“Money is everything. If you don’t have cash, no one will come to you:” investigating the relationship between socioeconomic status and HIV risk among adolescents and young adults in Kisumu, Kenya

Abstract Background Previous studies have reported a positive association between socioeconomic status (SES) and HIV infection in sub-Saharan Africa (SSA). This contradicts widespread understandings of how health disparities are created and sustained through socioeconomic disparity. The nature of high HIV prevalence in SSA among wealthier individuals, especially those aged 15–24 who experience wealth and HIV risk differently than other age groups, is less understood. Qualitative investigation can provide contextual “how” and “why” factors into the relationship between wealth and HIV in this population, aiding intervention and policy efforts. Methods We used data from the Adolescent Sexual Health and Economic Study, which comprised of in-depth interviews with 25 adolescents and young adults (AYA) aged 15–24 years residing in Kisumu County, Kenya. AYA were asked to explain their understanding of high and low social standing and describe the social standing of their peers, a measure encompassing socioeconomic status, social image, access to resources, and material possessions. AYA then described their peers’ sexual relationships and what they believed to be the relationship between social standing and sexual behaviors. Data was analyzed using thematic analysis. Results Transactional sexual relationships were a common experience for all AYA in the study. Notably, wealthy young men and women described engaging in transactional relationships more frequently than their less wealthy counterparts. While wealthy young men engaged in transactional sex to boost or maintain social status, wealthy young women sought money out of their transactional relationships to buy luxury items they could not afford with their current supply of money and lack of financial independence. Although less wealthy women also experienced transactional sex, they often did so to obtain money for food and shelter. Participants reported a high awareness of HIV in the community but few of their peers utilized HIV-preventative measures beyond condoms. Conclusion Research efforts and interventions cannot overlook groups who traditionally have not been the focus of HIV prevention and management, such as wealthy young men and women. The HIV epidemic in SSA is complex among AYA and cuts across gender and socioeconomic classes.