Non-consensual sex takes many forms, including forced sex, transactional sex, cross-generational sex, unwanted touch, and molestation. Perpetrators can be strangers, peers, intimate partners, family members, and authority figures such as teachers. In any form, nonconsensual sex has negative consequences for its victims. Some risks of nonconsensual sex include anxiety, depression, social isolation, academic trouble, sexually transmitted infections, unintended pregnancy, abortion, and a propensity for risky behavior in the future.

In the developing world, two types of non-consensual sexual relationships are widely practiced: transactional and cross-generational or age-disparate. Transactional sex is performed in exchange for material gifts, favors, or money. Cross-generational or age-disparate relationships occur when a girl or young woman, who is usually under the age of 20, engages in a sexual relationship with a man who is at least five years older. Individuals, especially young women,  engage in these types of partnerships for many reasons, including to support their basic survival, emotional comfort, perceived educational, work, or marriage opportunities, and/or monetary and material gifts. Young women who consent to these sexual experiences may not fully recognize their vulnerability to abuse, exploitation, and reproductive health risks. The power imbalance that exists between cross-generational partners, and the transactional nature of these relationships, often result in inadequate communication about risk, which ultimately leads to decreased condom use. Unprotected sex, along with the higher likelihood that an older male partner is HIV positive, increases the risk of HIV infection for these young women. In sub-Saharan Africa, young women ages 15–24 are three times more likely to be infected with HIV than young men of the same age.

Youth are especially at risk for nonconsensual sexual experiences. Individual risk factors include financial need, alcohol consumption, history of abuse, and involvement with multiple partners. Environmental and structural risk factors include poverty, patriarchy, gender inequity, early marriage, weak educational and health systems, and ineffective policies and laws. More research is needed on how to effectively address non-consensual sex among young people.

Sex Without Consent: Young People in Developing Countries

This book presents a disturbing picture of nonconsensual sex among girls as well as boys and among married as well as unmarried young women in a variety of settings. It documents the expanse of non-consensual experiences that young people face — from unwanted touch to forced penetrative sex and gang rape. Although focusing on young females, it also sheds light on the experience of young males as both victims and perpetrators (2005).

Protecting Young People from Sex Without Consent

This is brief overview regarding how to tackle the issue of sex without consent, the consequences of nonconsensual sex for youth, promising interventions, and policy and advocacy implications (2011).

Cross-generational and Transactional Sexual Relations in Uganda: Income Poverty as a Risk Factor for Adolescents

This report describes the results of a two-year, primarily qualitative study in Uganda. The findings provide evidence of the high incidence of cross-generational sexual relationships in the research sites, but also of its severity as a child protection deficit in both rural and urban contexts (2014).

A Review of Interventions Addressing Structural Drivers of Adolescents’ Sexual and Reproductive Health Vulnerability in Sub-Saharan Africa: Implications for Sexual Health Programming

This article reviews interventions that address the multiple structural factors, such as social norms and gender inequality, and how they reduce economic drivers that increase sexual risk behaviors. Conclusions highlight the importance of flexible intervention design when addressing adolescents, and the need for coordinated efforts among different stakeholders (2014).

Cross-Generational Relationships: Using a 'Continuum of Volition' in HIV Prevention Work among Young People

This article addresses youth, gender and HIV/AIDS prevention in Malawi. It describes the ‘Continuum of Volition’ developed by Save the Children as an explanatory model to help understand the motivations of young women for engaging in cross-generational relationships, as well as to guide the development of appropriate intervention strategies (2006).

Identifying Appropriate Livelihood Options For Adolescent Girls: A Program Design Tool

This tool guides users through a series of diagnostic steps to understand how particular groups of adolescent girls are put at risk of HIV infection by their lack of access to and control over social, natural, human, physical, and financial capital. By guiding the user to identify and consider various socioeconomic and cultural factors in the lives of adolescent girls with which he/she intends to work, the tool helps to pinpoint particular constraints and opportunities faced by those girls, and ultimately, the type of livelihood interventions that may be most appropriate for them. More specifically, the tool offers a menu of livelihood strategies that may contribute to overcoming the identified socioeconomic constraints or utilizing the identified opportunities to strengthen adolescent girls’ power to make and act on decisions that protect them from HIV infection (2009).

Cross-Generational and Transactional Sexual Relations in Sub-Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual Practices

This literature review assesses the extent of sexual relations between adolescent girls and older male partners in sub-Saharan Africa, the extent of transactional sex, and the behavioral dynamics of girls and men involved in these sexual relations (2002).

Addressing Cross-Generational Sex: A Desk Review of Research and Programs

This review identifies the range of programmatic approaches that be used to prevent or reduce cross-generational sex. The Interagency Gender Working Group [IGWG] collaborated with the IYWG in funding this project (2007).

“Something for Something” Love Campaign

The Young Empowered and Healthy Initiative in Uganda launched this campaign to raise awareness and promote action against transactional and cross-generational sex (2011).

Speak Out: Youth Report Sexual Abuse: A Handbook for Learners on how to Prevent Sexual Abuse in Public Schools

This handbook is designed to help create a safe, caring, and enabling environment for learning and teaching in public schools in South Africa. The handbook equips learners with knowledge and understanding of sexual harassment and sexual violence, its implications, ways to protect themselves from perpetrators, and where to report incidences of sexual violence or harassment (2010).

Forced Sexual Relations among Married Women in Developing Countries

This brief explores experiences of forced sex within marriage in a variety of socio-cultural contexts and examines the link between gender power imbalances and sexual violence.  The paper concludes with recommendations for action (2004).

The Adverse Health and Social Outcomes of Sexual Coercion: Experiences of Young Women in Developing Countries

This paper outlines associations between early coerced sex and compromised reproductive health, poor mental health, and psychosocial challenges.  The brief concludes with recommendations for action (2004).

Stepping Stones Training Package on Gender Communication and HIV

Stepping Stones is a life-skills training package that addresses gender, HIV, and communication and relationship skills.  These materials were developed in response to the vulnerability of women and young people in sexual decision-making due to gender norms that promote patriarchal domination of women and repressive attitudes toward youth (2011).


Multiple and concurrent partnerships (MCPs) occur when a person is involved in more than one sexual partnership at the same time. These concurrent partnerships enable HIV and other sexually transmitted infections to spread quickly within large sexual networks. Several case studies have demonstrated that even modest reductions in MCPs may substantially reduce HIV transmission in a community. Youth in many settings report having multiple and concurrent partners. Factors that contribute to MCPs among young people may include lack of communication and dissatisfaction in a relationship, certain cultural and social norms, and poverty. Young women's involvement in MCPs via cross-generational or transactional sex is of particular concern because research has shown that a large age difference between adolescent girls and their partners has been linked to increased risk of HIV infection in girls and young women. Also, adolescents have a more difficult time negotiating condom use with older partners and during transactional sex. Programs in settings where MCPs are common should promote condom use and address the structural drivers of concurrent partnerships, ensuring rights-based approaches to information and services. More research is needed on young people's perceptions of and attitudes toward MCPs in the context of HIV/AIDS and pregnancy prevention.

Multiple and Concurrent Sexual Partnerships in Southern Africa: A Ten Country Research Report

This report provides an overview of 10 qualitative studies conducted by Soul City Regional Programme partner organizations in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe. The primary goal of the research was to understand the views of both youth and adults on multiple and concurrent sexual relationships and their effect on the HIV pandemic in sub-Saharan Africa (2008).

AIDSTAR-One: Multiple and Concurrent Sexual Partnerships

This reference provides background information on the relationship between multiple and concurrent sexual partnerships and the spread of HIV. The page has summaries of numerous articles containing research findings on the link between MCPs and HIV transmission in developing countries. Links to MCP-related reports and briefs, program overviews, tools and curricula, and related prevention activities are also provided (2011).

Soul Beat Africa - Issue 119 - HIV Prevention - Multiple Concurrent Partnerships (MCP)

This issue of The Soul Beat looks at HIV Prevention with a specific focus on Multiple Concurrent Partnerships (MCP), which have been identified as one of the key drivers of the HIV epidemic in southern Africa. The newsletter offers strategic thinking documents, program experiences, and materials related to MCP and the role communication can play in promoting partner reduction, faithfulness, and safer sex within these relationships (2008).

Concurrent Sexual Partnerships amongst Young Adults in South Africa: Challenges for HIV Prevention Communication

This report examines concurrent sexual relationships among young adults ages 20-30 in South Africa and provides recommendations for HIV/AIDS communication. Data in the report show that many young people lack awareness of the risks of high turnover of sexual partners, casual sex, and sexual partner concurrency (2007).

Evaluating the Trusted Partner Campaign in Four Sub-Saharan African Countries

This document summarizes the findings of an evaluation of the Trusted Partner Campaign in Lesotho, Mozambique, Uganda, and Zambia implemented by Population Services International (PSI). The campaign used radio, TV, and print media to improve consistent condom use. Cross-sectional surveys of youth ages 15-24 suggest that exposure to this campaign was associated with consistent condom use in Mozambique, but not elsewhere (2009).

Why Multiple Sexual Partners?

In this article from The Lancet, James D. Shelton examines behavioral components of multiple concurrent sexual partnerships, identified as the driver of HIV infection in southern and eastern Africa (2009).

The Scrutinize Campaign: A Youth HIV Prevention Campaign Addressing Multiple and Concurrent Sexual Partnerships

Victor Scrutinize was the animated star of the Scrutinize Campaign, a year-long series of HIV prevention ads launched on South African television in June 2008. Irreverent and humorous, with strong, colorful visuals, the campaign's ads were markedly different from previous South African HIV prevention campaigns for youth (2009).

Addressing Multiple And Concurrent Sexual Partnerships In Generalized HIV Epidemics

To support the expansion of MCP programming, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Technical Working Group (TWG) for General Population and Youth Prevention, in collaboration with AIDSTAR-One, convened a technical consultation in Washington, DC, October 29–30, 2008, entitled Multiple and Concurrent Sexual Partnerships in Generalized HIV Epidemics. The objectives of this meeting were to (1) deepen understanding of the role of MCP in the spread of HIV and (2) share emerging programmatic approaches and build consensus on promising strategies to address MCP. The report surveys what we know about MCP, what we still need to learn, and what we can do now to advance efforts to address MCP (2009). 

Addressing Multiple and Concurrent Partnerships in Southern Africa: Developing Guidance for Bold Action

This report emerges from a two-day meeting on "Addressing MCP in Southern Africa: Developing Guidance for Bold Actions." The meeting brought together approximately 40 representatives from various organizations working in the southern Africa region with the aim of establishing a common vision and agenda to guide interventions and strategies addressing multiple and concurrent partnerships (2009).

Multiple Concurrent Partnerships and the Church: Assessing the Attitudes and Perceptions of Community Leaders of Faith

This report shares findings from a survey that sought to access churchgoers' perceptions about multiple concurrent partnerships and the church's response to these relationships, with a view that church leaders must understand the attitudes and perceptions surrounding these relationships in order to develop effective interventions (2009).

Case Study: Secret Lovers Kill

This case study describes Makhwapheni Uyabulala, or “Secret Lovers Kill,” Swaziland’s national media campaign focusing on the HIV risk of multiple and concurrent sexual partnerships. The campaign promotes HIV prevention by broadcasting behavior change messages in a society where discussing multiple and concurrent partnerships is taboo (2009).

Case Study: Club Risky Business

To address multiple and concurrent sexual partnerships and other drivers of HIV in Zambia, Club Risky Business, a fictional mini-series, and its associated One Love Kwasila! multimedia campaign encouraged viewers to protect themselves and their partners by "cutting their connections to HIV." Access the interactive AIDSTAR-One case study to learn more about how the program challenged viewers to question—and ultimately reduce—their overlapping sexual partnerships (2010).

OneLove Regional Campaign

The OneLove Campaign strives to reduce HIV incidence in Southern Africa by reducing multiple concurrent partnerships via mass media, face-to-face education, social mobilization, and advocacy. The campaign is intended to spark public discussion and debate about the roles of culture and gender in promoting risky behaviors such as MCPs and to promote safer health behaviors.