Risk aversion and HIV/AIDS: Evidence from Senegalese female sex workers

• Published in: Social science & medicine Vol. 256; no. July; pp. 113020 - 12
• Main Authors: Lépine, Aurélia, Treibich, Carole
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2020; Pergamon Press Inc; Elsevier; Pergamon
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome; Adult; AIDS; Behavior change; Behavior modification; Condoms; Epidemics; Female; Finance; Financial incentives; Health behavior; Health care expenditures; Health Knowledge, Attitudes, Practice; Health problems; Health status; High risk; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Humanities and Social Sciences; Humans; Infections; Middle Aged; Money; Prostitution; Risk; Risk behavior; Risk preferences; Risk taking; Senegal - epidemiology; Sex industry; Sex Work; Sex Workers; Sexual Behavior; Sexually Transmitted Diseases; STD; Workers; Senegal
• ISSN: 0277-9536; 1873-5347; 0037-7856; 1873-5347
• DOI: 10.1016/j.socscimed.2020.113020

HIV/AIDS is the second cause of mortality globally and there are 5000 new infections each day. Globally, sex workers are 13 times more at risk of HIV than the general population and in Senegal they have an HIV prevalence 16.5 times greater. Therefore, it is urgent to encourage behaviour change, which requires a better understanding of the reasons why sex workers engage in risky behaviours. We provide new evidence of the role of risk preferences on sexual behaviours, health behaviours and health outcomes of 600 female sex workers in Senegal in July and August 2017. We measure risk aversion of sex workers using an incentivised Gneezy and Potters task in addition to specific risk-taking scales in four domains (in general, finance, health and sex). Understanding of the experimental task was high despite low literacy level of participants. Using ordinary least squares, we find that risk aversion is an important predictor of sex workers’ sexual behaviours. We find that sex workers with higher level of risk aversion have less sex acts with clients, have less clients at risk of HIV, are more likely to engage in protected sex acts and as a result earn less money per sex act. Furthermore, we find that sex workers exhibiting higher level of risk aversion are less likely to be infected with sexually transmitted infections. Results highlight that some associations between risk preferences and sexual and health behaviours are domain specific. To conclude, our results confirm the role of risk preferences in the spread of HIV/AIDS epidemic and suggest the importance of collecting information on self-reported risk aversion to identify individuals who are at a greater risk of HIV/AIDS. Finally, our results provide some rationale in using lottery-based financial incentives to prevent sexually transmitted infections and HIV/AIDS among high-risk populations. •We study the role of risk preferences on HIV/AIDS among sex workers in Senegal.•Risk preferences were elicited in a lab-in- the-field experiment and self-reported.•Risk aversion is a main predictor of sexual behaviours.•The relationship between risk aversion and behaviours is domain-specific.