Background This was a qualitative study on the vulnerability to HIV of female post-secondary students engaging in transactional sex (TS) - defined as engaging in sex for the purpose of obtaining material goods, financial support, or grades, not including commercial sex work – in Kumasi, Ghana. While little is known about TS among students in Ghana, sub-Saharan African women with post-secondary education often have a higher HIV prevalence than those with secondary school education only. The objective of this study is to better understand motivations to engage in TS, the types of transactional sex, their partners, and their HIV/AIDS prevention needs.

Methods Data was collected at three post-secondary institutions in Kumasi using in-depth interviews with female post-graduate students (aged 18 to 25), and focus group discussions with female and male students (aged 18 to 25). Key informant interviews were conducted among faculty, residence hall matrons, and local hotel staff. Participants for in-depth and key informant interviews were recruited through snowball sampling.

Results Transactional sex appears to be quite common in post-secondary settings, and the men involved are older and financially stable. The drivers of TS include familial poverty, financial need, peer pressure, desire for luxury or fame and desire for good grades.

Participants reported inconsistent condom use with partners and identified unwanted pregnancy, mental turmoil from abortion, HIV, and other sexually transmitted infections as risks associated with TS. Risky behaviours identified included unprotected sex, multiple sexual partners, and age-disparate relationships. Participants were unfamiliar with institutional policies on reporting TS and expressed lack of confidence in the system. Students also reported little confidence in the reproductive and health services available to them.

Conclusion Transactional sex involves high risk behaviours for HIV infection. Further research is needed to explore the extent of TS and HIV prevalence and risk among post-secondary students