Gender Differences in Relationship Behavioral Expectations with Romantic Partners and Exchange-Sex Partners: Findings from a Mixed-Methods Study with Street-Connected Youth in the Republic of Georgia

Background and purpose: Street-connected youth, i.e., young people aged 10-19 who spend most of their time living and/or working on the street, are highly vulnerable to HIV/AIDS. Whereas prior research has documented high rates of condomless sex and exchange-sex among street-connected youth, less research has examined youth’s attitudes, beliefs, and expectancies for both romantic and exchange-sex relationships. The present study sought to address this gap by examining how street-connected youth in the Republic of Georgia view both romantic and exchange-sex relationships. Given prior research documenting gendered vulnerability to HIV, we also examined gender differences in how youth view each relationship type. The study was funded by the Shota Rustaveli National Science Foundation of Georgia (FR 17_31).

Methods: The present study conducted mixed-methods interviews with N=20 street-connected youth (50% female; M=13.95 years; SD=2.11) recruited from 10 social service centers in two cities. Youth were eligible if they were aged 10-19 and spent most of their time living or working on the street. Trained interviewers administered a close-ended survey on demographics, sexual behavior history and relationship behavior expectations for romantic and exchange-sex partners. Qualitative interviews explored youth’s attitudes, beliefs, and expectancies about romantic and exchange-sex relationships. Survey data was analyzed in SPSS 22. Gender differences in relationship expectations were calculated using Chi-square and Fisher’s exact-tests, with a Holm-modified Bonferroni to control for experimentwise-error rates and a Cramer’s phi (φ_c) to test the strength of significant associations. Qualitative data was audio-recorded, transcribed, and analyzed by three independent coders. All data was collected in Georgian and translated to English for linguistic and cultural equivalence.

Results: Forty-percent of youth had ever had sex and 15% reported exchange-sex. Among sexually active youth, condom use at last sex was low for oral (33.3%), vaginal (50%) and anal (20%) sex. There were no gender differences in relationship behavior expectations with a romantic partner. However, there were significant differences for exchange-sex partners. A higher proportion of boys than girls endorsed talking with (80% vs. 20%; p=.023; φ_c=.60) and saying I love you to (70% vs. 0%; p=.003; φ_c=.73) an exchange-sex partner, while a higher proportion of girls than boys endorsed using drugs (90% vs. 20%, p=.005; φ_c=.70) and having condomless vaginal sex (80% vs. 20%, p=.023; φ_c=.60) with an exchange-sex partner. Qualitative results contextualized these differences, with girls describing heightened states of vulnerability to sex, exchange-sex, and sexual violence, and little power in either romantic or exchange-sex relationships. Conversely, boys described a social environment where they had easy access to romantic and exchange-sex partners and expected to have greater power in these relationships.

Conclusions and implications: Findings point to clear gender differences in how street-connected youth view romantic and exchange-sex relationships, with girls having less social and economic power to refuse sex in either romantic or exchange-sex relationships. Programming to prevent HIV/AIDS among street-connected youth needs to develop gender-responsive content that addresses unequal power between boys and girls. This work should specifically target boys to foster attitudes and behaviors that promote joint-decision making in sexual relationships with female partners.