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Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory

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Abstract

Urban slum adolescents and young adults have disproportionately high rates of HIV compared to rural and non-slum urban youth. Yet, few studies have examined youth’s perceptions of the economic drivers of HIV. Informed by traditional and behavioral economics, we applied a scarcity theoretical framework to qualitatively examine how poverty influences sexual risk behaviors among adolescents and young adults. Focus group discussions with one hundred twenty youth in Kenyan’s urban slums were transcribed, coded, and analyzed using interpretive phenomenology. Results indicated that slum youth made many sexual decisions considered rational from a traditional economics perspective, such as acquiring more sex when resources were available, maximizing wealth through sex, being price-sensitive to costs of condoms or testing services, and taking more risks when protected from adverse sexual consequences. Youth’s engagement in sexual risk behaviors was also motivated by scarcity phenomena explained by behavioral economics, such as compensating for sex lost during scarce periods (risk-seeking), valuing economic gains over HIV risks (tunneling, bandwidth tax), and transacting sex as an investment strategy (internal referencing). When scarcity was alleviated, young women additionally described reducing the number of sex partners to account for non-economic preferences (slack). Prevention strategies should address the traditional and behavioral economics of the HIV epidemic.

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Acknowledgements

The authors wish to thank the study participants, program staff, and research assistants who made this research possible in partnership with the Johns Hopkins Bloomberg School of Public Health, University of Nairobi College of Health Sciences, and the National Health and Development Organization (NAHEDO), a registered non-governmental organization in Kenya providing HIV social and medical services.

Funding

This research was funded through resources and services provided by the Johns Hopkins University (JHU) Center for AIDS Research (CFAR), an NIH funded program (Grant: P30AI094189), which is supported by the following NIH co-funding and participating institutes and centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The primary author’s work on this manuscript was supported also by the National Institute of Mental Health (NIMH) (Grant: K01MH107310). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA

    Larissa Jennings

  2. Department of Psychiatry, College of Health Sciences, Kenyatta National Hospital, University of Nairobi, Off-Ngong Road, Nairobi, Kenya

    Muthoni Mathai

  3. Department of Mental Health, Kenyatta National Hospital, National Health and Development Organization (NAHEDO), Ralph Bunche Road, P.O. Box 20453, Nairobi, Kenya

    Muthoni Mathai & Margaret Mak’anyengo

  4. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA

    Sebastian Linnemayr

  5. Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, R8531, Baltimore, MD, 21205, USA

    Antonio Trujillo

  6. Health Behavior and Health Education Department, Fay W. Boozman College of Public Health, Univertiy of Arkansas for Medical Sciences, Little Rock, AR, USA

    Brooke E. E. Montgomery

  7. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA

    Deanna L. Kerrigan

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Jennings, L., Mathai, M., Linnemayr, S. et al. Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory. AIDS Behav 21, 2784–2798 (2017). https://doi.org/10.1007/s10461-017-1676-y

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