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      The Price of Sex: Condom Use and the Determinants of the Price of Sex Among Female Sex Workers in Eastern Zimbabwe

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          Abstract

          Background.  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.

          Methods.  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.

          Results.  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.

          Conclusions.  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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          Modern epidemiology

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            Modern Epidemiology

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              Negative Binomial Regression

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                Author and article information

                Journal
                J Infect Dis
                J. Infect. Dis
                jid
                jinfdis
                The Journal of Infectious Diseases
                Oxford University Press
                0022-1899
                1537-6613
                01 December 2014
                01 December 2014
                : 210
                : Suppl 2 , Developing and Applying Theoretical Frameworks in the Epidemiology of Sexually Transmitted Infections
                : S569-S578
                Affiliations
                [1 ]Department of Infectious Disease Epidemiology
                [2 ]MRC Centre for Outbreak Analysis and Modelling
                [3 ]NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
                [4 ]Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England , London, United Kingdom
                [5 ]Biomedical Research and Training Institute , Avondale, Zimbabwe
                Author notes

                Presented in part: STI and AIDS World Congress, Vienna, Austria, 14–17 July 2013. Oral session O07.5.

                [a]

                P. J. W. and S. G. are senior authors.

                Correspondence: Jocelyn Elmes, PhD, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Pl, London W2 1PG, UK ( jocelyn.elmes07@ 123456imperial.ac.uk ).
                Article
                jiu493
                10.1093/infdis/jiu493
                4231645
                25381377
                f38d71e1-00b4-4722-8c9a-7164e2e96cc8
                © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Developing and Applying Theoretical Frameworks in the Epidemiology of Sexually Transmitted Infections

                Infectious disease & Microbiology
                female sex work,payments,condom use,sub-saharan africa
                Infectious disease & Microbiology
                female sex work, payments, condom use, sub-saharan africa

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