How “Sugar Daddy Training” Saves Lives

The power imbalance and age imbalance in “sugar daddy” relationships – where a better-off older male has a sexual relationship with a young woman – are particularly bad for STD transmission rates and unplanned single-parent pregnancies.

The women don’t have the power in the relationship to demand safe sex, and the man is more likely to have multiple partners. A simple program implemented in Kenya, and since replicated elsewhere, lowered teenage pregnancies from relationships with adult men by more than half just by replacing existing abstinence training with training that specifically pointed out the dangers of going out with older men.

This is a big deal. And all it takes is telling teenagers at risk “hey, maybe date someone your own age.”

Image Source: By Adam Jones, Ph.D. (Own work) [CC BY-SA 3.0 (, via Wikimedia Commons

All these types of asymmetries are associated with nonuse of condoms. Increasing women’s power within asymmetric sexual relationships could improve their ability to negotiate safer sexual behaviors, such as condom use.

We use a randomized experiment to test whether and what information changes teenagers’ sexual behavior in Kenya. Providing information on the relative risk of HIV infection by partner’s age led to a 28 percent decrease in teen pregnancy, an objective proxy for the incidence of unprotected sex. Self-reported sexual behavior data suggests substitution away from older (riskier) partners and toward same-age partners. In contrast, the official abstinence-only HIV curriculum had no impact on teen pregnancy.

An information campaign that provided Kenyan teenagers in randomly selected schools with the information that HIV prevalence was much higher among adult men and their partners than among teenage boys led to a 65% decrease in the incidence of pregnancies by adult partners among teenage girls in the treatment group relative to the comparison. This suggests a large reduction in the incidence of unprotected cross-generational sex. The information campaign did not increase pregnancies among teenage couples.

It shows that 43 percent of men over 40 years of age in Botswana carry HIV, far higher than the 4 to 5 percent infection rate of men in their teens and early 20s.
Jaws drop. “Oh my gosh!” blurts out one girl.

The Largest Global Cause of Death Is Being Neglected Because of Headline-Grabbing Infectious Diseases

Seven of the top 10 causes of death are from chronic diseases, like obesity, heart problems, and cancer. But chronic diseases get the lowest research funding donated out of any health conditions. Most development agencies don’t invest in it at all, and most donors choose to spend their money fighting flashy infectious diseases like Malaria and HIV, which are more engaging to the public.

As a result, some really simple concepts have gone without funding to develop them, like a universal “generic risk pill,” or cheaper heart disease pills. Because of how interconnected health, economics, and poverty are, this whole mess was recently identified by the Copenhagen Consensus as one of the top things holding back global development.

But according to a recent review of donor health funding, chronic disease receives the smallest amount of donor assistance of all health conditions, having lost ground since 1990 relative to infectious diseases. Donor assistance for health was estimated at almost $26 billion in 2009. The amount allocated to chronic disease was $270 million, or about 1% of the total. Yet cardiovascular disease in low- and middle-income countries killed over twice as many people in 2001 as did AIDS, malaria, and TB combined.

Ten of the sixteen most cost-effective solutions were health related; seven of these focused on R&D innovation. These included new innovations, such as the development of a ‘generic risk pill’ for vascular diseases which would avert 1.6 million deaths per year and deliver $4 worth of benefits for every dollar spent.

Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths.