Karen Grepin's Global Health Blog

“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 transactional sex market functions.”

So begins a new research paper, out this month in the American Economic Journal: Applied Economics by Jonathan Robinson (UC Santa Cruz) and Ethan Yeh (World Bank) for what is likely to be an important, but poorly understood, driver of the HIV epidemic in parts of sub-Saharan Africa and elsewhere: transactional sex.   In this paper the authors identify a group of formal and informal sex workers in Western Kenya, basically women who frequently or occasionally supply sex in exchange for money but perhaps who do not identify themselves as “commercial sex workers”.  They may have another job and a family but engage in these risky sexual behaviors to help make ends meet.  Using diaries, the authors were able to track the sexual practices as well other aspects of their lives over time.

They find:

“We find compelling evidence that women increase their supply of risky, better compensated sex in response to short-term health shocks at home. 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 engage in unprotected sex on days in which another household member (typically a child) falls ill.”

When the women or someone else within their family falls ill, women increase their supply of transactional sex and engage in riskier sex in order to earn additional income, presumably to pay for medical treatments associated with these illnesses.  I found this line the most chilling:

“Women do this in order to capture the roughly 42 Kenyan shilling (US $0.60) premium for unprotected sex and the 77 shilling (US $1.10) premium for anal sex.”

Why would such women resort to such a risky activity in order to make up for – in the grand scheme of things – are relatively small income shortfalls?  It does seem kind of surprising, but the authors argue that this is due to the lack of alternative income coping mechanisms to offset these sudden and unexpected income shortfalls.  It also seems to be relatively consistent with finding that have come from other papers that have investigated similar shocks in similar settings.  But it is depressing just the same.