In Uganda, 10.3 percent of women ages 15-24 have HIV/AIDS compared to only 2.8 percent for similarly aged men. Experts attribute the gap largely to the "sugar daddy" phenomenon, in which men have sexual and economic relationships with much younger women.

In addition to being economically and socially vulnerable, women with sugar daddies are at greater risk for HIV, studies find. Older men are more likely to have HIV than younger men and, as sugar daddies, often prevail upon a woman to forgo protection. A Columbia University study found that women ages 15-19 whose partners were 10 or more years older were at double the HIV risk than women whose partners were the same age to four years older.

Subtle reasons young women accept sugar daddies include the traditional African custom to defer to elders and a belief that older men are wiser about sex. In addition, there is a tension between a respect for elders and rebuffing an older man's advances.

"He will give you all the things you want, but you have to follow his rules," said Tirisa Bonareri, a graduate student and member of the Go Getter Club, a Population Services International (PSI) program encouraging women to say no to sugar daddies. With some clothes or a mobile phone, a man "can expect to have sex with the young woman," said Musinguzi, a 38-year-old sugar daddy interviewed in Kampala by a research firm.

In response, government-sponsored posters in Ugandan schools caution, "Beware of Sugar Daddies." A radio soap opera features characters who discover the downside of a sugar daddy relationship. And in a PSI campaign using the Golden Rule approach, a picture of a middle-aged man asks, "Would you let this man be with your 18-year-old daughter? So why are you with his?" Similar campaigns to discourage such relations are proliferating across Africa.

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