Abstract
Background. Higher prices for unprotected sex threaten the high levels of condom use that contributed to the decline in Zimbabwe's human immunodeficiency virus (HIV) epidemic. To improve understanding of financial pressures competing against safer sex, we explore factors associated with the price of commercial sex in rural eastern Zimbabwe.Methods. We collected and analyzed cross-sectional data on 311 women, recruited during October–December 2010, who reported that they received payment for their most-recent or second-most-recent sex acts in the past year. Zero-inflated negative binomial models with robust standard errors clustered on female sex worker (FSW) were used to explore social and behavioral determinants of price.Results. The median price of sex was $10 (interquartile range [IQR], $5–$20) per night and $10 (IQR, $5–$15) per act. Amounts paid in cash and commodities did not differ significantly. At the most-recent sex act, more-educated FSWs received 30%–74% higher payments. Client requests for condom use significantly predicted protected sex (P < .01), but clients paid on average 42.9% more for unprotected sex.Conclusions. Within a work environment where clients' preferences determine condom use, FSWs effectively use their individual capital to negotiate the terms of condom use. Strengthening FSWs' preferences for protected sex could help maintain high levels of condom use.
Highlights
Higher prices for unprotected sex threaten the high levels of condom use that contributed to the decline in Zimbabwe’s human immunodeficiency virus (HIV) epidemic
Client requests for condom use significantly predicted protected sex (P < .01), but clients paid on average 42.9% more for unprotected sex
Within a work environment where clients’ preferences determine condom use, female sex worker (FSW) effectively use their individual capital to negotiate the terms of condom use
Summary
We collected and analyzed cross-sectional data on 311 women, recruited during October–December 2010, who reported that they received payment for their most-recent or second-most-recent sex acts in the past year. Data Collection Data came from round 2 of an open-cohort study conducted in 4 neighboring but socioeconomically diverse communities—a small town, a roadside trading center, a commercial forestry estate, and a subsistence farming area—in Manicaland, eastern Zimbabwe [10]. Data collection methods are described in the Supplementary Materials. Women aged ≥18 years who reported ever having had transactional sex were recruited between March 2010 and May 2011, using venue-based and snowball methods. To participants providing informed consent, trained interviewers asked questions face to face about demographic characteristics and sexual behavior. In informal confidential voting interviews designed to reduce social-desirability bias [12], respondents self-completed answers to questions about their 2 most-recent sex partners (none were illiterate). Ethical approval was obtained from the Medical Research Council of Zimbabwe (MRCZ/A/681) and Imperial College Research Ethics Committee (ICREC_9_3_13)
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