Transactional Sex and the Health Repercussions in Forced Migration

Why, when and how do refugees engage in transactional sex across genders and what are the sexual and reproductive health and mental health consequences of refugees involved in transactional sex?

Project Summary

In forced displacement, refugees can face extreme hardship due to food, housing and income insecurity, family separation, social exclusion and other factors.

Due to the lack of decent job opportunities, many refugees may resort to transactional sex for survival, to meet their basic needs. The elements of this exchange include obtaining security and protection from sexual violence or protection while crossing borders. Engaging in transactional sex can bear health risks – particularly sexual and reproductive health and mental health implications. Therefore, these refugees have greater health needs while facing greater barriers to access services, including due to stigma and discrimination

Although transactional sex is widespread among refugees, there is silence and stigma around it, which leads to a significant evidence gap. There is very limited information about factors that facilitate transactional sex in forced displacement or about its health repercussions. The leading research questions of our study are:

  • Why do refugees engage in transactional sex?
  • How do refugees engage in transactional sex?
  • What is the impact of transactional sex on refugees’ sexual. reproductive, and mental health?
  • What is the connection between gender and transactional sex?

Data will be collected in Greece, France and Switzerland through ethnographic observation, interviews and focus group discussions. A law and policy analysis will identify structural factors that facilitate transactional sex and impact refugees’ health. We also intend to engage refugees themselves in ethical digital storytelling to share their lived experiences in their own way. The project fosters the exchange of expertise and mutual learning through a collaborative and participatory approach with NGOs, researchers and refugees themselves.

This study is the first of its kind and with it we hope to generate evidence to inform local and international gender-responsive policies, to train health personnel to better identify cases of transactional sex and to offer appropriate care and improve programmes to address barriers to access appropriate health services.


Academic Output

Executive Summary

The increasing number of conflicts, crises, and disasters has led to a significant rise in forced displacement, with many refugees seeking safety and security in Europe. However, European governments have implemented stricter security measures and border controls in recent years, pushing refugees to embark on longer and more dangerous journeys. Instead of providing safe and legal pathways, EU policies prioritize border securitization. Once in Europe, refugees continue to face numerous challenges, including poor reception facilities, inadequate housing, limited livelihood options, and extended legal uncertainties. These precarious conditions create an environment where refugees engage in transactional sexual practices as a survival strategy and coping mechanism.

Our research represents a pioneering effort to shed light on the complex and diverse nature of transactional sexual practices in forced displacement settings, focusing on Greece, Switzerland, and France. Building upon our previous research in Lebanon, Jordan, and Turkey, we aimed to understand the gendered drivers, patterns, and health implications of transactional sex, particularly regarding sexual and reproductive health (SRH) and mental health. Our study included women, men, and individuals with diverse sexual orientations and gender identities, aiming to uncover the gender nature and interplay between vulnerability and agency in these contexts.

Through the collection and analysis of qualitative data, we gained valuable insights into the individual, social, and structural factors that shape transactional sex and its impact on health outcomes. While the qualitative nature of our study prevents us from drawing conclusions about the prevalence of transactional sex in forced displacement, the abundance of accounts detailing such experiences underscores its significance in this context.

Our analysis revealed the complexity of transactional sex, with narratives across genders, ages, and ethnic groups indicating that it often arises due to structural factors. Despite economic and political differences between the countries studied (Greece, France, and Switzerland), we identified common structural factors, such as asylum procedures, housing precarity, and limited employment and livelihood opportunities, that shape the experiences of asylum-seekers and refugees, pushing them into economies of transactional sex. Additionally, while our research highlighted the agency of refugees in navigating precarious conditions and complex asylum procedures, it also revealed the power imbalances, violence, harassment, and abuse they face in engaging in these practices.

Our research emphasizes that transactional sexual encounters are shaped by sexism, xenophobia, and homo- and transphobia. These intersecting forms of discrimination compound the challenges faced by individuals, particularly refugees with diverse sexual orientations and gender identities. Addressing systemic issues and fostering inclusive societies that uphold the rights and dignity of all individuals are crucial to addressing these challenges.

By bridging the evidence gap, our findings call for targeted policy interventions to address the multifaceted issues surrounding transactional sexual practices in forced displacement settings. Specialized services tailored to the unique health and protection needs of individuals involved in transactional sex are essential. Additionally, bottom-up approaches that actively involve communities in the development of effective strategies are necessary. Our research provides a foundation for informing policy and programming that supports the well-being and rights of refugees affected by transactional sex in forced displacement settings.

Other Output

Transactional sex in the wake of COVID-19: sexual and reproductive health and rights of the forcibly displaced

Other Output

Research in forced displacement: guidance for a feminist and decolonial approach


The concept of transactional sex (TS) has evolved over time, encompassing various forms of sexual exchange for material or non-material benefits. Extensive literature on TS in the context of HIV prevention focuses mainly on young women in Sub-Saharan Africa, while the emerging body of research in conflict and crises explores TS as a form of sexual exploitation of women, perpetrated by male peacekeeping forces. However, these studies predominantly center on women’s experiences and fail to consider the level of agency and health impacts of TS. Additionally, in humanitarian and forced displacement contexts, TS is often conflated with commercial sex work and at times, even with sex trafficking, overlooking the diverse motivations, patterns and implications of TS along the migratory journey.

Our research, to our best knowledge, is the first multi-country multi-disciplinary study to examine the complexities of TS in forced displacement. By including women, men and people of diverse sexual orientation and gender identities, we aim to understand the gendered drivers, patterns as well as health implications of TS, particularly in terms of sexual and reproductive health (SRH) and mental health and shed light on the interplay between vulnerability and agency in these contexts, in Greece, Switzerland and France. The study builds on previous research conducted by the applicant in Jordan, Lebanon, and Turkey, supported by a grant from IDRC. By bridging the evidence gap, we aim to inform evidence based policymaking, facilitate dialogue, and promote greater awareness among health providers regarding potential cases of TS. Through these efforts, we aim to address barriers to accessing appropriate SRH and MH services and pave the way for more comprehensive and effective interventions in forced displacement settings.

Research Team

Shirin Heidari
Graduate Institute Geneva

Vinh-Kim Nguyen
Graduate Institute Geneva

Thanasis Tyrovolas
Principal Member
Social Action and innovation Centre (KMOP) Athens


Sophie Durieux-Paillard
Associated Member
Geneva University Hospitals (HUG)

Monica Adhiambo Onyango
Associated Member
Boston University School of Public Health





Policy domains


Host Institution