Men’s understanding of three different measures of transactional sex: a cognitive interview study among men in Rakai, Uganda

Lack of valid and reliable measures and inconsistent transactional sex measurement has resulted in poor understanding of the practice, particularly among men. To improve transactional sex measurement and facilitate comparison across studies, we examined how men comprehend and respond to three common transactional sex measures. Cognitive interviews were conducted with 25 sexually active adult men in Rakai, Uganda and data were thematically analysed. Most men responded affirmatively to the three transactional sex measures, but there was variation in responses across measures. The two measures that assessed relationship motivation and gendered norms of material provision for sex showed better comprehension and consistency than the measure without these components. For these two measures, a substantial proportion of men answered "yes", but justified their answer by describing general expectations that men provide for their partners, rather than describing material exchange in a specific relationship, which was not what the measures intended capture. A measure developed by Wamoyi and colleagues appeared to most accurately measure transactional sex. Our findings support future measures that include a clear statement of motivation and account for gendered norms of giving and receiving. Given this heterogeneity in measurement, our study enhances understanding of common transactional sex measures.