Abstract
Formal and informal commercial sex work is a way of life for many poor women in developing countries. Though sex workers have long been identified as crucial in affecting the spread of HIV/AIDS, particularly in Sub-Saharan Africa, the nature of sex-for-money transactions remains poorly understood. Using a unique panel dataset constructed from 192 self-reported sex worker diaries which include detailed information on sexual behavior, labor supply, and health shocks, the authors find that sex workers adjust their supply of risky, better compensated sex to cope with unexpected health shocks, exposing themselves to increased risk of HIV infection. In particular, women are 3.1 percent more likely to see a client, 21.2 percent more likely to have anal sex, and 19.1 percent more likely to have unprotected sex on days in which a household member falls ill. Women also increase their supply of risky sex on days after missing work due to symptoms from a sexually transmitted infection. Given that HIV prevalence has been estimated at 9.8 percent in this part of Kenya, these behavioral responses entail significant health risks for sex workers and their partners, and suggest that sex workers are unable to cope with risk through other formal or informal consumption smoothing mechanisms.
Highlights
Exchanging sex for money, goods, or services is a way of life for many poor women in developing countries, yet little is understood about the way that the commercial or transactional sex market functions
To obtain a representative sample of women engaged in sex work in Busia Town, we identi...ed women through a peer group network which was originally established by the Strengthening STD/HIV Control Project in Kenya (SHCP), a Kenyan organization associated with the University of Manitoba and the University of Nairobi that worked with thousands of formal and informal sex workers across Kenya
Instead of relying on formal mechanisms, women tend to save through Rotating Savings and Credit Associations (ROSCAs): sixty-four percent of women participate in ROSCAs, and the average sex worker that participated in a ROSCA saved over 7,000 Kenyan shillings (US $100) in her ROSCA in the past year
Summary
Exchanging sex for money, goods, or services is a way of life for many poor women in developing countries, yet little is understood about the way that the commercial or transactional sex market functions. The increases in risky sex that we observe here have enormous health consequences for these women, their sexual partners, and society as a whole as HIV is passed on to the general population These results are all the more striking because we focus on daily income shocks, rather than larger shocks such as annual or seasonal agricultural ‡uctuations. The premium itself but whether the existence of a premium allows women to increase the amount of unprotected sex that they supply as a strategy to deal with health shocks In this respect, this paper contributes to recent work examining whether sexual behavior might be rational given certain economic conditions (Oster, 2007).[3]
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