Are Africans Practicing Safer Sex? Evidence from Demographic and Health Surveys for Eight Countries
We use repeated rounds of Demographic and Health Survey data from eight African countries to examine changes in and determinants of three HIV risk behaviors: age at first intercourse, number of current sexual partners, and use of condoms. As a prelude, we assess the within-country comparability of DHS surveys over time. We find some evidence of changes in sample composition, which is easily handled in a multivariate framework. More problematic is evidence that people may be changing how they respond to questions about HIV behavior. This likely represents an increase in social desirability bias over time, and where it occurs our estimates of risk reduction are probably upper bounds on the true effects. Overall the picture is one of reductions in risk behaviors over recent 4–6-year intervals, especially with respect to condom use; in some cases the changes seem large given the short time periods involved. With some exceptions, however, the extent and pervasiveness of these changes seems inadequate in relation to the urgency of the public health crisis represented by AIDS. With respect to the determinants of behaviors, schooling and wealth have contradictory impacts on risk behavior: they tend to increase the likelihood of using condoms while also (for men) increasing the demand for additional sexual partners.
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