I was in a taxi in the Central African country of Gabon, traveling from Lambarene, where I worked at Albert Schweitzer Hospital, to the capital, Libreville. Sharing the cab with me was a young village woman.
She offered 6,000 CFA ($12) for the ride. The driver wanted her to add another 500. She protested that her husband hadn't given her enough money. They haggled back and forth. She took a seat, and we started off without his verbal agreement to accept her offered price.
The bartering continued, in spurts and lags, as we continued past wooden slat huts with tin roofs, past banana stalks being sold by the side of the street on oil cans, the occasional bushmeat from the rainforest (monkey, armadillo, crocodile) hanging to be sold.
Her husband didn't support her as he should, the driver goaded her. He would have given his wife 60,000 CFA to travel.
In that case, she replied, he was a rich man who didn't need her money.
"I'm always looking for a good exchange," he said. She could buy him a Coca-Cola in Libreville.
Laughing nervously, she begged him to leave her alone. He kept pushing the Coke. She needed to give him the equivalent of the missing 500 CFA somehow.
He became threatening. Would she continue on to Libreville? Or would he have to drop her off on the side of the road?
Laughter continued, but the conversation was serious. Would he try to take advantage of her? She couldn't say no. "Men are stronger than women," the taxi driver reminded her.
I gave the woman a 500 CFA note. But when I got out, she remained in the front seat, alone with the driver.
Transactional sex. Consensual, but not really. Based on disenfranchisement rather than choice.
In the hospital where I worked, desperate women brought their malaria-ridden children to the pediatric ward. After paying the fee for a consultation, they had no money left for food. The quinine intravenous drip might attack the malarial parasites, but the children still would slowly starve to death.
"Buy food for the child!" one pediatrician, a Congolese woman, ordered a mother.
"There is no money," she replied.
"Find a new man," was the doctor's advice.
The woman's ability to provide for her children depended on her ability to attract a man to trade sex for child support.
Would the sex be safe? When members of the mobile Program for Mother Infant Health taught village women to use condoms to avoid getting HIV, Gabonese village men, standing at the edge of the circle of mothers and babies, heckled us: "Sex with a condom is like eating a banana with the peel still on!"
Three-quarters of people aged 15 to 24 living with HIV in sub-Saharan Africa are women.
Over three-quarters of the world's women living with HIV are in sub-Saharan Africa.
More is needed from the United States than its financial commitment to funding HIV prevention and treatment. The U.S. government should apply political leverage to ensure that the governments of developing countries address property rights, basic education and employment opportunities for women and girls. It should help women become financially independent, so they no longer have to trade sex for support and can grow, if they choose, to be the healthy mothers of a stable society.
The writer is a student at the Yale School of Medicine.