Baiting the hook: Fish scarcity, gendered division of labour, and the fish-for-sex trade.

Transactional sex in sub–Saharan Africa's fishing communities, driven by the highly gendered organisation of production, is widely recognised as a key driver of HIV transmission in lakeshore areas. This longitudinal study investigates the economic drivers of the trade and its impact on sexual health outcomes. Specifically, the impact of regional and district fish market shocks and comparable maize shocks on facility-level sexual health outcomes are examined in Tanzania's shoreline communities. Following unfavourable shocks to the fish market, such as high prices or low amounts of fish captured, this paper finds that new HIV cases, newly pregnant women attending antenatal clinic, and the number of people treated for syphilis increases with proximity to the shoreline, supporting the hypothesis that the fish-for-sex trade intensifies when fish supply is relatively scarce. Further, the observed increase in new HIV cases is driven by new cases in women. Contrasting effects are observed following maize price shocks, where facilities see an increase in both male and female new HIV cases following a favourable price shock. These findings highlight the role that gender-based organisation of production plays in shaping sexual health inequalities following shocks to a good. • Transactional sex increases in shoreline areas following months of fish scarcity. • Increases in HIV cases following fish market shocks are driven by new infections in women. • Increases in HIV cases following maize shocks are shared across the sexes. • A gender-based economic inequality is translating into a sexual health inequality. [ABSTRACT FROM AUTHOR]