Exchange of sex for resources: HIV risk and gender norms in Cabo Delgado, Mozambique

A qualitative analysis was carried out of data from 16 group discussions and 29 in-depth interviews conducted in rural and matrilineal areas of Cabo Delgado, Mozambique, to examine how the exchange of sex for resources - primarily money but also food, transportation, housing and gifts - is enacted and perceived in relation to HIV-related risk, and how prevalent gender norms are reflected in this practice. Findings reveal how gender norms shape access to resources differently for men and women as well as how variations in access to opportunities and income earning potential contribute to the emergence of sexual exchange for purposes of survival, but also as a means to ensure sexual and economic agency. Within this practice, individuals are confronting gender norms and re-defining their HIV-related risk. Some men refuse to spend scarce resources on other women by protecting their family from both financial insecurity and HIV acquisition. Among some women who engage in sexual transactions to obtain resources quickly, the resulting agency and decision making power gained are a trade-off to potential HIV risk. Nuanced understandings of gender dynamics and its influence on sexual risk taking and risk-reduction efforts in different local contexts are required.