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

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

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.

Suggested Citation

  • Rebecca G. Njuguna & Henry Cust & The POWER Team & Aurélia Lépine, 2025. "Does the Risk Premium Differ Between Women Engaging in Commercial and Transactional Sex? Evidence From Urban Cameroon," Health Economics, John Wiley & Sons, Ltd., vol. 34(8), pages 1474-1486, August.
    • Handle: RePEc:wly:hlthec:v:34:y:2025:i:8:p:1474-1486
    DOI: 10.1002/hec.4964
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    References listed on IDEAS

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