Abstract
Evidence suggests that economic factors play an important role in commercial sex work, in particular that condomless sex commands a price premium relative to condom‐protected sex. This paper explores whether the use of a new HIV prevention product, with 100% efficacy but modeled after pre‐exposure prophylaxis (PrEP), could change the price and quantity of condomless commercial sex supplied. We collected stated preference data from 122 HIV‐negative female sex workers in urban South Africa, using a repeated choice experiment to simulate the impact of using PrEP on choices. Results suggest that the price premium for condomless sex would decrease by 73% with PrEP use and the quantity of condomless sex is predicted to increase by a factor of 2.27. Act price does not significantly affect choices without protection but strongly influences choices under full HIV protection. The utility offered by condoms reduces by around 15% under PrEP use. Because new HIV prevention products do not protect against other STIs or pregnancy, the unintended consequences of introducing HIV prevention products should be closely monitored, whereas users should not face stigma or blame for reacting rationally to exogenous changes to market conditions.
Highlights
Women engaged in commercial sex, or female sex workers (FSWs), face daily risks of HIV acquisition (Bekker et al, 2015), not least in urban South Africa where HIV prevalence among FSWs is estimated to be as high as 72% in some cities (UCSF, Anova Health Institute, & WRHI, 2015)
From the discrete choice experiment (DCE), we find that pre‐exposure prophylaxis (PrEP) use will reduce the price premium for condomless sex by 73%, and simulations indicate that the quantity of condomless sex supplied will more than double
Age Secondary education Married In a relationship Any children Always use condoms with clients Experienced IPV in the last year Used alcohol at last sex Low household income (
Summary
Women engaged in commercial sex, or female sex workers (FSWs), face daily risks of HIV acquisition (Bekker et al, 2015), not least in urban South Africa where HIV prevalence among FSWs is estimated to be as high as 72% in some cities (UCSF, Anova Health Institute, & WRHI, 2015). Econometric work has estimated a price premium for condomless sex relative to protected sex, referred in the literature as the condom differential. Anecdotal evidence of a differential (e.g., Wojcicki & Malala, 2001) was first empirically estimated by Rao et al (2003) who found that Indian FSWs who used condoms consistently faced income losses of up to 79%, whereas further econometric evidence has estimated price premia in different contexts between 7% (Belgium and the Netherlands) and 81% (Bangladesh; Arunachalam & Shah, 2013; de la Torre, Havenner, Adams, & Ng, 2010; Gertler et al, 2005; Levitt & Venkatesh, 2007; Muravyev & Talavera, 2013; Rao et al, 2003; Robinson & Yeh, 2011). FSWs are highly dependent on sex work to support themselves and their families (Beattie et al, 2012) and may be at heightened risk when offered more money for unprotected sex
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