The two-decade civil war in Liberia resulted in 270,000 casualties. Thousands more were tortured, maimed, or victimized by sexual violence, including being held as sexual slaves or exchanging sex for protection, shelter, and food. During the civil conflict, the domestic gross national product (GNP) in Liberia fell 90% from 1987 to 1996, one of the largest ever-recorded recessions (1). The civil conflict ended eight years ago (2003), and in 2005, Liberia held its first democratic election and is now witnessing a remarkable re-investment by the international donor communities in all sectors of its economy (1,2). Despite these efforts, the economy of Liberia is plagued by 85% unemployment (3-4), insufficient domestic and human capital (2,4), and a destroyed physical and economic infrastructure (4).
Little is known about the rates of HIV prevalence in Liberia, and detection efforts are hampered by a severely-damaged public-health system and loss of trained personnel (4-6). The most recent Liberian Demographic Health Survey indicates that 1.5% of people aged 15-49 years are HIV-infected. The prevalence rates are higher among females than among males (1.8% vs 1.2%), indicating a low-level generalized epidemic (7). Gender differences in prevalence rates are greater for those aged 15-25 years, suggesting that young females are at a greater risk of infection than males of the same age-group (7). In Monrovia, the nation's capital, the rate of HIV infection is 2.8% for women and 2.1% for men. Surveillance studies of women attending antenatal clinics in 10 urban centres found an overall prevalence rate of 5.4% (8).
The Ministry of Health and Social Welfare of Liberia reports that the primary focus of heterosexual transmission is among older males and younger females (9). It is suggested that transactional sex emerged in Liberia during the conflict and post-conflict periods as a means of coping with scarce resources and limited economic opportunities (4), although few published qualitative or quantitative studies in Liberia have examined this issue to date (10).
Results of studies in sub-Saharan Africa indicate that transactional sex tends to occur in exchange for cash, goods, and services (11-13), school-fees (12,13), advancement (11,13,14) or to gain heightened social status, and it is cited as placing women at an increased risk of HIV infection (14-17). These transactions often occur between older male adults and young females where power differentials--the inability to negotiate condom-use and coercion--contribute to women's risk of HIV/sexually transmitted diseases (STDs), unwanted pregnancy, and sexual violence (17-20). Transactional sex has also been suggested to be part of a larger pattern of social interdependence in sub-Saharan Africa where women receive material goods while males gain outward displays of power and prestige (11,21). With the uncertainty that surrounds daily life in these countries, women may develop several concurrent transactional sex partners as a form of 'social insurance' (21) providing them with resources to call upon, should crises such as famine or war re-emerge (21,22). For the purposes of this study, transactional sex was defined as engaging in sexual intercourse in exchange for cash, goods, services, commodities, or privileges that are perceived as needs or wants by the participant.
While it is well-established that transactional sex places women at a risk of sexual violence, unprotected sex, early pregnancy, and HIV infection (15,23-25), several researchers have critiqued the analysis of women as primarily victims of transactional sex and men as the perpetrators (26-29). These researchers call for a broader understanding of transactional sex as nested in complex sexual economies where women make choices to engage in transactional sex to meet a broad array of needs in resource-constrained communities (26-28).
Similar to other post-conflict countries, Liberia has witnessed the establishment of a large and successful peace-keeping infrastructure to restore peace and rebuild the governmental infrastructure (1). …