The price of sex: condom use and the determinants of the price of sex among female sex workers in eastern Zimbabwe.
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.
Department of Infectious Disease Epidemiology.
Jocelyn
J
Elmes
Biomedical Research and Training Institute, Avondale, Zimbabwe.
Kundai
K
Nhongo
Department of Infectious Disease Epidemiology.
Helen
H
Ward
MRC Centre for Outbreak Analysis and Modelling NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London.
Timothy
T
Hallett
Biomedical Research and Training Institute, Avondale, Zimbabwe.
Constance
C
Nyamukapa
MRC Centre for Outbreak Analysis and Modelling NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom.
Peter J
PJ
White
Department of Infectious Disease Epidemiology Biomedical Research and Training Institute, Avondale, Zimbabwe.
Simon
S
Gregson
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016000:Cluster Analysis; D017280:Condoms / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work; D060386:Sex Workers; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
condom use; female sex work; payments; sub-Saharan Africa