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The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India

Quaife, M; Lepine, A; Deering, K; Terris-Prestholt, F; Beattie, T; Isac, S; Paranjape, R; (2019) The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India. Health Policy and Planning 10.1093/heapol/czz100. (In press). Green open access

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Abstract

There is some evidence that female sex workers (FSWs) receive greater earnings for providing unprotected sex. In 2003, the landscape of the fight against HIV/AIDS dramatically changed in India with the introduction of Avahan, the largest HIV prevention programme implemented globally. Using a unique, cross-sectional bio-behavioural dataset from 3591 FSWs located in the four Indian states where Avahan was implemented, we estimate the economic loss faced by FSWs who always use condoms. We estimate the causal effect of condom use on the price charged during the last paid sexual intercourse using the random targeting of Avahan as an instrumental variable. Results indicate that FSWs who always use condoms face an income loss of 65% (INR125, US$2.60) per sex act compared to peers providing unprotected sex, consistent with our expectations. The main finding confirms that clients have a preference for unprotected sex and that policies aiming at changing clients’ preferences and at improving the bargaining power of FSWs are required to limit the spread of HIV.

Type: Article
Title: The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/heapol/czz100
Publisher version: https://doi.org/10.1093/heapol/czz100
Language: English
Additional information: Copyright The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. 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.
Keywords: HIV prevention, condom use, instrumental variables, compensating differential, sex work, India
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10082788
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