The price of sex: Condom use and the determinants of the price of sex among female sex workers in eastern Zimbabwe

Jocelyn Elmes*, Kundai Nhongo, Helen Ward, Timothy Hallett, Constance Nyamukapa, Peter J. White, Simon Gregson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)S569-S578
JournalJournal of Infectious Diseases
Publication statusPublished - 1 Dec 2014

Bibliographical note

Funding Information:
Financial support. This work was supported by the Medical Research Council (grant to J. E. and grant MR/K010174/1 to P. J. W. and T. H.); the Wellcome Trust (grant 090285/Z/09/Z to J. E. and grants 084401/Z/07/Z and 090285/Z/09/Z to S. G. and H. W.); the UK National Institute for Health Research Health Protection Research Unit in Modelling Methodology at Imperial College London, in partnership with Public Health England (to P. J. W. and T. H.); the Bill and Melinda Gates Foundation (grant OPP 106713 to T. H.); the Joint United Nations Programme on HIV/AIDS (grant EIP/DFA/PG/ca12/18 to T. H.); the World Bank (grant 1078406 to T. H.); and the Rush Foundation (to T. H.).

Publisher Copyright:
© The Author 2014.


  • Condom use
  • Female sex work
  • Payments
  • Sub-Saharan Africa


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