Survival Sex or Sugar-Daddies? Gender, Wealth and HIV Infection in 16 African Countries

Ashley M. Fox, Columbia University

Researchers have traced women’s disproportionate burden of HIV/AIDS in sub-Saharan Africa to their economic dependence on men. Yet, unlike the notion of “survival sex” which points to women’s economic privation as a source of HIV risk, the “sugar-daddy” phenomenon paints a picture of men lavishing gifts and women competing for this attention. Recent evidence from demographic and health surveys (DHS) with linked HIV biomarkers defies both of these images, revealing that wealthier women are more at risk for HIV in many African countries. Using data from 16 DHS in sub-Saharan Africa, this study examined the survival sex/sugar-daddy phenomenon or the proposition that richer men and poorer women are more likely to be infected with HIV in a given area. Results from a two-level, hierarchical linear model found that while the survival sex/sugar-daddy phenomenon holds in richer regions, in poorer regions/rural areas HIV increases with wealth for both men and women.