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.
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.
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.
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.
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By:
1Department of Infectious Disease Epidemiology
2MRC Centre for Outbreak Analysis and Modelling
3NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
4Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
5Biomedical Research and Training Institute, Avondale, Zimbabwe
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