Combating Cross-Generational Sex in Uganda

(February 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 women are ages 15 to 19 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.


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 to 24 in sub-Saharan Africa are three times more likely to be infected with HIV than young men the same age.1 It is clear that in much of Africa, young women bear the brunt of the AIDS epidemic.


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. However, in Uganda, an important collaboration between the government, local organizations, and the U.S. Agency for International Development may be leading the way. According to the 2006 Demographic and Health Survey in Uganda, 7 percent of young women ages 15 to 19 reported that they had recently had high-risk sex with a partner 10 or more years older than themselves.2 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.3 These factors often leave young women vulnerable to high-risk sexual behavior and HIV infection.


Cross-Generational Sex



Country, Year of Survey Percentage of Sexually Active Women Ages 15-17 With Partner at Least 10 Years Older in Past Year Percentage of Sexually Active Women Ages 18-19 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, 2004–5  9.4  9.9

Source: Macro International Inc., country survey data.


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, designed and implemented the Young Empowered and Healthy (Y.E.A.H.) Initiative. The purpose of the initiative was to address the growing need to improve health and social practices among young people in Uganda and answer the government’s call for improved and coordinated behavior change communication efforts. Developed by and for young people ages 15 to 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.


‘Something for Something Love’


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


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, and HIV/AIDS or 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.


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 to 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.


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.


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


Donna Clifton is communications specialist at the Population Reference Bureau.




  1. UNAIDS, Report on the Global AIDS Epidemic (Geneva: UNAIDS, 2006).
  2. The DHS HIV/AIDS Sero-Behavioural Survey for Uganda, 2004-2005, indicated that the prevalence for girls ages 15 to 17 was 9.4 percent and for ages 18 to 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 to 19. There is no explanation of the decline in the 2006 DHS report.
  3. Uganda Bureau of Statistics and Macro International Inc., Uganda Demographic and Health Survey 2006 (2007).