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HIV and sexual behavior change: Why not Africa?

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  • Oster, Emily
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    Abstract

    Despite high rates of HIV in Sub-Saharan Africa, and the corresponding high mortality risk associated with risky sexual behavior, behavioral response has been limited. This paper explores three explanations for this: bias in OLS estimates, limited non-HIV life expectancy and limited knowledge. I find support for the first two. First, using a new instrumental variable strategy I find that OLS estimates of the relationship between risky sex and HIV are biased upwards, and IV estimates indicate reductions in risky behavior in response to the epidemic. Second, I find these reductions are larger for individuals who live in areas with higher life expectancy, suggesting high rates of non-HIV mortality suppress behavioral response; this is consistent with optimizing behavior. Using somewhat limited knowledge proxies, I find no evidence that areas with higher knowledge of the epidemic have greater behavior change.

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    Bibliographic Info

    Article provided by Elsevier in its journal Journal of Health Economics.

    Volume (Year): 31 (2012)
    Issue (Month): 1 ()
    Pages: 35-49

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    Handle: RePEc:eee:jhecon:v:31:y:2012:i:1:p:35-49

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    Web page: http://www.elsevier.com/locate/inca/505560

    Related research

    Keywords: HIV/AIDS; Sexual behavior; Life expectancy;

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    References

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    1. Jane Fortson, 2008. "The gradient in sub-saharan Africa: Socioeconomic status and HIV/AIDS," Demography, Springer, vol. 45(2), pages 303-322, May.
    2. Alan D. Lopez & Colin D. Mathers & Majid Ezzati & Dean T. Jamison & Christopher J. L. Murray, 2006. "Global Burden of Disease and Risk Factors," World Bank Publications, The World Bank, number 7039, February.
    3. Angus S. Deaton, 2009. "Instruments of development: Randomization in the tropics, and the search for the elusive keys to economic development," NBER Working Papers 14690, National Bureau of Economic Research, Inc.
    4. Pascaline Dupas, 2009. "Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya," NBER Working Papers 14707, National Bureau of Economic Research, Inc.
    5. Emily Oster, 2005. "Sexually Transmitted Infections, Sexual Behavior, and the HIV/AIDS Epidemic," The Quarterly Journal of Economics, MIT Press, vol. 120(2), pages 467-515, May.
    6. Francis, Andrew M., 2008. "The economics of sexuality: The effect of HIV/AIDS on homosexual behavior in the United States," Journal of Health Economics, Elsevier, vol. 27(3), pages 675-689, May.
    7. Tomas J. Philipson & William H. Dow & Xavier Sala-i-Martin, 1999. "Longevity Complementarities under Competing Risks," American Economic Review, American Economic Association, vol. 89(5), pages 1358-1371, December.
    8. Oster Emily, 2010. "Estimating HIV Prevalence and Incidence in Africa from Mortality Data," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 10(1), pages 1-46, September.
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    Cited by:
    1. Delavande, Adeline & Sampaio, Mafalda & Sood, Neeraj, 2014. "HIV-related social intolerance and risky sexual behavior in a high HIV prevalence environment," Social Science & Medicine, Elsevier, vol. 111(C), pages 84-93.
    2. Olivier C. Sterck, 2014. "Natural resources and the spread of HIV/AIDS: curse or blessing?," CSAE Working Paper Series 2014-12, Centre for the Study of African Economies, University of Oxford.
    3. Wilson, Nicholas L. & Xiong, Wentao & Mattson, Christine L., 2014. "Is sex like driving? HIV prevention and risk compensation," Journal of Development Economics, Elsevier, vol. 106(C), pages 78-91.
    4. Gabriel Picone & Robyn Kibler & Benedicte Apouey, 2013. "Individuals’ Preventive Behavioral Response to Changes in Malaria Risks and Government Interventions: Evidence from six African countries," Working Papers 0313, University of South Florida, Department of Economics.
    5. Gianmarco León & Edward Miguel, 2013. "Transportation choices and the value of statistical life," Economics Working Papers 1389, Department of Economics and Business, Universitat Pompeu Fabra.
    6. Miron Tequame, 2012. "HIV, Risky Behavior and Ethno-linguistic Heterogeneity," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), Justus-Liebig University Giessen, Department of Statistics and Economics, vol. 232(6), pages 606-632, November.
    7. Casabonne, Ursula & Kenny, Charles, 2012. "The Best Things in Life are (Nearly) Free: Technology, Knowledge, and Global Health," World Development, Elsevier, vol. 40(1), pages 21-35.
    8. Kenny, Charles, 2009. "Why Do People Die In Earthquakes? The Costs, Benefits And Institutions Of Disaster Risk Reduction In Developing Countries," Policy Research Working Paper Series 4823, The World Bank.
    9. Hans-Peter Kohler & Rebecca L. Thornton, 2012. "Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?," World Bank Economic Review, World Bank Group, vol. 26(2), pages 165-190.
    10. Chin, Yoo-Mi, 2013. "Does HIV increase the risk of spousal violence in sub-Saharan Africa?," Journal of Health Economics, Elsevier, vol. 32(5), pages 997-1006.
    11. Gibson, John & McKenzie, David, 2007. "Using the global positioning system in household surveys for better economics and better policy," Policy Research Working Paper Series 4195, The World Bank.
    12. Weil, David N., 2014. "Health and Economic Growth," Handbook of Economic Growth, in: Handbook of Economic Growth, edition 1, volume 2, chapter 3, pages 623-682 Elsevier.
    13. Djemaï, Elodie, 2010. "HIV-Related Risk Taking Behavior and Income Uncertainty : Empirical Evidence from Sub-Saharan Africa," Economics Papers from University Paris Dauphine 123456789/7310, Paris Dauphine University.
    14. Francis, Andrew M. & Mialon, Hugo M. & Peng, Handie, 2012. "In sickness and in health: Same-sex marriage laws and sexually transmitted infections," Social Science & Medicine, Elsevier, vol. 75(8), pages 1329-1341.
    15. Durevall, Dick & Lindskog, Annika, 2013. "Adult Mortality, AIDS and Fertility in Rural Malawi," Working Papers in Economics 570, University of Gothenburg, Department of Economics.
    16. Robinson, Jonathan & Yeh, Ethan, 2009. "Transactional sex as a response to risk in western Kenya," Policy Research Working Paper Series 4857, The World Bank.
    17. Dang, Hai-Anh & Rogers, Halsey, 2013. "The decision to invest in child quality over quantity : household size and household investment in education in Vietnam," Policy Research Working Paper Series 6487, The World Bank.

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