1
Introduction
In the early stages of the HIV/AIDS epidemic in sub-Saharan Africa, economic status
was found to be positively associated with HIV infection (Kimuna and Djamba 2005, Hargreaves
et al. 2002). A key explanation for this relationship was that wealthier men could attract and
afford multiple sexual partners—particularly commercial sex workers, who were believed to be
the main sources of infection—and therefore faced greater risk of acquiring the disease. At
present, economic status is generally found to be negatively associated with HIV infection,
particularly among women. It is commonly believed that many African women engage in
transactional sex, where money and gifts (what we refer to as “transfers”) are traded off for
unsafe sexual activities within non-marital sexual partnerships (Hallman 2004, Ulin 1992). In
many African contexts, women are motivated by poor economic conditions to exchange sex
without a condom for receipt of needed financial transfers.
The relationship between economic status and unsafe sexual behavior and HIV infection
is less clear for men in such an environment of widespread transactional sex. On the one hand,
wealth may continue to be a risk factor for men of higher economic status, who can afford to
engage in transactional sex. Indeed, the high prevalence of “sugar daddies” and their use of
transfers to lure young women into dangerous sexual relationships has been highlighted in the
Africa press and by health agencies (Luke 2005, ZNFPC 1997). On the other hand, wealthy men
are likely to have internalized concerns about their health or their future at this stage of the
epidemic due to extensive information and behavior change campaigns that have been
disseminated throughout the population. Therefore, wealthy men may have greater incentives to
protect themselves from HIV infection than poorer men.
Despite these assumptions about the role of transactional sexual relationships in the
ongoing HIV/AIDS epidemic in sub-Saharan Africa, there has been no statistical investigation of
the direct connection between economic status, transfers, and unsafe sexual behavior. One
Convention