Does the Risk Premium Differ Between Women Engaging in Commercial and Transactional Sex? Evidence From Urban Cameroon

IF 2 3区医学 Q2 ECONOMICS

Health economics Pub Date : 2025-06-13 DOI:10.1002/hec.4964

Rebecca G. Njuguna, Henry Cust, The POWER Team, Aurélia Lépine

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Abstract

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.

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从事商业性和交易性行为的女性风险溢价不同吗？来自喀麦隆城市的证据。

女性性工作者（FSWs）可以因从事无保护和其他危险的性行为而获得奖励。从事交易性行为的女性，被定义为“非商业性的性关系，其动机是隐性假设性行为是为了换取物质支持”，被认为与从事商业性行为的女性有着相似的经济动机。我们从纵向数据集中选取了多达六次的性行为，这些性行为由fsw和喀麦隆从事交易性行为的女性分层，我们提供了与fsw无安全套风险溢价30%的文献一致的证据。然后，我们提供了第一个经验证据，证明从事交易性行为的女性无套性行为的折扣为14%。定性分析为这一令人惊讶的发现提供了两种解释，第一，从事交易性行为的女性缺乏艾滋病毒意识，第二，冒险的性行为是对关系信任投资的一种表现，代表着不可观察的价值交换。考虑到撒哈拉以南非洲从事交易性关系的妇女人数多于fsw，而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青少年和年轻妇女中不成比例的艾滋病毒发病率负担提供了重要解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health economics 医学-卫生保健

CiteScore

3.60

自引率

4.80%

发文量

177

审稿时长

4-8 weeks

期刊介绍： This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems. Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses. Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.