<p>A new wave of clandestine sex transactions (CSTs) is emerging within Ghana’s informal communities, yet scholarly research on this subject remains limited. This conceptual study aims to shed more light on the nature, drivers, and implications of CSTs in the underserved areas. This study systematically reviewed published articles related to CST, utilising a Google search supported by the Boolean algorithm and scanning globally recognised citation databases, including the Social Science Citation Index (SSCI) and Scopus. The study found a combination of factors driving CSTs in informal communities, including economic desperation, refugee migration, and limited access to education and healthcare. These factors have a profound impact on the mental well-being of those involved, leading to devastating consequences such as depression and anxiety. To combat CSTs, it requires providing sustainable livelihood opportunities to help reduce the prevalence of STDs, depression, and anxiety. This study provides pioneering insights into the dynamics of this concept in a developing context, shedding light on its underlying mechanisms and key factors at play. The study expanded the frontiers of CST literature within the informal settlements in the Global South.</p>