Authors: Aleya Khalifa, Sally Findley, Elizabeth Gummerson, Joanne E Mantell, Avi J Hakim, Neena M Philip, Choice Ginindza, Ahmed Saadani Hassani, Steven Y Hong, Mohamed F Jalloh, Wilford L Kirungi, Limpho Maile, George S Mgomella, Leigh Ann Miller, Peter Minchella, Nicholus Mutenda, Prosper Njau, Amee Schwitters, Jennifer Ward, and Andrea Low.

Background: Mobile women are at risk of HIV infection in sub-Saharan Africa, though we lack evidence for HIV risk among women in mobile partnerships, especially in the context of household food insecurity, a growing concern in the region.

Setting: Women aged 15-59 years with a cohabitating male partner and who participated in Population-based HIV Impact Assessment surveys in Eswatini, Lesotho, Namibia, Tanzania, Uganda, and Zambia.

Methods: We evaluated the association between women’s and their partner’s mobility (being away from home for over one month or staying elsewhere) and transactional sex (selling sex or receiving money or goods in exchange for sex). We examined associations for effect measure modification by food insecurity level in the household in the past month. We used survey-weighted logistic regression, pooled and by country, adjusting for individual, partner and household-level variables.

Results: Among women with a cohabitating male partner, 8.0% reported transactional sex, ranging from 2.7% in Lesotho to 13.4% in Uganda. Women’s mobility (aOR 1.35 [95% CI 1.08 – 1.68]), but not their partner’s mobility (aOR 0.91 [0.74 – 1.12]), was associated with transactional sex. Food insecurity was associated with transactional sex independent of mobility (aOR 1.29 [1.10 – 1.52]). Among those who were food insecure, mobility was not associated with an increased odds of transactional sex.

Conclusion: Food insecurity and women’s mobility each increased the odds of transactional sex. Since transactional sex is associated with HIV risk, prevention programs can address the needs of mobile and food-insecure women, including those in cohabitating relationships.