Sexual economic exchanges, including sex work and transactional sex, have been consistently associated with HIV acquisition among young women in sub-Saharan Africa. Heterogeneity in HIV vulnerability across overlapping types of sexual economic exchange has not been sufficiently explored, limiting appropriate and effective linkage to prevention interventions. From January 2017 to May 2018, cross-sectional data were captured at screening for entry into an HIV incidence cohort in Kisumu, Kenya. Men and women aged 18–35 years completed a socio-behavioral questionnaire. Latent class analysis was used to classify sexually active women into discrete groups based on self-identification of occupational sex and other sexual exchanges, including exchange for money, gifts, food, school fees, substances, shelter/rent, and/or clothing. Profiles examined characteristics within and across typologies. Mixed logistic regression models assessed demographic and socio-behavioral characteristics associated with probabilistic class membership. A total of 1063 participants were screened, of whom 536 (50.4%) were sexually active women (median age: 27 years [interquartile range 23–30]). Sexual economic exchange was reported by 403 (77.2%) sexually active women, who most commonly reported recent exchange of sex for money (73.9%), gifts (19.6%), food (25.9%), and substances (17.7%); 44.6% reported selling sex as a primary or secondary occupation. Three profiles of sexual economic exchange were identified, each with distinct demographic, behavioral, and occupational characteristics: exchange for money and other necessities (23.3% prevalence), exchange for primarily money (38.2% prevalence), and sex comprising limited or no exchange (38.4% prevalence). In mixture modeling, as compared to limited or no exchange, exchange for money and other necessities, and exchange for primarily money were both associated with increased age, higher number of partners, and partners at least 10 years older. Heterogeneous patterns of sexual economic exchange were observed among women in Kenya reflect the different motivations and pathways by which women exchange sex. Female sex workers are often considered a homogeneous group, but these data highlight the need for differentiated services based on the diverse needs of women who engage in sexual economic exchange.

在撒哈拉以南非洲，性经济交流，包括性工作和易，一直与年轻女性的 HIV 感染有关。尚未充分探讨重叠类型的性经济交换中 HIV 脆弱性的异质性，这限制了与预防干预措施的适当和有效联系。从 2017 年 1 月到 2018 年 5 月，在肯尼亚基苏木的 HIV 发病率队列筛查时捕获了横断面数据。18-35 岁的男性和女性完成了一份社会行为问卷。使用潜在类别分析根据职业性别和其他换的自我认同将性活跃的女性分为离散组，包括金钱、礼物、食物、学费、物质、住所/租金和/或衣服的交换。用户档案检查了类型内和类型之间的特征。混合 logistic 回归模型评估了与概率类成员身份相关的人口统计学和社会行为特征。共筛选了 1063 名参与者，其中 536 名 （50.4%） 是性活跃的女性 （中位年龄： 27 岁 [四分位距 23-30]）。403 名 （77.2%） 性活跃的女性报告了性经济交换，她们最常报告最近用性换取金钱 （73.9%）、礼物 （19.6%）、食物 （25.9%） 和物质 （17.7%）;44.6% 的人报告说卖淫是主要或次要职业。确定了性经济交换的三种概况，每种都有不同的人口统计学、行为和职业特征：金钱和其他必需品的交换（23.3% 的流行率），主要是金钱的交换（38.2% 的流行率）和性行为包括有限或没有交换（38.4% 的流行率）。 在混合建模中，与有限交换或不交换相比，货币和其他必需品的交换以及主要货币的交换都与年龄增加、伴侣数量增加和伴侣年龄至少大 10 岁有关。在肯尼亚女性中观察到的异质性经济交换模式反映了女性进行易的不同动机和途径。女性性工作者通常被认为是一个同质群体，但这些数据凸显了根据从事性经济交易的女性的多样化需求提供差异化服务的需求。