Publication: Safety First, Then Condoms: Commercial Sex, Risky Behavior, and the Spread of HIV/AIDS in Managua, Nicaragua
Abstract
This study analyzes the commercial sex market in Managua, Nicaragua, to understand risky behavior among sex workers. While health risks are a major concern for sex workers, the risk of violence weighs more heavily in decision making, such that they more often take risks to their health than to their immediate, physical well-being. These concerns are reflected in the lower premiums sex workers charge for unprotected sex (39 percent more for vaginal sex without a condom) compared with risks of violence, such as accompanying a client to an unknown place (a 118 percent premium). Risk behaviors reflect a rational calculation of actual risk: while only 9 percent of the sample knew anyone diagnosed with HIV, nearly 44 percent of sex workers had been assaulted. These observations indicate the need to consider sex workers' physical safety in policies to contain the spread of HIV/AIDS and other sexually transmitted diseases.
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Publication Risk and Reward in Managua's Commercial Sex Market: The Importance of Workplace(2010)This article focuses on the capabilities of women in sex work--a sector in which a substantial number of women in developing countries find themselves. Sex workers confront important unfreedoms-violence and disease--on a daily basis. How well sex workers can manage these threats has implications not only for the workers themselves but also their families and communities, and thus is an important concern in development policy. Using original data from Managua, Nicaragua, I show how workplace conditions determine women's autonomy to manage risks of disease and violence, including their capacity to negotiate appropriate risk compensation. I present a model of a segmented labor market, and describe how women's autonomy in choosing a particular segment is constrained by access to networks and human capital. Next, I estimate the compensation to different risks by market segment. I find that sex workers in higher-end segments are less likely than women in other segments to take risks to their health or safety, and more able to charge a high-risk premium when they do. In addition, women who enjoy more autonomy in decision-making take risks less often than those whose decisions are constrained either by a manager or by low earnings. These findings indicate the need to consider differences in workplace conditions in designing policy to expand the capabilities of women in sex work.Publication Variations in Condom Use by Type of Partner in 13 Sub-Saharan African Countries(2011)Using nationally representative data from 13 sub-Saharan African countries, we reinforce and expand upon previous findings that men report using condoms more frequently than women do and that unmarried respondents report that they use condoms with casual partners more frequently than married individuals report using them with their spouses. Based on descriptive, bivariate, and multivariate analyses, we also demonstrate to a degree not previously shown in the current literature that married men from most countries report using condoms with extramarital partners about as frequently as unmarried men report using them with casual partners. Married women from most of the countries included in the study reported using condoms with extramarital partners less frequently than unmarried women reported using them with casual partners. This result is especially troubling because marriage usually ensures regular sexual intercourse, thereby providing more opportunities for a person to pass HIV infection from an extramarital partner to his or her spouse. These findings about high-risk behaviors can be used to better target future HIV-transmission-prevention efforts.Publication The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women(2010)Recent evidence suggests that conditional cash transfer (CCT) programs for schooling are effective in raising school enrolment and attendance. However, there is also reason to believe that such programs can affect other outcomes, such as the sexual behavior of their young beneficiaries. Zomba Cash Transfer Program is a randomized ongoing CCT intervention targeting young women in Malawi that provides incentives (in the form of school fees and cash transfers) to current schoolgirls and recent dropouts to stay in or return to school. An average offer of US$ 10/month conditional on satisfactory school attendance--plus direct payment of secondary school fees--led to significant declines in early marriage, teenage pregnancy, and self-reported sexual activity among program beneficiaries after just one year of program implementation. For program beneficiaries who were out of school at baseline, the probability of getting married and becoming pregnant declined by more than 40 and 30%, respectively. In addition, the incidence of the onset of sexual activity was 38% lower among all program beneficiaries than the control group. Overall, these results suggest that CCT programs not only serve as useful tools for improving school attendance but may also reduce sexual activity, teen pregnancy, and early marriage.Publication Antiretroviral Therapy Awareness and Risky Sexual Behaviors : Evidence from Mozambique(2010-11-01)This paper studies the effect of increased access to antiretroviral therapy on risky sexual behavior, using data collected in Mozambique in 2007 and 2008. The survey sampled both households of randomly selected HIV positive individuals and households from the general population. Controlling for unobserved individual characteristics, the findings support the hypothesis of disinhibition behaviors, whereby risky sexual behaviors increase in response to the perceived changes in risk associated with increased access to antiretroviral therapy. Furthermore, men and women respond differently to the perceived changes in risk. In particular, risky behaviors increase for men who believe, wrongly, that AIDS can be cured, while risky behaviors increase for women who believe, correctly, that antiretroviral therapy can treat AIDS but cannot cure it. The findings suggest that scaling up access to antiretroviral therapy without prevention programs may not be optimal if the objective is to contain the disease, since people would adjust their sexual behavior in response to the perceived changes in risk. Therefore, prevention programs need to include educational messages about antiretroviral therapy, and address the changing beliefs about HIV in the era of increasing antiretroviral therapy availability.Publication Sexual and Gender-Based Violence : What is the World Bank Doing and What Have We Learned, A Strategic Review(World Bank, Washington, DC, 2013-11)Sexual and gender-based violence (SGBV) is the most prevalent form of gender inequality. More than one third of the women in the world have experienced some form of gender based violence. The impacts of such violence extend far beyond the individual survivors, affecting households and communities, and spanning across generations. SGBV is widely recognized as a development constraint that falls within the World Bank's mandate. This report is an effort to take stock of the experience of the World Bank in addressing SGBV, from 2008 to 2013, in order to capture lessons for engaging more strategically on this issue across the Bank portfolio. The report elaborates on the prevalence of SGBV, the methodology adopted for the purpose of this review, an overview of World Bank activities for SGBV, lessons learned, addressing SGBV in design and implementation, cross-cutting and operational lessons, conclusions and recommendations.
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