Prevalence and factors associated with transactional sex among sexually active school-going adolescents in Kitwe District of Zambia

Background: Transactional sex among adolescents is a significant public health issue in Zambia, yet little is known about its prevalence and associated factors among sexually active school-going adolescents. Aim: To determine the prevalence and factors associated with transactional sex among sexually active school-going adolescents. Setting: Thirteen secondary schools in Kitwe district, Zambia. Methods: A total of 326 sexually active Grade 12 students were recruited through proportionate probability sampling and interviewed using a pre-validated questionnaire. Data were analysed using STATA v19 and SPSS v17. Prevalence of transactional sex was estimated and associated factors were examined using univariate, bivariate, and multivariable logistic regression. Results: Of 326 students (169 boys, 157 girls; mean ages 18.1 years and 17.7 years), 152 (46.6%) did not use a condom at last sex. Prevalence of transactional sex was 11.4% (37 students; 18 boys). Significant adjusted factors included living with mother only (odds ratio [OR] = 10.17; 95% confidence interval [CI] [2.02–51.3]), sexually abused before (OR = 4.81 [1.96–11.76]), alcohol use (OR = 5.75 [2.50–13.2]), social media access (OR = 3.04 [1.22–7.56]), and multiple sexual partners (OR = 5.51 [2.42–12.5]). Conclusion: Findings highlight the need for multi-level interventions addressing family, community, and societal factors, with attention to gender dimensions shaping prevalence and drivers. Contribution: The study provides evidence of HIV risk from transactional and condomless sex among school-going adolescents, identifying social, behavioural, and structural risk factors.