Njuguna Rebecca G, Cust Henry, Lépine Aurélia
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Centre for Global Health Economics, Institute for Global Health, University College London, London, UK.
Health Econ. 2025 Aug;34(8):1474-1486. doi: 10.1002/hec.4964. Epub 2025 Jun 13.
Female sex workers (FSWs) can receive a premium for engaging in unprotected and other risky sexual behaviours. Women engaging in transactional sex, defined as 'non-commercial sexual relationships motivated by the implicit assumption that sex is exchanged for material support', are thought to share similar economic incentives as women engaging in commercial sex. Using a panel of up to six sex acts from longitudinal datasets stratified by FSWs and women engaging in transactional sex in Cameroon, we provide evidence consistent with literature of a 30% condomless risk premium for FSWs. We then provide the first empirical evidence of a discount for condomless sex of 14% for women engaging in transactional sex. Qualitative analysis offers two explanations for this surprising finding, first a lack of HIV awareness among women engaging in transactional sex, and second, that risky sex acts are a demonstration of investment of trust in relationships and represent unobservable exchange of value. Given the larger number of women engaging in transactional relationships compared to FSWs in sub-Saharan Africa, and their lower awareness of HIV risks, this finding offers a significant explanation for the disproportionate burden of HIV incidence among adolescents and young women in sub-Saharan Africa.
女性性工作者从事无保护措施及其他危险性行为可能会获得额外报酬。从事交易性行为（定义为“基于性与物质支持相互交换这一隐含假设的非商业性关系”）的女性，被认为与从事商业性交易的女性有着相似的经济动机。利用来自喀麦隆女性性工作者和从事交易性行为女性分层的纵向数据集的多达六种性行为组成的面板数据，我们提供了与文献一致的证据，即女性性工作者存在30%的无保护性行为风险溢价。然后，我们首次提供了实证证据，表明从事交易性行为的女性无保护性行为存在14%的折扣。定性分析为这一惊人发现提供了两种解释，一是从事交易性行为的女性缺乏对艾滋病毒的认识；二是危险性行为是对关系中信任投入的一种表现，代表着不可观察的价值交换。鉴于撒哈拉以南非洲地区从事交易性关系的女性数量多于女性性工作者，且她们对艾滋病毒风险的认识较低，这一发现为撒哈拉以南非洲地区青少年和年轻女性中艾滋病毒感染率不成比例的负担提供了重要解释。
