‘They were just enjoying love and she was making money’: A qualitative analysis of UN peacekeeper sexual interactions in the Democratic Republic of Congo

Abstract

Background

Peacekeeper-perpetrated sexual exploitation and abuse (SEA) is widespread. While the United Nation’s (UN) zero-tolerance policy prohibits all exploitative and abusive peacekeeper sexual interactions with host community members, its implementation has been criticized for failing to recognize women’s agency and survival needs by oversimplifying the complex and dynamic romantic and transactional elements. This study aims to demonstrate that not all sexual interactions between peacekeepers and host community members are equally exploitative or abusive.

Methods

The Democratic Republic of Congo (DRC) was chosen for this study due to its longstanding history of UN peacekeeping operations, documented cases of peacekeeper-perpetrated SEA, and socio-economic and gendered inequalities that contribute to transactional and coercive sexual interactions. To provide evidence that not all sexual interactions between peacekeepers and host community members are equally exploitative and/or abusive and to better understand how local community members perceive these sexual interactions at the intersection of romance and mutually beneficial transactions, we analysed micro-narrative data (n = 1822) from the eastern DRC.

Results

Four prominent types of sexual interactions were identified: romantic, transactional sex, sex work, and sexual assault/harassment. The characteristics of the interactions highlighted the influence of structural factors, economic need, and gendered power. Community perceptions around initiation, intermediaries, and beneficiaries varied and were, by construct, at odds with the UN’s conceptualization of sexual interactions between their staff and beneficiaries as exploitative and/or abusive due to the power dynamics inherent in such relationships.

Conclusions

The zero-tolerance policy fails to recognize the nuanced range of diverse and dynamic sexual interactions between UN peacekeepers and host community members in the DRC. It is recommended that SEA reporting measures be reconfigured in light of this complexity, and we suggest a non-binary method of measuring the degree of exploitation and abuse. Accepting that sexual interactions between host community members and UN peacekeepers represent varying levels of exploitation and abuse may improve interventions to better prevent and address peacekeeper-perpetrated SEA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-025-00693-x.

Background

United Nations conceptualization of sexual exploitation and abuse

The perpetration of sexual exploitation and abuse (SEA) by United Nations (UN) peacekeepers is a historical and ongoing concern for peacekeeping host communities [1, 2]. Sexual exploitation is defined by the UN as ‘any actual or attempted abuse of vulnerability, differential power or trust, for sexual purposes, including but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another’ [3]. This conceptualization encompasses sex work, transactional sex and solicitation of transactional sexual interactions. Sexual abuse, in comparison, is described as ‘an actual or threatened physical intrusion of a sexual nature, whether by force or under unequal or coercive conditions’, with sexual interactions with minors under the age of 18 always being considered abusive [3].

In response to increasing reports of SEA, the UN implemented a zero-tolerance policy in 2003, banning all forms of exploitative and abusive sexual interactions between peacekeepers and the local population, while firmly advising against any other sexual interactions between peacekeepers and aid recipients due to inherent power imbalances [4] The zero-tolerance policy focused on safeguarding victims’ rights, enhancing reporting and investigations, strengthening communication with external partners, and promoting greater transparency and awareness. Despite these positive impacts, it has been critiqued for being ‘overly broad and insufficiently clear’ [5]. Although intended to address cases of SEA and prevent further incidents through punitive action [4], the zero-tolerance policy has faced criticism for not acknowledging that host community adult women may willingly enter consensual relationships with full autonomy and informed decision-making [6, 7]. Described as overprotective, the policy does not recognize that host communities are heterogenous with respect to their vulnerability to SEA and it can limit women’s agency in a patronizing manner that perpetuates negative gender stereotypes not only about male perpetrators and female victims, but also around (male) protectors and (female) vulnerability [8, 9]. As a result, complex social structures and dynamics are ignored, reinforcing paternalistic attitudes vis-à-vis abuse survivors and their local communities [10, 11].

Timeline and extent of peacekeeper-perpetrated SEA

Since the 1990s, reports of SEA involving peacekeepers have emerged in almost every major peace support operation (PSOs) [12–16]. Mozambique served as the first country with reported allegations of increased sex work and trafficking [17], with additional reports following in PSOs in Cambodia [18], Somalia [19, 20], and Bosnia and Herzegovina [21]. In 1999, East Timor became the first PSO to recognize peacekeeper-fathered children, highlighting the critical lack of child-care support available to Timorese mothers raising them [22]. Allegations of SEA continued to be reported in the 2000s in Sierra Leone, Liberia, Sudan, Kosovo, and Haiti, amongst others [23]. Since 2007, a total of 1,094 SEA allegations have been documented across 32 PSOs although the actual number of cases is likely much greater since each report may involve multiple perpetrators or victims [24] and sexual violence has long been known to be underreported [25].

Factors contributing to peacekeeper-perpetrated sexual violence in the DRC

Spanning over 20 years, PSOs in the DRC have been implicated in the perpetration of SEA. The United Nations Organization Mission in the Democratic Republic of Congo (MONUC) was initially deployed in 1999 to support a peaceful government transition and facilitate the withdrawal of armed forces derived from the Second Congo War [26]. This mission moderately reduced violence over a period of 10 years before it was reconfigured as the United Nations Organization Stabilization Mission (MONUSCO) in 2010 with the goal of providing ongoing government stabilization and protecting civilians [27]. Overall, MONUC and MONUSCO are cited as contributing 36.4% of the total SEA reports with 398 allegations from 2007 to present [24], demonstrating a notable breach of the zero-tolerance policy enacted by the UN.

Several factors are thought to contribute to the occurrence of peacekeeper-perpetrated SEA in PSOs, including large deployments with a high concentration of peacekeeping personnel and operations in economically disadvantaged countries as indicated by GDP per capita [23]. The DRC serves as a key example of a host country exhibiting both factors, as MONUSCO was the world’s largest UN mission for a time with almost 20,000 personnel in 2018, including 16,215 military, 660 observers and staff, 1441 police, and volunteers [28]. Furthermore, the country is categorized as low-income, experiencing widespread poverty and a GDP per capita of $556.80 [29]. The intersection of severe economic hardship and the authoritative presence of relatively affluent peacekeeping personnel exacerbates power imbalances between peacekeepers and the local population, resulting in an increased risk for coercion [25]. In the DRC, peacekeepers may receive salaries ranging from 500 to 1000 times higher than the average Congolese worker, giving them significant economic influence within the local economy [25]. Furthermore, the composition of predominantly male troops from varied cultural backgrounds with differing gender attitudes and norms can be highly problematic with respect to acceptance of sexual and gender-based violence within PSOs [17]. These factors, combined with inequitable gender norms and limited access to justice for sexual violence survivors in the DRC, cumulatively contribute towards widespread impunity for peacekeeper-perpetrated SEA [30, 31].

Variation in sexual interactions between peacekeepers and host community members

Recent scholarship has questioned the assumption that all sexual interactions between local women and peacekeepers are inherently exploitative and/or abusive, as suggested by the UN framework [6–9]. Indeed, research on community perceptions of sexual interactions in peacekeeping communities has indicated that some interactions are considerably more nuanced and that in some cases, affected women/girls demonstrate varying degrees of agency in engaging with peacekeeping personnel. In fact, evidence of romantic relationships has been reported in the peacekeeping contexts of East Timor [32], Ethiopia [32], and Haiti [14, 15, 33] suggesting the plausible presence of these interactions across various missions. As evidenced in other studies, however, feelings of love can be intertwined with sexual transactions [33, 34] or with disillusionment by feelings of betrayal when peacekeeper-fathered children go unsupported by their fathers and the UN [15].

In the DRC, little is known about the nature of transactional sex, sex work and romantic interactions in peacekeeping host communities. Given this gap in knowledge and a potential contradiction between local perceptions and the UN’s framing of almost all sexual interactions as equally exploitative and abusive, the purpose of this analysis is to explore host community perceptions of sexual interaction types and characteristics with a goal of describing their diverse and dynamic nature. While previous studies, including that from members of our team [34–44], have documented the extent and nature of sexual interactions with peacekeepers and community-level concerns, there remains a lack of in-depth analysis of how these interactions are socially understood, categorized, and navigated by affected populations. This paper makes a novel contribution by: [1] delving into how perceived benefits (financial, material, social) shape community interpretations of these relationships; [2] unpacking the nuanced roles of intermediaries (e.g., family members, friends, or neighbors) in facilitating or shaping these interactions; and [3] foregrounding agency, negotiation, and ambivalence in a context marked by structural inequality. In doing so, this analysis offers new empirical evidence and theoretical insight into the complexities of consent, agency, and exploitation in peacekeeping contexts, contributions that challenge widely accepted policy assumptions. Ultimately, we believe that this more detailed understanding of host community perceptions around sexual interactions with peacekeepers is critical for reassessing the limitations of the UN’s zero tolerance policy as it is currently implemented, and for moving toward responses that are more contextually grounded and survivor-informed within the context of systemic power imbalances.

Methods

Study setting and recruitment of participants

The DRC was chosen for this study due to its longstanding and large-scale UN peacekeeping presence, with MONUSCO being one of the world’s largest peacekeeping missions, hosting approximately 20,000 personnel from diverse troop-contributing countries at its peak [28]. MONUSCO has been implicated in widespread allegations of SEA [45, 46] and has hosted a continuous peacekeeping presence since 1999, allowing for both historical and spatial analysis of peacekeeper-community interactions.

Here we present a qualitative analysis of cross-sectional data collected in eastern DRC in June to August 2018. Interviews were conducted within a ~ 30 km perimeter surrounding MONUSCO bases at six locations: Kalemie, Bunia, Beni, Goma, Bukavu and Kisangani. Utilising a convenience sample, locally trained researchers approached potential participants in public spaces including transportation hubs, shops, markets, and parks, inviting them to take part in the study. Both females and males aged 13 and older were eligible to take part.

The predominant pattern of peacekeeper/host community sexual interactions involves male peacekeepers and local women, which is the focus of this study. While men, boys, and LGBTQI + individuals may also be affected, their experiences fall beyond the scope of this analysis.

SenseMaker survey

The original mixed-method survey aimed to explore community perceptions regarding interactions between UN peacekeepers and local women and girls. Data collection was conducted using Cognitive Edge’s SenseMaker^®, a narrative capture tool that helps to derive insights from micronarratives shared by participants on a specific topic (in this case, the experiences of Congolese women / girls interacting with MONUSCO personnel). Participants were given three prompting questions (Appendix 1) and were asked to audio-record a short narrative based on their selected prompt. Following this, they analysed their own narratives by answering to a set of pre-defined questions, including multiple-choice questions that gathered demographic details and contextual information such as the subject of the narrative and its emotional tone.

The SenseMaker survey was initially created in English, translated to Lingala/Swahili, and then independently back-translated to ensure accuracy. Notably, the survey did not ask for narratives related to sexual relations, sexual exploitation / abuse, sexual assault or about children fathered by MONUSCO peacekeepers. This approach was deliberate to minimise potential reporting biases. A pilot test was conducted in the DRC with 24 participants, after which the survey was refined to enhance clarity, ease of response, participant comfort and translation accuracy.

Study implementation

Two Congolese organizations played a key role in facilitating the original data collection: (i) Solidarité Féminine pour la Paix et le Développement Intégral (SOFEPADI) - a non-governmental organisation focused on promoting women’s rights and addressing gender inequality in DRC; and (ii) Multidisciplinary Association for Research and Advocacy in the Kivus by United Junior Academics (MARAKUJA) - a non-profit network of Congolese researchers with extensive experience conducting large-scale research projects in DRC. Among the 12 research assistants, two were female SOFEPADI staff with expertise in supporting vulnerable populations including survivors of sexual and gender-based violence (SGBV). The other 10 (four male and six female) were recruited from MARAKUJA. Prior to launching the study, all research assistants completed a five-day training covering topics such as standardized interviewing, research ethics (including informed consent), data management, handling adverse events and referring participants to appropriate services when necessary. Male research assistants were primarily assigned to interview male participants, while female research assistants focused on interviewing female participants. All micronarratives were recorded as audio files and later transcribed/translated from Lingala/Swahili to English by native speakers of the respective languages.

Ethics

After reviewing the informed consent in Lingala/Swahili, participants indicated their agreement to take part by selecting a consent box on the tablet. No identifying information was collected and all interviews were conducted in private. Participants were not offered financial compensation or other incentive since the survey was relatively short (~ 15 min) and did not require travel. Adolescents as young as 13 were included in this minimal risk study because we recognized, based on anecdotal evidence, that they are affected by SEA, and excluding their perspectives would have been ethically problematic. Parental consent was not sought because the adolescents were considered mature minors, and involving parents could have introduced bias and/or led to intrafamily conflict [47]. Furthermore, the sensemaking survey posed only open-ended questions about experiences living in a community hosting a peace support operation, without direct references to SEA, rape, sexual violence or any type of sexual interactions. Any participant who became distressed, or who required counselling or follow up services was referred to SOFEPADI using a designated referral card. Additionally, a SOFEPADI research assistant was present on-site to provide immediate support if necessary. Approval for this study was provided by the Congolese National Committee of Health Ethics (CNES) and by the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board (protocol # 6020398).

Analysis

We performed a thematic analysis on the micronarratives about sexual interactions (n = 1,822) to better understand their nature, key characteristics (e.g. who initiated, who benefited), and underlying motivations as described by host community members. The first author (SG) performed coding using NVivo 12 with an evolving hybrid approach derived from Saldaña [48]. Using a provisional coding lens, a pre-set list of anticipated codes describing SEA was generated from the literature. This list included relevant and quantifiable indicators of SEA including sexual transactions, non-consensual sex, and unsupported pregnancies [14, 15, 18, 19, 21, 23, 32, 33]. Other important characteristics such as who initiated the interaction and who benefited from the interaction were coded inductively from the data. Pre-set codes were then modified as coding progressed to include the newly emerging concepts [48]. Employing a ‘level of meaning’ approach, relevant information was coded based on significance, whether expressed in a few words or a paragraph [49].

Results

Study population

The demographic characteristics of the sample are highlighted in Table 1. Of the 1,822 micronarratives, 52.1% were shared by female narrators, and 44.5% of the sample was under the age of 25. Nearly half of the sample had a moderate socio-economic status (45.2%), and 80.8% of participants reported attaining a secondary or higher education. The majority of micronarratives were captured in geographic areas with a population of 500,000 or more (65.7%), with micronarratives collected in Kisangani representing 24.6% of the sample. Additionally, 53.6% of the narrators reported being single and never married.

Table 1.

Demographic characteristics of the sample [44]

Characteristic	Frequency (% of N)
Sex
Female	947 (52.1%)
Male	872 (47.9%)
Total	1819
Age
13–17	139 (7.7%)
18–24	667 (36.8%)
25–34	632 (34.84%)
35–44	237 (13.1%)
45–54	90 (5%)
55–64	40 (2.2%)
65 and Older	9 (0.5%)
Total	1812
Socio-Economic Status
Low	506 (27.8%)
Moderate	822 (45.2%)
High	492 (27%)
Total	1820
Highest Education Achieved
No Formal Schooling	112 (6.2%)
Primary School	330 (18.17%)
Secondary School	751 (41.4%)
Technical Training / University	615 (39.4%)
Other	6 (0.3%)
Total	1814
Marital Status
Single, Never Married	976 (53.6%)
Married / Living with Partner	690 (37.9%)
Separated / Divorced	90 (5%)
Widowed	60 (3.3%)
Total	1816
Geographic Location
Kisangani	449 (24.6%)
Bunia	417 (22.9%)
Goma	337 (18.5%)
Bukavu	248 (13.6%)
Beni	208 (11.4%)
Kalemie	163 (8.95%)
Total	1820

Table 2 outlines the characteristics of the micronarratives. The micronarratives were often told from a third-person perspective (87.6%), thus indicating that they were primarily the experiences of others. Overall, 56.9% mentioning peacekeepers in an armed soldier role and 53.2% mentioning peacekeeper-fathered children. Of the named peacekeeper nationalities, South Africa, Uruguay, Tanzania, and Morocco were most common.

Table 2.

Characteristics of the micronarratives [44]

Characteristic	Frequency (% of N)
Story Perspective
First-Person	226 (12.4%)
Third-Person	1592 (87.6%)
Total	1818
Peacekeeper’s Role
Armed solider	1035 (56.9%)
Unarmed solider	266 (14.6%)
UN Civilian	288 (15.8%)
UN Police	38 (2.1%)
Don’t Know	142 (7.8%)
Other	50 (2.8%)
Total	1819
Peacekeeper’s Nationality
South Africa	343 (18.8%)
Uruguay	200 (11%)
Tanzania	197 (10.8%)
Morocco	187 (10.3%)
Senegal	138 (7.6%)
India	125 (6.9%)
DRC	103 (5.7%)
Bangladesh	101 (5.5%)
Pakistan	83 (4.6%)
Nepal	71 (3.9%)
Egypt	69 (3.8%)
Ghana	30 (1.6%)
Sierra Leone	10 (0.6%)
Other	352 (19.3%)
Don’t Know	236 (12.94%)
Total	1822
Story About a Peacekeeper Fathered Child
About or Mentioned a peacekeeper child	970 (53.24%)
Neither	852 (46.76%)
Total	1822

Thematic analysis

Four types of sexual interactions emerged from the thematic analysis: [1] Romantic Interactions [2], Transactional Sex [3], Sex Work, and [4] Sexual Assault. The SenseMaker interpretation questions had highlighted varying interaction characteristics such as who initiated the interaction, who benefited from the interaction, and intermediaries who may have facilitated the interaction. Therefore, these three characteristics were additionally considered for each of the four types of sexual interactions, and each will be explored below with accompanying illustrative quotes. Based on our conceptualization of ‘benefit’, for the purposes of this analysis, we defined the ‘beneficiary’ as the individual or group who is perceived to receive a net advantage from the sexual interaction. This advantage may be financial, social, political, or romantic, or some combination thereof, and was understood within the context of inherent power imbalances between foreign peacekeepers and host community members. Table 3 summarizes these findings and provides one example quote for each type of sexual interaction and characteristic.

Table 3.

Common characteristics by type of sexual interactions

Nature of Sexual Interaction	Characteristic	Example Quote
Romantic	Initiator	Peacekeeper Initiator ‘…One of them got interested in one friend of us. So, he started visiting the friend at his. One day, that friend’s elder sister came to watch our game, she met with that soldier from Uruguay. They fell in love with each other. And now they are both in Uruguay because he married her before they travelled.’ (Male, aged 18–24, Kisangani)
	Intermediary	‘They always send us, we, young men to go and court ladies for them. We do it. When we meet a lady, we tell her there is a man who’d like to talk to her. Ladies never refuse when they hear it’s about an important man, a white guy. When they meet, they get on well at once.’ (Male, aged 18–24, Kalemie)
	Beneficiary	Peacekeeper Beneficiary ‘I know a story of a primary school classmate who, after war in 2010, she fell in love a MONUSCO soldier. That soldier married her legally, but after having one child with her, he rejected her. Now, she is doing her best to see how to survive.’ (Female, aged 35–44, Bukavu)
		Woman-Family-Peacekeeper Beneficiary
		‘That is the way we were living. He used to come to my house from their camp. We were partners because he wanted to avoid having many lovers. Anytime when he had time to go out, he came home. When he had much work, I also joined him by the camp. Later on, they brought water to us. I could get water from MONUC, actually, we were partners. He used to stop, parked the car and got in my house. That’s the way we were living with him.’ (Female, 18–24, Goma)
Transactional Sex	Initiator	Peacekeeper Initiator ‘MONUSCO agents come in the quarter for searching for ladies because they don’t pass night with some of them, when they come to search for ladies here, they make sexual intercourses in exchange for money.’ (Male, aged 13–17, Goma)
		Woman Initiator
		‘Women were getting into MONUSCO gates because of their selling activities. They were at the same time having sex with MONUSCO agents in exchange for money.’ (Female, aged 18–24, Goma)
	Intermediary	Community Member ‘There were pilots who were working at MONUC at that time. They were collaborating with us. We were facilitating them in their operations…’ (Male, aged 35–44, Kisangani)
	Beneficiary	Peacekeeper Beneficiary ‘…Where they always go, they unfortunately, most of them, get infected with HIV. And if you try to see how much money they used to get, you’ll feel mercy for them; they were paid very little money indeed, little enough for house building. I really can’t understand that.’ (Female, aged 35–44, Kalemie)
		Woman Beneficiary
		‘One day, I was somewhere. I got into a shop where I met a girl who was buying perfume and other items. She had a lot of money. Then, they asked her why she didn’t want to give them anything. She said that she was lucky because MONUSCO agents provide her with a lot of money.’ (Male, aged 18–24, Beni)
Sex Work	Initiator	Woman Initiator ‘Though the prostitution degree/ level is getting lower today, our sisters exaggerated once with their harlotry. They have brought us much shame actually. It must be because of these contingents that harlotry has been perpetrated in this community.’ (Female, aged 18–24, Bukavu)
		Peacekeeper Initiator
		‘When MONUSCO came, the time they have arrived they have started looking for prostitutes, when those prostitutes arrived at MONUSCO Camp; they were being caught by MONUSCO agents for sexual intercourse, now they have been chased from the camp.’ (Female, aged 18–24, Goma)
	Intermediary	Community Member ‘Sometimes these whites ask us to go and find women for them. They promise to give us 5 dollars and 20 dollars for the woman in case we succeed to bring one. Many girls or women often agree. When a woman has agreed to come, we always lead them to MONUSCO base where they have their sex deal and come back.’ (Male, 13–17, Bukavu)
	Beneficiary	Peacekeeper Beneficiary ‘They came in that quarter; the fact that the agent of MONUSCO arrived there, our sisters misbehaved and became prostitutes. How did they become prostitutes? On weekends, especially on Saturday, they joined them in our quarter; with their money they have power on young ladies and did sexual intercourse. Thanks to money they succeeded to do whatever they wanted; they made them pregnant and had children.’ (Male, aged 25–34, Goma)
		Woman Beneficiary
		‘…My sister joined the group of prostitutes whereas the family sent her to me to help me because I’m ill very often. Her brother- in-law chased her because of her love with the agents of MONUSCO. This is the story that I experienced. She didn’t have a child with them. They were just enjoying love and she was making money until they left. The partner with whom she was dating went as well, parents came and took her home.’ (Female, 18–24, Goma)
Sexual Assault and Harassment	Rape	‘…I came across a white MONUSCO guy. He was very drunk. When I passed him, he came behind me and started hugging and kissing me by force. He really caught me tightly, threatened me horribly and then pulled me into a bushy place where he raped me.’ (Female, aged 25–34, Kisangani)
	Statutory Rape	‘There was a man working for MONUSCO in Beni. That man had a wife. They were deployed in Bunia, so she came with her young sister of about 8 years. That girl had already made a baby with the man. In Bunia, the man had intimate relations with that young girl of 8 years old.’ (Female, aged 18–24, Bukavu)
	Sexual Assault and Harassment	‘When she discovered that they had hidden cameras, and were having pornographic positions with her, she accused them, then one among them gave her 1,000 dollars. Those guys left that place to another.’ (Female, 45–54, Kisangani)

Romantic interactions

Romantic interactions were identified as sexual encounters in which there was no indication of transactional sex, sex work, or sexual assault in the micronarrative. Romantic relationships were frequently described as situations where the peacekeeper and local women were dating, cohabitating, or married.

Initiator

The majority of romantic interactions were initiated by the peacekeepers. Narratives often described peacekeepers approaching women in public places such as markets or at/near MONUSCO bases where women often worked as merchants selling food or other goods. In one instance, a woman accessing a MONUSCO base to sell food was courted by a peacekeeper, leading to a long-term relationship and peacekeeper-fathered child.

‘Let me talk about the presence of MONUSCO. I heard of a young lady who was selling bananas and « liwane ». They used to open the camp for her to sell her items inside. This activity took much time. At a given moment, a Malawian fell in love and started courting her.’ (Male, aged 18–24, Goma).

Peacekeeper-initiated romantic relationships also evolved from encounters in which the peacekeeper was initially seeking sex work, but then transformed into a more long-term relationship. The following micronarrative from Kisangani demonstrates the transformation of a commercial sexual transaction into a co-habiting relationship.

‘I know a girl that I was a bit familiar with. She was working at a place called [ ]. Since she was a prostitute, she met with a MONUSCO agent from the USA. That man started going out with her and lived together with her. They made a baby, so that man bought two houses in downtown for the girl.’ (Male, aged 35–44, Kisangani).

Intermediary

While more of the transactional sex or sex work micronarratives described an intermediary, intermediaries were also described for romantic relationships, often involving friends of a peacekeeper introducing him to a local woman.

‘I had a friend of mine who was working at MONUSCO from Senegal. We used to visit each other. Sometimes I used to meet him here, and some other times, I could meet him at the camp. One day he fell in love with a given girl. I was actually the one who connected her to him. They were living together.’ (Male, aged 65+, Kisangani).

Beneficiary

Both host community women and peacekeeping personnel were at times perceived to have benefitted from the sexual interaction. To a higher degree than in other interaction types, the woman and/or her family were positively impacted by romantic relationships. This positive benefit was often related to an improved quality of life provided by the peacekeeper’s higher income, as peacekeepers were frequently cited as contributing to household expenses and large purchases such as a car or the construction of a house. In some cases, this income stream led to improved long-term economic opportunities for the women such as the chance for her to start her own business.

I know a woman who was going out with a MONUSCO agent. That woman was lucky because she was bought a house and cars for her transportation. It was revealed that she was even given some money to start up her business, but they didn’t have any child. (Male, aged 25–34, Kisangani)

However, two stark perceptions of women in these positive interactions were evident. In some cases, community members regarded the women as fortunate to have fallen into such circumstances, whereas in others, the women were frowned upon for having sought out luxuries or an improved social status through romantic relationships with peacekeeping personnel. In interactions where the peacekeeper was cited as the beneficiary of the interaction, the woman was often described as being distracted from her life goals or education, and/or experiencing a reduced quality of life due to circumstances such as an unsupported peacekeeper-fathered child or the absence of the peacekeeper himself.

‘There was a sister who was living with a white of MONUSCO. She was actually my classmate. She loved that man seriously. As she was my classmate, I noticed that she had even forgotten her objectives according her studies. That white was taking the majority of her time. She failed that academic year because of him.’ (Male, aged 18–24, Bukavu).

The blame associated with unsupported pregnancies was generally placed on the peacekeeper for failing to live up to his paternal responsibilities or on MONUSCO for repatriating or redeploying the peacekeeper.

He told me that he wanted to have a child with me; I accepted, so we made a baby. It didn’t take long while his chiefs sent him back to his [country]. I stayed here alone with the child. He wanted to come back, but the chiefs didn’t want because he made a woman pregnant in Congo, me. (Female, aged 35–44, Kisangani)

Transactional sex

The occurrence of a sexual transaction was defined as a non-commercial, non-marital exchange of any of the following: basic-needs goods, services, money, or opportunities for sex [50]. As described by Stoebenau et al. [50], the TS outlined by participants was prompted by a variety of motivators (‘sex for basic needs’, ‘sex for improved social status’, and ‘sex and material expressions of love’). The most frequently-identified motivator for TS in our data was money and/or food. In some cases, women were described as seeking items of value or social appeal such as a better mobile phone. TS relating to material expressions of love, while possibly present in the sample, was harder to distinguish from romantic relationships.

Initiator

The occurrence of peacekeeping personnel actively seeking Congolese women for sexual transactions was repeatedly reported in our sample, with peacekeepers utilizing their economic influence to draw the attention of Congolese women. Some micronarratives cited the effect that this behaviour had on the community, leading to UN personnel being negatively perceived.

‘First of all, those MONUSCO people are destroyers; we don’t appreciate the way they behave. Sometimes when we are walking around the quarter, we observe those MONUSCO white men calling young ladies. Once a MONUSCO white man calls her twice or three times, she joins him for avoiding problems.’ (Male, aged 35–44, Kalemie).

Congolese women were also reported as initiating TS with peacekeepers for the purposes of accessing money or goods, often prompted by knowledge of peacekeeping personnel’s higher income. Within these sexual transactions, varying degrees of agency were highlighted amongst women, with some engaging in TS out of necessity for money and food, and others pursuing items such as cellphones and fashionable clothes. The occurrence of women-initiated transactional sex is described below in one such example.

‘Today, we see women go to MONUSCO camp to have intimate relations with MONUSCO agents. We don’t have to target a category of women and girls who always go there. Every woman and girl is going there, even married women are going there. They are leaving their households to MONUSCO camps for the purpose of getting money.’ (Female, aged 25–34, Goma).

Intermediary

In comparison to romantic relationships, the orchestration of sexual transactions more often involved third parties to aid negotiations and the intermediaries of TS were more diverse. Intermediaries ranged from friends of the woman or peacekeeper to community members, and/or the woman’s family. These individuals acted as ‘middlemen’ to overcome language barriers, assist the woman in payment negotiations, and to reduce the publicity of the negotiation, likely with the purpose of protecting reputations in the community and/or hiding the TS from the UN.

When I connected them, they went to a hotel. As my sister doesn’t know English, so I had to be there for facilitating the communication. He was giving me chickens and other things. They met at a hotel since he didn’t want to come to ours though he could be in civil uniform. (Male, aged 25–34, Bukavu)

Beneficiary

In many cases, the primary beneficiary in sexual transactions depended on whether the woman was perceived to have been adequately paid or not. Peacekeepers were cited as the primary beneficiaries of sexual transactions when they deceived the woman by paying less than the negotiated price or by not paying at all. In one example, a woman was promised a job with MONUSCO in exchange for sex, only to find out after the exchange that the job opportunity did not exist.

These MONUSCO agents must be crazy. They are real tricksters. When they meet a girl on the way, they always tell her to come to their basecamp and be employed. Our girls, when they hear that they think the white guy is feeling sorry for them. Surprisingly when the girl goes to the camp, you will see the MONUSCO guy telling her to deal sexually with him first before she can start work. Girls often are fooled like that. The guy will then give her something like 20 dollars to have sexual intercourse with him. After the act, he tells her to go back home and come back for starting the job later. The girl leaves and the white guy no longer calls her. (Female, aged 18–24, Bukavu)

On the other hand, women receiving large amounts of money were regarded as benefitting more from the interaction, and in some cases were encouraged to continue taking money from peacekeeping personnel to improve their livelihoods and socio-economic situations.

MONUSCO are not fair because it’s only women who often get benefits from them. If our girls were clever, they would do their best to get as much money as possible from those MONUSCO guys. (Male, aged 18–24, Kalemie)

Sex work

Sex work was defined as a direct exchange of sex for money or goods with an identified sex worker and typically involved little emotional intimacy [51]. These interactions, often described as occurring in hotels or rented houses which served as brothels within local neighbourhoods, were common in our dataset.

Initiator

The initiation of commercial sex work appeared to be more equally distributed between women and peacekeepers when compared to TS and romantic relationships. Women in some contexts were described as ‘owning all of the MONUSCO agents for the purpose of prostitution’ or leaving their families to pursue sex work. As in the case of TS, peacekeeper initiators were often described as seducing women away from their families or education with their money and power.

‘As they have got their own houses, they are searching for men to bring them inside their houses. If you try to move to Eriko, you can meet so many possible prostitutes; their number has risen more than the former time.’ (Male, aged 13–17, Goma).

Intermediary

The intermediaries of sex work were similar to those described in situations of TS and often included family members of the women or community members recruited by the peacekeepers. Acting intermediaries were in some circumstances incentivized through payments to orchestrate the interaction and to ensure its secrecy. In the following example, detailed instructions given by a peacekeeper to the Congolese intermediary highlighted the lengths taken by some UN personnel to reduce their own involvement in the interaction logistics.

‘An agent of MONUSCO asked me to fetch for him a young lady. How do we manage to find a young lady for him? He tells me he has his money, but he doesn’t want people to see him with a young lady. He wants me to call him on the telephone as soon as there’s a young lady who is available. He wants me to come with her down the way. Then I give her money, for food, drink, and for a room where we are going to sit down. Buy him meat to eat. When I have what I planned done, I do what? I pay her money again and ask her to go back. This is the way we have been living with the agents of MONUSCO.’ (Male, aged 25–34, Goma).

Alternatively, a few intermediaries advised recruited women/girls about how to take advantage of peacekeeping personnel who were soliciting sex. In one instance, a Congolese man who was asked to find a sex worker for an intoxicated peacekeeper advised her to rob him so that she would benefit from the additional financial gain.

‘After being drunk, he told me to find a prostitute. I went to bring one, I told her to rob the man of his money from his purse. I knew it was a lot of money, but I did not know the amount. The prostitute came and drank together, so they went to have sex, but the prostitute did her best to rob him of all his money.’ (Male, aged 25–34, Kisangani).

Beneficiary

There were few examples of participants explicitly stating that peacekeepers were the primary beneficiaries of the sexual interaction. However, there were more instances where the woman was clearly perceived to have not benefited from the sexual interaction, particularly when payment was inadequate. This phenomenon closely paralleled the reports of underpayment in transactional sexual encounters.

‘That young lady is our neighbor. She loved an agent of MONUSCO. He often promised her money but he never gave. He gave her an appointment to meet in the evening, three times without giving her money, she realized that the man from MONUSCO was deceiving her and she decided to break up such love.’ (Female, aged 25–34, Goma).

Some sex workers were perceived to have not benefited from the interaction because of the risk of sexually transmitted infections (STIs), presumably due to limited condom usage. Additionally, unsupported peacekeeper-fathered children derived from sex work were cited as creating increased financial anguish for the women and their families in many micronarratives.

That girl had a child with a white. She was a prostitute. That white left her without anything. She struggles by herself in order to raise the child thanks to the occupation she has. (Male, aged 25–34, Bukavu)

In contrast, women and their families were described as the beneficiaries when the woman was perceived to have been paid appropriately for the exchange. Payments received ranged from $10 to $300USD and there was no consensus on what constituted fair compensation.

‘She earned much money thanks to sexual intercourse. She helped her family financially. The family agreed with her and received money from her.’ (Male, aged 18–24, Goma).

Sexual assault and harassment

Sexual harassment was defined as ‘any form of unwanted verbal, non-verbal or physical conduct of a sexual nature with the purpose or effect of violating the dignity of a person, in particular when creating an intimidating, hostile, degrading, humiliating or offensive environment’ [3]. Sexual assault, on the other hand, was defined as ’sexual activity with another person who does not consent… that (a) may be committed by other means than force or violence, and (b) does not necessarily entail penetration’ [3]. Sexual harassment described among participants included unwanted verbal comments as well as hidden or forced acts intended to violate the dignity of the affected women. Peacekeepers in some instances were reported as harassing Congolese women in public areas. In one example, a woman recalls consistent harassment by peacekeepers at the market where she worked.

‘I am a saleswoman in the market. As I go back every day, I always see MONUSCO agents shaking their penises, calling me, ‘mom see here’. When I saw that for the first time, I ran away. They always do that; I saw that many times.’ (Female, aged 45–54, Bukavu).

Rape, as a form of sexual assault, was reported under the circumstances of sex with a minor, threats of violence, intoxication removing the inability to give consent, and/or disputes over wage payments. Girls as young as eight years old were described as having experienced peacekeeper-perpetrated rape in areas outside of their schools and churches.

‘That day I was on my way to school. A MONUSCO white guy came behind me, caught me tightly and raped me. I was 13 at that time. I cried and cried, but nobody came to help me. Later I found myself pregnant. I went on suffering up to delivery time.’ (Female, aged 25–34, Bukavu).

In some circumstances of statutory rape, girls were manipulated with the promise of money, food or other items prior to the encounter. Lastly, drugs and alcohol were also mentioned as tactics used by peacekeepers in settings such as bars to immobilize women and girls, thereby facilitating the perpetration of sexual violence [44].

‘He offered me some drinks. He put drugs in my drink. He asked me to drink. I wondered why he wanted me to drink alone. He replied that he will buy his. I drank it. After drinking he lifted me in a room without being aware. He raped me and then he went back.’ (Female, aged 13–17, Goma).

Some micronarratives indicated that women were filmed during sex without their consent and were forced by peacekeeping personnel to be naked in public.

In their building site, there are around 11 ladies who were raped by MONUSCO men. They forced them to be carrying sand and some of them were forced to walk naked along the road.

(Male, aged 55–64, Kalemie)

Discussion

Building off earlier published quantitative work [42–44], this study offers host community insights into the varied nature of sexual interactions between local women/girls and MONUSCO personnel, in addition to highlighting the diversity of conditions in which these interactions occur. While peacekeeper perpetration of sexual assault and harassment remains an urgent issue, it is apparent that other types of sexual interactions (romantic, TS, sex work) also occur and with varied characteristics in terms of initiation, perceived beneficiary, and intermediaries. We note, however, that the boundaries between categories of sexual interactions are not always distinct, as they can overlap and shift depending on cultural, linguistic, and contextual factors that shape how sex and relationships are understood [52]. Additionally, perceptions of sexual interactions may vary between parties, with individuals not always in agreement on the nature of a given relationship or encounter. For example, what may be understood by one party as a consensual romantic or emotional connection may be perceived by another as transactional, exploitative, or coercive. These relationships may be shaped by a co-existence of emotional attachment, economic necessity, strategic negotiation, and structural power asymmetries — all of which complicate binary distinctions as “romantic” and “abusive.” Acknowledging this complexity is important for understanding the full spectrum of experiences and for developing more effective policy responses that move beyond simplistic categorizations. In support of that, an improved understanding of the host community’s experiences and perceptions around sexual interactions with peacekeepers will allow for better appreciation of the perceived harms and benefits at the local level. Ultimately, we believe these findings have implications for the UN’s evaluation of sexual interactions between peacekeepers and local women while also shedding light on how the zero-tolerance policy as it is currently implemented, with almost all sexual interactions being considered exploitative due to inherent power differences, is ineffective in preventing romantic relationships, TS and sex work.

Peacekeepers as perpetrators of violence

Approximately 70% of micronarratives referenced armed or unarmed soldiers, which aligns with MONUSCO’s personnel composition - approximately 80% of its deployed personnel were military. In some cases, peacekeeper-perpetrated sexual violence occurred in public spaces such as outside of schools, churches, bars, or in markets rather than in private residences or within UN bases. This finding suggests that the peacekeepers’ presence may have heightened the perceived degree of public insecurity for women/girls. Furthermore, our data substantiates the breadth of peacekeeper-perpetrated violence in the DRC. Measures intended to humiliate women (verbal harassment, threats, and forced self-exposure) were reported on numerous occasions in addition to rape involving girls as young as eight years old. This heightened level of insecurity is particularly concerning in the face of ongoing conflict-related sexual violence in the eastern regions of DRC [53]. While one of the many purposes of PSOs is to protect civilians against conflict-related sexual violence [54], peacekeepers perpetrated these same atrocities, representing a clear violation of Sect. 3 of the zero tolerance policy [55].

Transactional sex and agency in the context of socioeconomic disparities and racial hierarchies

TS and sex work were common in the current data, consistent with prior literature [56]. Not only were these sexual interactions occurring, but in some cases women initiated the interactions themselves and were perceived to benefit from them. In the absence of other economic opportunities, and when appropriately paid, the monetary and material gains from some cases of TS and sex work mirrored those in romantic interactions and were a source of improved livelihood for Congolese host community women and their families. These results challenge the blanket classification of all sexual interactions between UN peacekeepers and host community women as inherently exploitative, as is understood by the current implementation of the zero-tolerance policy.

We recognize, however, that the entanglement of economic need as a major motivator within transactional interactions requires a closer consideration of agency and how it is exercised in this context [57]. Agency within TS has been explored in peacekeeping and African literature where there is some consensus that women are more vulnerable in sexual encounters when structural inequalities, such as wealth disparities, racial hierarchies, and socio-economic constraints, limit their range of choices [50, 58, 59]. However, our findings also underscore how these vulnerabilities are compounded by the frequent breaches of TS agreements by peacekeepers, a reflection of pervasive impunity. Many women enter into these exchanges with set expectations of compensation, only to find these agreements violated without any viable mechanism for recourse.

Misperceptions about peacekeepers, including the belief that relationships may yield financial security or social mobility, can further complicate agency, as these expectations do not always align with reality. These misperceptions are shaped not only by peacekeepers themselves but also by broader systemic factors including socioeconomic and racial power hierarchies, as well as patriarchal norms that position peacekeepers as desirable partners. Similar to other findings [34, 39], an economic disparity between peacekeepers and local women was apparent across our data, and was seemingly navigated through negotiation and/or intermediaries with both positive and negative outcomes. For example, the role played by intermediaries raises questions about who is really benefiting and to what degree, particularly in contexts with inequitable gender norms as in the DRC.

Furthermore, the ability to negotiate was not evident in all instances. Some women faced language barriers when communicating with peacekeepers. Other women experienced deceptive practices of inadequate or non-payment in TS encounters and likely had few mechanisms for recourse. Others were single mothers caring for unsupported peacekeeper-fathered children and undoubtedly faced long-term financial strain and challenges as single parents. While elements of power imbalance exist in many transactional sex contexts globally, peacekeeping settings amplify these disparities due to the transient nature of deployments, and the lack of effective oversight.

These limitations highlight that, while some women exercised choice in engaging with peacekeepers, their autonomy was shaped and often constrained by intersecting structural, social, and economic forces [33]. While acknowledging these women’s agency, it is also essential to avoid placing undue responsibility on them for the structural conditions that shape their decisions. Recognizing agency should not be misinterpreted as implying consent in exploitative situations or absolving peacekeepers of accountability. Instead, it underscores the need for more nuanced frameworks that account for the complexity of these interactions. Further qualitative research is needed to gain a better understanding of perceived benefits and women’s agency in different types of sexual interactions with UN peacekeepers.

Romantic relationships, power imbalances, and structural inequalities

Romantic relationships between UN peacekeepers and host community women were also well described in the current data, again with women sometimes initiating the relationships and benefitting from them. Overall, descriptions of romantic relationships between host community women and UN personnel have been much less commonly reported in comparison to TS, sex work, and sexual violence. Although recent literature focusing on peacekeeper sexual interactions in Haiti [33] and the DRC [37] have mentioned the occurrence of romantic interactions with peacekeepers, a more nuanced understanding of these encounters is still lacking. Nonetheless, the romantic relationships present in this analysis challenge the blanket classification of all sexual interactions between UN peacekeepers and host community women as inherently exploitative.

Despite our recognition that some woman initiated sexual interactions with peacekeepers and from the perspective of the host community often benefited as a result, it is important to be cognizant of the apparent disparities of power between peacekeeping personnel and the local community. In our analysis, peacekeepers frequently gave the impression of being wealthier than average local community members allowing them to attract women’s attention and recruit community members as intermediaries. Events such as unsupported peacekeeper-fathered children, inadequate payment in transaction-based encounters, and the perpetration of sexual violence illustrate abuse of this power as peacekeepers were seemingly able to disproportionally dictate the conditions of the exchange and/or avoid paternal responsibility. Beyond economic means, the continuous instigation of sexual violence exhibited a gendered power and tolerance for violence against women and girls at the troop level. The gendered and economic nature of peacekeeper power, and inadequate justice mechanisms for host communities that reinforce them are recognized in the broader literature [20, 49].

Recognizing some women’s exercised agency and perceived benefit, as we have done in the current analysis, does not negate or distract from the ongoing power and control held by UN peacekeepers, which are maintained partially through structural feminized poverty and ongoing inequitable gender norms. At the same time, acknowledging these complexities presents an opportunity to develop more effective interventions. For instance, a more nuanced policy approach that does not categorically designate all interactions as inherently violent but instead accounts for the full spectrum of experiences may help increase compliance with regulations and improve overall effectiveness. Such an approach could mitigate some of the harms described while potentially contributing to lower overall rates of SEA and related violence. Furthermore, as argued by Westendorf, addressing peacekeeper-perpetrated SEA could be strengthened by integrating it within the broader Women, Peace and Security agenda [60].

Perceptions of whiteness and racial power

Our analysis revealed a contradiction between the racial composition of peacekeeping forces (from South Africa, Tanzania, Morocco, Senegal, India and so on) and the prominence of ‘whiteness’ mentioned in the micronarratives about sexual interactions. Our findings suggest that in this context, whiteness is not simply a racial category but also a symbol of power, privilege, and impunity within the socio-political structure of peacekeeping operations. While most peacekeepers originate from non-white troop-contributing countries, the racialized perceptions of authority, protection, and harm in peacekeeping settings continue to be influenced by colonial histories. As demonstrated by Wagner et al., racial identity in peacekeeping contexts is often shaped by social expectations and economic hierarchies rather than purely by skin color [36]. In the DRC, for example, the term “Muzungu aliye homba” (white child gone bankrupt) illustrates how whiteness is associated with privilege, wealth, and access to resources, even when individuals who are labeled ‘white’ do not possess those advantages [36]. This phenomenon is relevant to our current study, where local communities talked about SEA perpetration within a racialized framework, even when the perpetrators themselves were not white.

Policy implications

Our findings highlight the importance of moving beyond one-size-fits-all approaches to SEA by recognizing the complexity and nuance in sexual interactions between peacekeepers and local populations. Strategies that rely on blanket assumptions risk further marginalizing those they aim to protect, particularly when they fail to account for local agency, economic constraints, and gendered power imbalances. A more contextually grounded understanding of these dynamics can contribute to more effective strategies for addressing SEA while avoiding the reinforcement of colonial, paternalistic, or harmful power structures. Future research should explore how to develop interventions that not only prevent peacekeeper-perpetrated SEA but also engage meaningfully with local communities to ensure that responses do not reproduce the very inequalities they seek to address.

Limitations and strengths

The study has several notable limitations. First, a key limitation of this study is that many of the micronarratives were recounted in the third person, so we cannot definitively verify the exact nature of the sexual interactions or the intent behind them. Consequently, our findings reflect community perceptions and narratives rather than direct empirical observations of these interactions. Second, our convenience sample was not representative of the broader community and may not have included certain perspectives, thus the results cannot be generalized. Third, the SenseMaker micronarratives were briefer than narratives collected in more traditional qualitative research and in some cases may have lacked important details. In this regard, we recommend further in-depth interviews to better capture host community perspectives around women’s agency and perceived benefit for women. Finally, we acknowledge our positionality and remain aware that, as a primarily non-Congolese academic team, our interpretations of the results may be influenced by inherent biases.

This analysis also has several key strengths including a substantial sample size of 1,822 self-interpreted micronarratives, offering diverse perspectives from host community members in the DRC. Furthermore, because the SenseMaker approach avoided asking direct questions about sexual interactions, social desirability bias was mitigated and the narratives emerged more naturally from participants’ broader landscape of experiences. Additionally, by enabling participants to interpret their own shared experiences, SenseMaker likely reduced interpretation bias and provided deeper, more nuanced insights that might have otherwise been unidentified. Finally, an examination of the characteristics and roles that comprise the various types of interactions (romantic, TS, sex work, and sexual harassment/assault) is unique to this study.

Conclusions

By neglecting to consider host community women’s exercised agency and the financial benefits derived from TS and sex work in settings of extreme poverty, in addition to romantic relations between peacekeepers and host community women, the zero-tolerance policy offers an incomplete conceptualization of sexual interactions with peacekeeping personnel in the DRC. While some sexual interactions between UN peacekeepers and host community members involve agency, agency does not eliminate vulnerability, and it is critical to consider how decision-making is continually shaped and restricted by systemic inequities. As a result of the incomplete picture of peacekeeper/host community member sexual interactions, the zero-tolerance policy is not aligned with the lived experiences of at least some women who choose to engage sexually with peacekeepers and furthermore, the policy as it is currently implemented, is not effective in preventing these sexual interactions.

Given the varied and dynamic nature of the sexual interactions described in our analysis and given that it is difficult to dichotomize the complexity of romantic and transactional interactions, we propose that a non-binary model to measure the degree of exploitation and abuse would be helpful in this regard. Moving away from a binary evaluation of peacekeeper-perpetrated SEA as present or absent (with the designation being that SEA is present in almost all cases given the current implementation of the zero-tolerance policy), and towards an appreciation that the degree to which sexual interactions are exploitative or abusive is varied, dynamic, and more nuanced, might lead to more effective policies to prevent and address peacekeeper-perpetrated SEA. For instance, if reporting mechanisms for peacekeeper-perpetrated SEA considered the varied circumstances surrounding peacekeeper-host community sexual interactions, formal reporting rates might improve. Additionally, strategies to support SEA-affected women/girls might then have the flexibility to adapt to better meet those needs depending on the nature and characteristics of the sexual interaction.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Acronyms

DRC

Democratic Republic of Congo

MARAKUJA

Multidisciplinary Association for Research and Advocacy in the Kivus by United Junior Academics

MONUC

United Nations Organization Mission in the Democratic Republic of the Congo

MONUSCO

United Nations Organization Stabilization Mission in the Democratic Republic of the Congo

PSO

Peace support operation

SEA

Sexual exploitation and abuse

SGBV

Sexual and gender-based violence

SOFEPADI

Solidarité Féminine Pour la Paix et le Développement Intégral

TPCC

Troop and police contributing countries

UN

United Nations

Author contributions

The study was designed by SAB and SLee, who also oversaw the original data collection in the DRC. SG conducted the data analysis while HS, SLee, SAB, and SLusamba contributed to the interpretation. The manuscript was drafted by SG. All authors read and approved the final manuscript.

Funding

This research was funded by the Social Sciences and Humanities Research Council of Canada, Insight Grant #435-2017-1289 (S. Bartels Principal Investigator). This publication was supported, in part, thanks to funding from the Canada Excellence Research Chairs Program (S. Bartels).

Data availability

No datasets were generated during the current study.

Declarations

Ethics approval and consent to participate

This study was approved by the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board (protocol # 6019042) and locally by the Congolese National Committee of Health Ethics (protocol #001/DP-SK/119PM/2018). Participants aged 13 to 17 were considered mature minors. Parental consent was not obtained as it was believed that involving parents could have introduced bias and potentially parental conflict and/or abuse.

Competing interests

The authors declare no competing interests.