years, with odds decreasing significantly with age. This trend is consistent with global literature suggesting that younger MSM are more likely to engage in TS due to economic vulnerability, limited employment opportunities, and social exclusion [20<\/a>,21<\/a>,22<\/a>,23<\/a>]. In Ghana, the high youth unemployment rate and lack of income-generating alternatives may push adolescents into transactional arrangements as a form of survival.<\/p>\n Education emerged as a significant protective factor. MSM with tertiary education had significantly lower odds of engaging in transactional sex compared to those with lower educational attainment. This finding is consistent with several studies showing that education enhances employability, economic independence, and health literacy\u2014factors that reduce reliance on transactional partnerships [12<\/a>, 20<\/a>, 22<\/a>,23<\/a>,24<\/a>]. Educated individuals may also have increased access to health information and support networks, reducing their reliance on transactional partnerships.<\/p>\n MSM who were separated, divorced, or widowed were also less likely to engage in transactional sex. This finding contrasts with some previous studies that have shown higher odds of engaging in transactional sex among individuals who are single or not in a current relationship, where the absence of a committed partner is often associated with increased sexual risk-taking [23<\/a>].<\/p>\n This may reflect a combination of age, emotional fatigue, and social withdrawal following the dissolution of a prior relationship. In the Ghanaian context, individuals who have experienced the emotional toll of long-term relationships may become more risk-averse, potentially distancing themselves from casual or transactional sexual partnerships. The trauma of a previous union might contribute to lower sexual activity overall, including engagement in economically motivated encounters.<\/p>\n Geographic disparities were also evident. MSM residing in the Volta, Northern, and Upper East regions had significantly lower odds of engaging in transactional sex compared to those in Greater Accra. As Ghana\u2019s capital and most urbanized region, Greater Accra presents unique structural drivers of transactional sex, including a high cost of living, widespread youth underemployment, and housing instability [20<\/a>, 25<\/a>, 26<\/a>]. The city also attracts internal migrants seeking better opportunities, many of whom may face economic precarity and lack social support networks, thereby increasing their vulnerability to exchanging sex for shelter or basic necessities. Urban environments such as Greater Accra also offer greater anonymity and lower risk of social sanction, which can facilitate the normalization or concealment of transactional sex behaviors.<\/p>\n The findings echo broader patterns observed globally, where transactional sex is often more prevalent in urban centers due to concentrated economic pressures and greater exposure to commercialized sexual networks[7<\/a>]. While the Greater Accra Region has been the focal point for HIV prevention programming in Ghana, this study highlights the need to consider how social and structural inequalities within urban settings may paradoxically increase vulnerability even in regions with high programmatic coverage. Economic strain, social isolation, and migratory instability may dilute the protective effects of health interventions unless they are explicitly designed to address these contextual realities.<\/p>\n In this study, income level was not found to be associated with transactional sex, which contrasts with several prior studies conducted globally. While this finding may reflect context-specific dynamics, it diverges from a well-established trend observed in research from Africa, North America, and Europe, where lower income has consistently been linked to a higher likelihood of engaging in transactional sex among MSM [20<\/a>, 21<\/a>, 27<\/a>]. In those contexts, financial insecurity often compels individuals to exchange sex for money, shelter, or material support. The deviation observed in this study may suggest that the motivations for transactional sex are multifaceted and not only shaped by absolute income but also by local social networks, housing instability, access to employment, and prevailing norms within the MSM community. Further investigation is needed to unpack the nuanced role of income and economic opportunity in shaping transactional sex behaviors in this setting.<\/p>\n MSM who were equally attracted to both men and women had lower odds of engaging in TS compared to those exclusively attracted to men. Bisexual men may benefit from more diverse sources of emotional and financial support, including female partners, which can reduce reliance on transactional arrangements. Bisexual MSM in sub-Saharan Africa have been observed to engage in fewer high-risk behaviors. A systematic review found that on average, bisexual MSM in sub\u2010Saharan Africa have lower HIV prevalence and report less receptive anal intercourse than exclusive MSM [28<\/a>]. These differences in risk profile are broadly consistent with our observation of lower TS among those with bisexual attractions. Conversely, a study in Nigeria found that MSM identifying as bisexual had over twice the odds of transactional sex compared to exclusively gay MSM. This may be due to Nigeria\u2019s Same-Sex Marriage (Prohibition) Act (2014), which criminalizes same-sex relationships with up to 14\u00a0years\u2019 imprisonment, and common police mass raids. Many bisexual men, therefore, adopt or retain heterosexual partnerships and use discreet, paid encounters with male partners to satisfy same-sex desire while minimizing public exposure. This dynamic makes TS a safer way to meet male partners under intense surveillance, hence its high prevalence in Nigeria\u2019s bisexual group. Ghana also criminalizes same-sex activity, but enforcement is generally less aggressive, and large-scale raids are rare. MSM social venues (e.g., house parties, community-based organizations) operate with lower risks, allowing gay-identified men to find casual partners without explicit payment.<\/p>\n Our study also observed that participants who reported having multiple sexual partners in the last 6\u00a0months were more likely to engage in transactional sex. MSM reporting four or more partners had nearly double the odds of TS compared to those with only one partner. This mirrors findings from other studies of MSM in West Africa. The CohMSM prospective cohort (Burkina Faso, C\u00f4te d\u2019Ivoire, Mali, Togo) found that MSM with multiple male partners had significantly higher odds of reporting TS[29<\/a>]. Similarly, this finding is also consistent with findings from Smith et al. in a cross-sectional study that observed that the larger the sexual network of MSM, the greater the probability of TS with a member who also engages in transactional sex[30<\/a>]. Generally, having many partners expands opportunity for transactional encounters, both in terms of more encounters, each representing an opportunity for exchange, and reflecting a propensity for casual or group-sex settings that may involve exchanges.<\/p>\n In our study, MSM who had not heard of PrEP were less likely to engage in transactional sex compared to those who were aware of PrEP. This suggests that PrEP awareness may be more prevalent among individuals with higher HIV risk profiles, including those involved in transactional sex, who are more frequently reached by targeted prevention efforts. In Ghana, men who learn about PrEP often are connected to peer educators and prevention programs[18<\/a>], suggesting that outreach is prioritized toward higher risk MSM. PrEP awareness in this context may serve as a marker of engagement with HIV prevention services among those already facing elevated vulnerability. Importantly, PrEP education and awareness among MSM are still scaling up in Ghana.<\/p>\n PrEP education and awareness among MSM are still scaling up in Ghana. Romo et al. in a study in Kenya found PrEP awareness to be 69% among MSM[31<\/a>], higher than the 44% reported in Ghana[18<\/a>]. As PrEP roll-out continues, attention should be paid to ensuring that higher-risk MSM, including sex workers, maintain safe practices.<\/p>\n The strongest protective factor we found was knowledge of HIV testing sites. While this specific association has not been widely reported, it is consistent with the idea that awareness and use of HIV services are linked to safer behaviors. Knowing where to test indicates engagement with the healthcare system and suggests better HIV literacy, which may discourage transactional sex. Conversely, MSM who do not know testing locations might be more marginalized and less informed about prevention, making them more likely to rely on sex-for-gain. This underscores the need for outreach; expanding community-based testing campaigns and publicizing MSM-friendly clinics could have dual benefits of increasing testing uptake and indirectly reducing risky practices like TS.<\/p>\n While TS was not significantly associated with HIV or syphilis in multivariable models, the direction of association was consistent with prior global findings. A systematic review from 28 countries found that MSM engaging in transactional sex had 30% higher odds than those who did not engage in transactional [8<\/a>]. Research conducted in China and sub-Saharan Africa demonstrates that transactional sex leads to higher rates of HIV and STIs including syphilis, mainly because of economic disadvantage and social discrimination [32<\/a>, 33<\/a>]. The absence of significance may be due to confounding protective factors such as age, PrEP awareness, or health service engagement. MSM aged 35 and above had significantly higher odds of HIV infection, suggesting cumulative risk over time. Similarly, PrEP awareness and HIV testing knowledge were protective against both HIV and syphilis. Studies in Kenya and sub-Saharan Africa have shown that improved PrEP literacy and access to tailored services are strongly associated with greater willingness to use PrEP and reduced HIV vulnerability among MSM[34<\/a>, 35<\/a>].<\/p>\n","protected":false},"excerpt":{"rendered":"This study provides insights into the factors driving engagement in transactional sex among MSM in Ghana. In addition…\n","protected":false},"author":2,"featured_media":137432,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[78],"tags":[18,135,575,19,4381,17,81613,2101,81614,31650,81612,4384,8660],"class_list":{"0":"post-137431","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-eire","9":"tag-health","10":"tag-hiv","11":"tag-ie","12":"tag-infectious-diseases","13":"tag-ireland","14":"tag-msm","15":"tag-public-health","16":"tag-sexual-risk","17":"tag-syphilis","18":"tag-transactional-sex","19":"tag-tropical-medicine","20":"tag-vaccine"},"share_on_mastodon":{"url":"","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/137431","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=137431"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/137431\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/137432"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=137431"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=137431"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=137431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}