Determining the sexual health risks for adolescent girls and young women engaging in a transactional relationship with a Blesser.

This study examined how relationships with a Blesser, a form of transactional partner, along with age-disparate men, affect sexual health risks among adolescent girls and young women (AGYW) in South Africa. Using data from a cross-sectional survey of 4932 AGYW aged 15-24 conducted between February and May 2024 across eight provinces, we explored links to HIV, adolescent pregnancy, intimate partner violence (IPV), and sexually transmitted infections (STIs). About 5.7% reported a recent relationship with a Blesser, and 25.8% had an age-disparate partner. AGYW involved with both were significantly more likely to be HIV positive, experience IPV, have an STI diagnosis, and among adolescents, be pregnant. Specifically, combined relationships increased odds of HIV (AOR: 1.31), IPV (AOR: 1.87), STI (AOR: 1.55), and adolescent pregnancy (AOR: 1.66). These findings underscore how transactional and age-disparate partnerships heighten AGYW's vulnerability to the intertwined risks of HIV, pregnancy, and violence. Interventions must address the social and economic factors driving such relationships and equip AGYW to make safer choices, highlighting the critical need for comprehensive, context-sensitive programming.