by Donna Clifton

(March 2009) Cross-generational sex—or Sugar Daddy syndrome—is a pattern of sexual behavior between young women and much older men that brings increased health risks and consequences for young women. In most cases of cross-generational sex, the young women are 15 to 19 years old and unmarried; their male partners are at least 10 years older. Although most cross-generational sex is based on the exchange of favors or material goods, it is different from commercial sex or prostitution.¹

Cross-generational sex is not limited to sub-Saharan Africa, but most research on the practice has been conducted in that region (see table) because the behavior is associated with a higher risk of HIV infection. Data show that young women ages 15-24 in sub-Saharan Africa are three times more likely to be infected with HIV than young men the same age.² It is clear that, in much of Africa, young women bear the brunt of the AIDS epidemic.

Cross-Generational Sex Country Data

Country, year of survey	Percentage of sexually active women ages 15 to 17 with partner at least 10 years older in past year	Percentage of sexually active women ages 18 to 19 with partner at least 10 years older in past year
Ghana, 2003	1.7	7.9
Nigeria, 2003	21.3	4.2
Malawi, 2004	0.9	2.4
Tanzania, 2004	4.9	7.8
Lesotho, 2004	7.5	7.0
Uganda, 2004-05	9.4	9.9

Source: Macro International Inc., country survey data.

Sadly, few large-scale interventions have been undertaken to combat this risky behavior, and even fewer have been evaluated to show how well they actually work.³ However, in Uganda, an important collaboration between the government, local organizations, and USAID may be leading the way. According to the 2006 Demographic and Health Survey in Uganda, seven percent of young women ages 15-19 reported that they had recently had high-risk sex with a partner 10 or more years older than themselves.⁴ The survey also reports that age mixing in sexual relationships is more common among young women who do not know where to get a condom, those in rural areas, and those with only primary-level education.⁵ These factors often leave young women vulnerable to high-risk sexual behavior and HIV infection.

The Y.E.A.H. Initiative

In 2004, a coalition of Ugandan organizations and Young People’s Advisory Groups, under the auspices of the Uganda AIDS Commission HIV/AIDS Partnership,⁶ designed and implemented the Young Empowered and Healthy (Y.E.A.H.) Initiative. Its purpose was to address the growing need to improve health and social practices among young people in Uganda as well as to answer the government’s call for improved and coordinated behavior change communication efforts. Developed by and for young people ages 15-24, Y.E.A.H. is a communication campaign that combines mass media, person-to-person dialogue, and community media. The mission of Y.E.A.H. is to stimulate discussion and action among communities, families, schools, and health institutions; and, through the use of local and national media, to encourage positive practices. Its end goal is a reduction in the incidence of HIV and early pregnancy, and at the same time, an increase in the number of young people who complete primary education and beyond.⁷

‘Something for Something Love’

In 2005, Y.E.A.H. worked with young people throughout Uganda, as well as with key individuals and groups in adolescent sexual and reproductive health, to determine the most useful focus of a communication campaign. Workshops with young people exploring background research and campaign strategies determined that transactional sex poses a common and significant risk to youth in Uganda. At the suggestion of young people, Y.E.A.H. termed these relationships “Something for Something Love” and designated it as the main theme of its first campaign.⁸

According to campaign organizers, young women are often pressured into compromising situations, such as having unwanted or unprotected sex. These relationships are usually problematic for young women and lead to consequences such as unplanned pregnancy, dropping out of school, abortion, HIV/AIDS, and other sexually transmitted infections. Violence is common in “Something for Something Love,” especially if the young woman refuses sex or tries to end the relationship. For the older married partner, “Something for Something Love” often results in broken marriages or violence if the spouse learns about it.⁹

Y.E.A.H. has made significant progress stimulating dialogue and action around “Something for Something Love,” using its popular “Rock Point 256” radio drama series and reinforcing media materials and community outreach activities. Young people ages 15-24 were given three clear messages: abstain from sex until you are ready to settle down for a long-term relationship; set long-term goals that you do not compromise for material gain; and do not give or receive gifts or favors in exchange for sex. Hence, the campaign’s catch phrase, “Short term gain, long term loss.” Adults were also given a message: Examine your personal role in protecting young people.¹⁰

Political and cultural leaders in Uganda, including the First Lady, have spoken out about the harmful effects of “Something for Something Love” on young people and their health. Media coverage of the issue has not only increased but also become more critical of the practice.¹¹

‘Be a Man’ Campaign

Ongoing research in Uganda has led to increased scrutiny of traditional male attitudes and behaviors, particularly as they contribute to an increase in HIV infections. According to the 2004 Behavioural Surveillance Survey conducted by the country’s Ministry of Health, HIV infection rates are highest among unmarried women and married men.¹² Due to cultural and societal expectations in Uganda, men generally have more power in sexual relationships, are not expected to be faithful, often use violence as a way to resolve conflicts, and are not involved in reproductive health matters, including HIV testing and disclosure.¹³ A 2006 study by the Uganda AIDS Commission concludes that challenging existing gender imbalances can be an important element of HIV prevention.¹⁴

Building on such research and its previous successes, Y.E.A.H. launched the “Be a Man” campaign during the 2006 World Cup soccer broadcasts on national television. The campaign, which was estimated to reach 9 million viewers nationally, aimed to promote and facilitate responsible behaviors among men, specifically those that will contribute to a reduction in the prevalence of HIV and to improvements in the health and well-being of both men and women. In addition to television broadcasts, messages were spread through the “Rock Point 256” radio drama, posters, billboards, newspaper articles, and community theatre productions. All media materials were produced in five languages and disseminated nationally. Community and interpersonal activities focused on targeted audiences such as workplaces and clubs.¹⁵

Does It Work?

A qualitative evaluation of the “Be a Man” campaign was conducted in 2007 in specific areas including tea plantations, army barracks, and selected districts. The purpose of the evaluation was to assess how gender norms and attitudes toward gender equity may have been affected by the campaign. Through focus group discussions, participants shared their attitudes about such topics as gender-based violence, HIV, and gender equity. Participants included married men and women ages 20-24 and unmarried men and women ages 15-19 who were exposed to the “Be a Man” campaign through the media, special events, or community outreach.

Respondents clearly identified with “respectable men,” those who are faithful to their partners, have only one partner, drink little or no alcohol, and resolve conflicts with women in a non-violent manner. One male respondent proclaimed, “Long ago, the culture used to support the wife beating in case she does anything wrong. But according to me [sic], it is something that should not be done because a woman is also a human being.” However, some men and women said that there are instances where a man is justified in using violence against a partner, such as if she is unfaithful or becomes “big headed.”¹⁶

While participants indicated that the materials used in the “Be a Man” campaign were changing attitudes among males, testimony from the focus group discussions showed that men who have undergone HIV testing are still unlikely to reveal the results of the test if it is positive. This type of behavior is particularly harmful, putting many young women in vulnerable situations and unable to take the necessary precautions.

The “Be a Man” evaluation provides several helpful recommendations for others planning such behavior change programs, including:

• Create opportunities for youth to interact with “respectable men,” or role models, in their own communities.
• Target religious leaders and other influential opinion leaders, especially if the goal is to change community gender norms.
• Anticipate the need for additional HIV counseling and treatment services in communities where such campaigns successfully raised awareness.

A Resonant Chord

The association between cross-generational sex, unsafe behaviors, and HIV risk makes the situation a priority concern in Africa today. While there is much work to be done, Y.E.A.H. has successfully involved the community in its efforts. According to program organizers, in one year, audiences sent in more than 900 letters with questions and comments about the radio dramas and related materials.¹⁷ The program has obviously struck a resonant chord in Uganda, one that could possibly be replicated in other countries of sub-Saharan Africa.

Donna Clifton is a communications specialist at the Population Reference Bureau.

References

1. Charlotte Feldman-Jacobs and Heidi Worley, Cross-Generational Sex: Risks and Opportunities (Washington, DC: PRB/IYWG, 2008).
2. UNAIDS, Report on the Global AIDS Epidemic, Joint United Nations Programme on HIV/AIDS (Geneva: UNAIDS, 2006).
3. Ruth Hope, Addressing Cross-Generational Sex: A Desk Review of Research and Programs (Washington, DC: PRB, 2007).
4. The Uganda HIV/AIDS Sero-behavioural Survey 2004-2005 indicated that the prevalence for girls 15-17 was 9.4 percent and for 18-19 was 9.9 percent. No data is shown for the 2006 numbers on cross-generational sex, nor is it subdivided by age groups other than 15-19, and there is no explanation in the Uganda Demographic and Health Survey 2006 for the decline.
5. Uganda Bureau of Statistics (UBOS) and Macro International Inc., Uganda Demographic and Health Survey 2006 (Calverton, Maryland: UBOS and Macro International Inc., 2007).
6. Y.E.A.H., Annual Report 2006 (Kampala, Uganda: Y.E.A.H., 2007).
7. Y.E.A.H., Phase I Campaign Strategy (Kampala, Uganda: Y.E.A.H., 2005).
8. Y.E.A.H., Phase I Campaign Strategy.
9. Y.E.A.H., “Something for Something Love” Fact Sheet (Kampala, Uganda: Y.E.A.H.), accessed online at www.yeahuganda.org/pdfs/Mediamaterials/S4SL/Factsheets.pdf, on Dec. 4, 2008.
10. Health Communication Partnership website, accessed online at www.hcpartnership.org/Programs/Africa/uganda/yeah.php, on Dec. 4, 2008.
11. Y.E.A.H., Annual Report 2006.
12. Health Communication Partnership, “Y.E.A.H. Launches ‘Be a Man’ Campaign in Uganda During World Cup,” Press Release, Kampala, Uganda, June 21, 2006.
13. Cheryl Lettenmaier, “Tackling Entrenched Social Norms Among Young Men in Uganda,” The Health Communication Partnership’s End-of-Project Meeting (Baltimore, MD: Health Communication Partnership, October 2, 2007).
14. Paul Bukuluki and David Kyaddondo, Rapid Assessment of Trends and Drivers of the HIV Epidemic and Effectiveness of Prevention Interventions, Volume 3: A Review of the Cultural, Behavioural and Socio-Economic Factors Driving the HIV/AIDS Epidemic in Uganda (Kampala, Uganda: Uganda AIDS Commission, June 2006).
15. Information on the “Be a Man” campaign and evaluation was taken from: Reev Consult International, Qualitative Evaluation of the Be a Man Campaign in Selected Communities (Kampala, Uganda: Health Communication Partnership, 2007).
16. Reev Consult International, Qualitative Evaluation of the Be a Man Campaign in Selected Communities.
17. Y.E.A.H., 2006 Annual Report.