Number of youth who have ever received money or other form of exchange for sex

The number of males and females aged 15-24 years who have ever received money, favors, or gifts in exchange for sex.  

This indicator includes a broad range of exchanges for sex, including ”sex work”, which is defined by UNAIDS as “female, male and transgender adults and young people who receive money or goods in exchange for sexual services, either regularly or occasionally, and who may or may not consciously define those activities as income-generating.” Sex work can be categorized as either ‘formal’ or ‘informal’. Formal sex work includes an establishment to mediate sexual exchanges (i.e. nightclubs, brothels, and massage parlors) and is often found in Asia, while informal sex work requires finding the clients independently and is more common in Africa (UNAIDS, 2002). Those who have occasional commercial sexual transactions or where sex is exchanged for basic immediate needs such as food, shelter, or protection do not consider themselves linked with formal sex work (UNFPA, 2006).  Another term which is often used for more informal exchanges is transactional sex which the Demographic and Health Surveys (DHS) describes as “the exchange of sex for money, gifts or favors”.

“Other form of exchange” can take a wide variety of forms including small things such as rides, food, or clothing, to larger gifts such as payment of school fees, housing or money.  When surveying or interviewing youth, evaluators may need to give examples of other forms of exchange.

Evaluators may want to replace the word “ever” – which captures prevalence – with a time frame such as the past 12 months, as done in the DHS/AIS in order to get the incidence and track trends for programmatic reasons related to interventions around decreasing risky sexual behavior.

As a percentage, this indicator is calculated as:

(Number of individuals 15-24 who have received money or other exchange for sex/total number of individuals 15-24 surveyed who have had sexual intercourse) x 100


Self-reported data from survey respondents. Data can be disaggregated by sex, location, educational attainment, wealth quintile, etc. It can also be disaggregated for the age groups 10-14,15–19 and 20–24.


Self-reported responses from surveys, interviews with youth, population based surveys


This indicator looks at the level of risk behavior for 15-24 year olds who have ever received something in exchange for sex. While both young men and women are involved in transactional sex and sex work, it is more commonly reported among women and girls. Studies indicate large majorities of adolescent girls have been involved in transactional sexual relations at some point (Luke, 2002). With young women in sub-Saharan Africa being three times more likely to be infected with HIV than young men of the same age (UNAIDS 2006), this indicator helps monitor a key path of HIV transmission.  

Because they often lack the power to negotiate condom use, there is a heightened risk for those engaged in transactional sex. In both formal and informal sex work, not using condoms may mean more money. Because informal sex work is often done irregularly and in order to meet short-term needs, the extra money can be lucrative (UNAIDS, 2002). In transactional sex in many parts of Africa, receiving a gift is expected, even though it reinforces the power differential between partners.

Due to a combination of factors, significantly higher rates of sexually transmitted infections (STIs), including HIV, have been documented among sex workers compared with the general population (UNAIDS, 2002).   Therefore, this indicator can be used to measure the impact of HIV prevention and life skills programs which seek to decrease the rates of transactional sex for young people.

There are a wide variety of motivations that drive transactional sex.  Studies from across the developing world indicate poverty and the need for economic gain and survival is overwhelmingly the core reason for bartering sex (Luke, 2002). A few studies have also documented wanting to find love and companionship.  For many people, especially women and girls, who are living in poverty, sex work may be the only employment or survival option. While some may freely choose sex work as their occupation, many more young girls, young boys and women are coerced through violence, trafficking, debt-bondage or the influence of more powerful adults. A wide variety of groups and individuals are directly involved in sex work in commercial sex establishments, or indirectly involved, for example as restaurant servers and escorts.


In most parts of the developing world, sex work is illegal, and there is significant discrimination and stigma against male and female sex workers, which can lead to a high level of silence around the practice.  Furthermore, if someone is forced into sex work, there is an incredible amount of shame, which influences one’s decision to reveal this behavior.  Thus, if data is being collected through an interview, it needs to be conducted in a safe and sensitive manner in order to protect the young person from experiencing distress if s/he discloses her/his experience.

It is customary and expected for young women to receive gifts from boyfriends or sexual partners in many cultures.  Girls may see this as a token of affection from her partner and an expected part of romantic relationships and thus not report it as direct exchange (Luke, 2002). For example a study in Malawi found that in both mixed and same age relationships, monetary transactions are standard, and that girls found these to be both a symbol of men’s feelings as well as monetarily beneficial. The specific context of gift giving between partners is something that evaluators must consider closely when collecting this data.


empowerment, sexually transmitted infection (STI), HIV/AIDS, adolescent

The low status of women is a major driver of women entering sex work. In many parts of Africa girls do not complete secondary school, either because their families can’t afford it, don’t value girls’ education, or need her to work and bring in income for the family. However, in impoverished areas, there are few work opportunities, especially for women, and the jobs that are available – generally domestic help – are low paying. Sex work, on the other hand, can be relatively lucrative.

Male and female sex workers, both formal and informal, are generally seen as defying social norms and face multiple levels of discrimination. Women who ask for compensation for sex break traditional norms expected of women in many societies, and those who engage in transactional sex are still labeled as prostitutes. For male sex workers who have sex with men, the combination of homosexuality and engaging in sex work leads to extreme stigma, violence, and persecution, especially where homosexuality is illegal (UNFPA, 2004). For these groups, admitting their work could mean risking violence from police or pimps, abandonment by their families, and loss of social support.


UNAIDS.Sex work and HIV/AIDS, UNAIDS Technical Update. 2002.

Hope R. Addressing Cross-Generational Sex: a Desk Review of Research and Programs. Population Reference Bureau (PRB) BRIDGE Project. 2007. http://www.igwg.org/pdf/addressing-CGsex.pdf.

Luke N. and Kurz K.M. Cross-generational and Transactional Sexual Relations in Sub-Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual Practices. ICRW and PSI as part of the AIDSMark Project, September 2002.

Feldman-Jacobs C., Worley H. Cross-Generational Sex: Risks and Opportunities. Population Reference Bureau (PRB). July 2008.

UNFPA Fact Sheet.  HIV/AIDS, Gender and Sex Work.  2006.  http://www.unfpa.org/hiv/docs/factsheet_genderwork.pdf.

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