# Transactional sex and HIV incidence among men in Rakai, Uganda: A mixed-methods analysis

> **NIH NIH F31** · JOHNS HOPKINS UNIVERSITY · 2022 · $1

## Abstract

PROJECT SUMMARY / ABSTRACT
Background: Transactional sex may account for a significant number of new HIV infections in sub-Saharan
Africa, yet most studies have focused on female partners in these relationships. Male partners are an
important group to study as they may drive demand for transactional sex and their HIV risk is unclear. To
design targeted interventions for effective prevention of HIV in heterosexual partnerships, there is an urgent
need to understand the risk of HIV transmission and acquisition among male transactional sex partners.
Study Goal and Aims: This study will characterize male engagement in heterosexual transactional sex
partnerships and examine the causal relationship between transactional sex and HIV in Rakai, Uganda.
Specific aims are to: 1) identify factors associated with transactional sex among men; 2) estimate the causal
effect of transactional on incident HIV among men; 3) measure perceptions and response processes of an
RCCS transactional sex measure through cognitive interviewing; and 4) qualitatively explore the context for
transactional sex and causal mechanisms that may heighten risk for HIV in transactional sex partnerships.
Approach: This explanatory, sequential mixed-methods study will leverage the data and infrastructure of
Rakai Community Cohort Study (RCCS), an open, population-based cohort study of approximately 18,000
individuals in 50 communities in Rakai District, Uganda. Aims 1 & 2 will be a secondary analysis of men aged
15-49 from 3 rounds of RCCS data collected between 2015 and 2019. Aim 1 will use multivariable log-
binomial regression to examine factors associated with transactional sex. Aim 2 will use marginal structural
models to quantify the causal effect of transactional sex on incident HIV, controlling for time-dependent
confounding. Aims 3 & 4 entail primary data collection of semi-structured in-depth interviews of men ages
18-49 reporting transactional sex. Aim 3 will examine how men perceive and respond to transactional sex
questions in the RCCS. Aim 4 will conduct 25-40 semi-structured in-depth interviews with men to explore the
contextual factors motivating transactional sex and the potential causal mechanisms that heighten risk for
HIV in transactional sex partnerships.
Fellowship Information: The proposed research will serve as the doctoral dissertation of Ms. Holly
Nishimura. The training is guided by one Sponsor, two Co-sponsors, and one Scientific Advisor who offer
complementary methodological and topical expertise in HIV epidemiology, mixed methods research and
masculinity theory. Training includes coursework, field research in Uganda (pending travel COVID-related
travel restrictions), and other activities to prepare Ms. Nishimura to become a leading independent researcher
in global HIV prevention and control. The proposed study directly aligns with NIH research priorities to reduce
gendered disparities in HIV incidence through cross-cutting applications in epidemiologic methods...

## Key facts

- **NIH application ID:** 10456596
- **Project number:** 5F31MH124535-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Holly Makiko Nishimura
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1
- **Award type:** 5
- **Project period:** 2021-08-01 → 2022-08-02

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10456596

## Citation

> US National Institutes of Health, RePORTER application 10456596, Transactional sex and HIV incidence among men in Rakai, Uganda: A mixed-methods analysis (5F31MH124535-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10456596. Licensed CC0.

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