In sub-Saharan Africa, cross-generational relationships, typically between adolescent girls and older male partners, have been pointed out as a key vector in the high rates of HIV infection, especially among young girls.
However, little to no programmatic attention has been given to reducing the HIV risk that is rampant within cross generational partnerships.
Adolescent girls that enter into relationships with older men have limited negotiating power making the sexual partnership significantly imbalanced in favor of the older men.
"Girls appear to be able to negotiate relationship formation and continuance; for example, they can choose the types and number of partners they have, and can discontinue a relationship if gift-giving ceases," states a report titled Cross-generational and Transactional Sexual Relations in Sub-Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual Practices.
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"However, once in a sexual partnership, adolescent girls are less able to control sexual practices," adds the report.
Men engaged in cross generational relationships are largely responsible for the conditions of sexual intercourse, including condom and contraceptive use and the use of violence.
"Girls are not likely to insist on condom use for many reasons, including social norms and lack of self perceived risk of HIV," says the report. "On the whole, suggesting condom use jeopardizes their goals for the relationship, including the receipt of money and gifts."
Though young girls are perceived as mere victims of cross-generational sexual partnerships, research shows that they enter into such relationships with a motive, primarily to gain economic favors.
"Women's primary incentive for engaging in cross-generational relationships is financial and material gain while men seek younger partners for sexual gratification," states another report, titled Cross-Generational Relationships in Kenya: Couples' Motivations, Risk Perception for STIs/HIV and Condom Use.
In some case, women are pressured to engage in cross-generational partnerships by peers or family members.
According to the Kenya report, most cross-generational couples underestimate their risk for infection from STIs and HIV.
"Young women believe that older men are low-risk partners because they are less likely to be promiscuous and more likely to remain faithful to younger partners and wives. Men believe that young partners are innocent and sexually inexperienced," states the report.
As a result, condom use is low and young women's ability to negotiate use is compromised by age disparities and economic dependence.
Given this scenario, there is a clear need for campaigns that encourage changes in sexual patterns among women and men involved in cross-generational relationships. Both men and women need to be educated about the need for safe sexual behavior as well as the increased risk of STIs/HIV associated with cross-generational relationships.
"Programs should also promote safer sexual practices, such as consistent condom use, within relationships. Campaigns could employ positive role models to encourage young women to seek safer alternatives to cross-generational relationships and decrease peer pressure among men to pursue such relationships," states the report on cross generational relationships in Kenya.
Empowering young girls to be able to make decisions about the conduct of sex is also necessary to reducing HIV infection rates within cross generational sexual relationships.
"Long-term interventions include improving young women's access to educational and career opportunities, and working with communities to determine the best approach for changing social norms and the acceptability of cross-generational relationships," say the Kenya report.